The human body will maintain a serum [Na+] between 135 and 145 mEq/L. Hyponatremia in the context of hypergylcemia is a commonly discussed problem. It presents with hyponatremia (<135 mEq/L) in the setting of increase plasma osmolality. (Posm >295 mOsm/kg H2O)
HOW DOES IT WORK? Remember hyponatremia is always a problem with free water. Glucose acts as an osmole (won’t enter cell without insulin) and draws water from the intracellular fluid (ICF) into the extracellular fluid (ECF). Thereby effectively diluting the ECF [Na+].
CORRECTION FACTOR: plasma Na+ concentration falls by ~1.6 mmol (Katz, 1973) to 2.4 mmol (Hillier et al in 1999) for every 100 mg/dL (5.55 mmol/L) increase in glucose, due to glucose-induced water efflux from cells; this “translational” hyponatremia resolves after correction of hyperglycemia. CALCULATOR
NOTE: This dilutional psuedohyponatremia can occur in other instants.
|Hyponatremia with a normal plasma osmolality Asymptomatic Marked hyperlipidemia Marked hyperproteinemia Symptomatic Marked glycine absorption during transurethral surgery|
|Hyponatremia with an elevated plasma osmolality Hyperglycemia Administration of mannitol|
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