Sun28November0628PM 6

Is it true or false that the following are causes of hyponatraemia with a high urinary sodium excretion?

True / False

Diuretic use Correct

Burns Correct

Small bowel obstruction Correct

Poorly controlled diabetes Correct

Addison's disease Correct

Explanation

Hyponatraemia can be subdivided into those with large amounts of sodium in their urine and those with little urinary sodium (classically large sodium excretion is greater than 20 mmol/L).

Hyponatraemia due to excessive urinary loss (hence high urinary sodium excretion) can result from diuretic use, Addison's disease or diabetes (due to an osmotic diuresis).

Hyponatraemia due to sodium loss elsewhere is caused by burns, small bowel obstruction, diarrhoea, cystic fibrosis and heat exposure.

Hyponatraemia can also be divided into the patient's hydration status:

Euvolaemic - causes include hypothyroidism and the syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Hypovolaemic - causes include vomiting, diuretics and hypoadrenal states (for example, Addison's disease)

Hypervolaemic - causes include liver cirrhosis, nephrotic syndrome and congestive cardiac failure.

Reference:

Longmore M, et al. Oxford Handbook of Clinical Medicine. 8th edition. London: Oxford University Press; 2010.

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