What Causes Low Sodium? Hyponatremia Workup (Lab Interpretation for New Nurse Practitioners)

I had a patient this week and the reason for her overhydration and subsequent hyponatremia (133 mEq/L) was all the water she was drinking to relieve the dry mouth caused by Sjögren’s syndrome.

Two years ago my sodium dropped from 134 level for 3 years, to 102. I was admitted to ICU and stayed for 4 days. I’m now 132 and doing much better. I couldn’t walk for 1 week after getting released from the hospital. I had some neurological issues with speaking and balance for a year afterwards. Glad to be ok now.

Well recently, I got sick with cramping vomiting that lasted me almost 5 days I was in bad shape, but thank God I have gotten better and my doctor did my bloodwork and told me I had low sodium not sure if it’s from drinking too much water or not adding enough salt in my diet I wouldn’t eat a lot of salt because I try to watch my blood pressure but I didn’t know it could lead to this.

i started at 113 now im at 125(this is what my doctor said) and he wants me to get right about 130

JIM SOUNDS LIKE ME... SAME CURRENT ISSUES.

Thank you! Excellent video!

Hi Liz! Great lecture as always!
I apologize if I simply missed this... Based on your algorithm, what would the next step be (from a family practice NP perspective) once you discover that the urine osmol is high and that the cause is likely ADH-related? Is there further workup we should do in primary care or would you refer? And if referral is warranted, would that be under the umbrella of endocrinology or nephrology? Thank you as always for your awesome content!

thank you for very informative video. what is the impact of SSRIs ?

So you don't think that Lisinopril would increase his risk of hyponatremia. ACE inhibitors can bring it on from the literature.

Great informative video, made a lot of sense, Thank You

I’ve been watching your videos for a few weeks and they are so helpful. You are humble and knowledgeable. Love how you break down concepts and
I love the case studies. I’m a NP student in my last year. Wish I had all your knowledge. Thank you!

Thanks! Some of your presentation was a little fast and the words ran together. Hard to understand.

I'm not a brand new np but still find your vedioes very helpful. Thank you

about 2 months back i started taking cranberry capsules because i though it would help me clear any uti infection if i had. i was already peeing more than usual before this but for the past 2 months i had been taking these cranberry capsules which caused me a lot of frequent urination and it would be like a sudden urge. i was already very conscious with my salt intake and I go to run daily but for the past 2 months i had noticed sudden swelling of my cheeks which i couldnt understand. i drink over 4 liters of water daily. yesterday i got my blood test and i saw my sodium at 134, a year back i had sodium at 141, 138 in april and now 134. chloride also is low at 95. i dont know if this sudden puffiness of these cheeks in past 2 months will go away or not. really worried. help

This was very useful information! i do have a question: I have always understood that drinking beer or alcohol would lead to dehydration, which could lead to hypernatremia, right? but in this case study, this man who is hardly drinking water and having a 6 pack of beer every day has hyponatremia. Can you help me think this through? could he actually have been in a state of hypernatremia if it weren't for the Chlorthalidone??

Can over training possibly cause this combined with over hydrating + stimulants? Can it possibly cause nueropathy in feet and hands?

Can stimulant medications cause low sodium? My sodium has been 134 since starting adderall xr. I’ve never had a problem before starting it. My kidney labs have come back normal and my doctor isn’t sure what’s causing it. I don’t drink more than two liters of water a day

I ended up in the ER recently because of low sodium levels. I guess I was drinking too much water.
I was drinking up to 2 gallons a day sometimes more.
My level was below 130. Could I just continue drinking the same amount of water and just take some salt throughout the day?
Or do the other electrolytes and other minerals/vitamins etc need replaced also.
They said to just cut down on the water to no more than 5 of the plastic hospital drinking mugs per day.
Great video.Thank you.

Not sure if it's okay to ask here but just trying to figure out what's going on with me. Had abdominal pain and should pain which seemed like gallbladder problems but it wasn't and ultrasound checked out normal. Looking at my blood results my sodium is at134, Glucose 98 after fasting 8 hours, protein is at 8.0. Is this signs of Hyponatremia? also had diarrhea issues the day before. I do drink sweet tea a lot sometimes so not sure if thats anything?

Thank you! Great explanation

I heard there is a type of hyponatremia where you can’t replace the sodium by eating more sodium/salt, but instead you have to get the sodium through an IV. Would that be in cases of CHF and cirrhosis to correct the perfusion problem?

Thank you, Liz for your wonderful videos. You are an awesome provider. You are compassionate and have a great passion to teach and share. I wish I could have you as my mentor.

You're a great teacher. Thank you for your videos.

Good lecture. Please try to be at slow speed.

Thanks

Is there a place that you hide these great algorithms?

GFR of 32ml/min normal? Um no. I think his eGFR is actually over 100ml/min with Scr of 0.8. So correct statements but slide is incorrect... GREAT VIDEO! Really difficult topic and explained VERY WELL! RBDNP

I enjoyed this video on hyponatremia. Would you please share the calculation (or where to find it) which you adjusted sodium level with an elevated glucose level.

Hi! All of the references I’ve been reading (up to date and AAFP) mention that your acid levels are low and SIADH. However, you mention in your video that serum uric acid levels are high in SIADH. Can you clarify this?

Do you have a resource for switching from one BP med to another in terms of equivalency?

Also I think I’ve asked if you have a method of triage when you’re deciding which lab abnormalities to tackle first?

Subscribed, thank you so much!

These are really good! Please keep them coming!

Thank you so much for posting this. It's very informative.