In hyponatremia, one or more factors — ranging from an underlying medical condition to drinking too much water — cause the sodium in your body to become diluted. When this happens, your body's water levels rise, and your cells begin to swell. This swelling can cause many health problems, from mild to life-threatening Diagnostic evaluation of adults with hyponatremia isotonic or hypertonic hyponatremia are likely to have hypotonic hyponatremia. The key aspects of the history and physical examination directed toward determining the cause of hyponatremia are as follows Causes of hypotonic hyponatremia in adult Hyponatremia: Classification and Diagnosis. Author: Noah H. Carpenter, MD. CE: 2.5 hours. Rated 4.7 out of 5.0 based on 2681 reviews. Click for South Carolina Information Course Summary. Hyponatremia is the most common disorder of body fluid and electrolyte balance, which can lead to a wide range of clinical symptoms that can be severe or even. Hyponatremia means that the sodium level in the blood is below normal. Your body needs sodium for fluid balance, blood pressure control, as well as the nerves and muscles. The normal blood sodium level is 135 to 145 milliequivalents/liter (mEq/L). Hyponatremia occurs when your blood sodium level goes below 135 mEq/L . A brief discussion of tonicity as a classification system for hyponatremia is followed by an indepth exploration of only three specific hyponatremias: TURP syndrome, SIADH and cerebral salt wasting
Classification & Diagnostic Criteria Of Hyponatremia In the following video, Dr. Geoffrey Lockwood and Dr. Brad LaMotte speak about the classification and diagnostic criteria of hyponatremia. You must be logged-in to view this content Hyponatremia Disease: Hyponatremia disease represents low sodium levels in the blood. The normal level of sodium 135mEq/L- 145mEq/L. When the sodium level < 135mEq/L is called hyponatremia and A level < 120mEq/l is considered severe hyponatremia Hyponatremia—defined as a serum sodium concentration of less than 135 mEq/L—is a common and important electrolyte imbalance that can be seen in isolation or, as most often is the case, as a..
As a result, the plasma or serum sodium concentration is used as a surrogate for assessing tonicity of the extracellular fluid. Hyponatremia is commonly defined as a serum sodium concentration below 135 mEq/L, but the definition can vary to a small degree in different clinical laboratories [ 1,2 ] Hyponatremia is one of the most electrolytes disturbances in clinical practice, its enormous differential diagnosis makes it a complex problem in the praxis. Definition and classification Hyponatremia exists when natrium amount in serum < 135 mmol/ Hyponatremia has complex pathophysiology, is frequent and has potentially severe clinical manifestations, and its treatment is associated with high risks. Hyponatremia can be hypertonic, isotonic or hypotonic. Hypotonic hyponatremia has multiple etiologies, but only two general mechanisms of development, defective water excretion, usually because of elevated serum vasopressin levels, or. A lazy man's classification of hyponatremia There are two possible approaches to the diagnosis of hyponatremia:. Both are offered here. In their most basic form, the classical method and the lazy man's method require essentially the same tests (serum osmolality, urine osmolality and urinary sodium) When hyponatremia occurs in the presence of increased plasma osmolality, this can only be due to an increased amount of other. Table 11.1 Clinical Classification of Hyponatremia; Volume status. Hypovolemic. Normovolemic. Hypervolemic. Mechanism. Loss of both water. Total body water increased, Excess of both total. and Na+ Na
Classification of Hyponatremia—Tonicity. As mentioned, hyponatremia can arise in varying states of tonicity. Apparent hyponatremia coupled with an effective serum osmolality of 275 to 295 mOsm/kg H 2 O is consistent with either isotonic hyponatremia or pseudohyponatremia. As its name implies, pseudohyponatremia does not represent true. Hyponatremia / classification Hyponatremia / diagnosis* Hyponatremia / urine Osmolar Concentration Sodium / blood Sodium / urine Substances Biomarkers Glycopeptides copeptins.
Patients with severe (serum sodium ≤120 mEq/L), symptomatic hyponatremia can develop life-threatening or fatal complications from cerebral edema if treatment is inadequate and permanent neurologic disability from osmotic demyelination if treatment is excessive. Unfortunately, as is true of all electrolyte disturbances, there are no randomized trials to guide the treatment of this challenging. Buy Images here: armandoh.org/shopHyponatraemia is commonly defined as a serum sodium concentration below 130 mmol/L. It affects anywhere from 1-15% of hosp.. The Sodium Correction Rate for Hyponatremia Calculates recommended fluid type, rate and volume to correct hyponatremia slowly (or more rapidly if seizing). This is an unprecedented time. It is the dedication of healthcare workers that will lead us through this crisis -- The first section of this topic is shown below --This is defined as a serum [Na +] <135 mmol/L and is among the most common electrolyte abnormalities encountered in hospitalized pts.Symptoms include nausea, vomiting, confusion, lethargy, and disorientation; if severe (<120 mmol/L) and/or abrupt, seizures, central herniation, coma, or death may result (see Acute Symptomatic Hyponatremia, below) . Syndrome of inappropriate antidiuretic hormone (SIADH) is considered in this classification if the patient is euvolemic and urine osmolarity is greater than 100 mOsm/kg
Dilutional hyponatremia has two primary classifications: normal extracellular volume (euvolemic) or elevated extracellular volume (hypervolemic). Euvolemic hyponatremia is defined by a serum osmolarity of <270mosm/l and a urine osmolarity of 100mosm/l. It is most commonly a syndrome of inappropriate antidiuretic hormone (SIADH) and is. The treatment of hyponatremia is diagnosed the underlying cause and t cut down, hospital admission, Intravenous access, Hypertonic saline 3%, conivaptan, vaprisol, tolvaptan, etc. Classification of Hyponatremia Disease: Depends on the volume status there are three types of hyponatremia. Those are-Euvolemic hyponatremia, Hypervolemic hyponatremia HYPONATREMIA: CLASSIFICATION AND DIAGNOSIS NOAH CARPENTER, MD Dr. Noah Carpenter is a Thoracic and Peripheral Vascular Surgeon. He completed a Bachelor of Science in chemistry and medical school and training at the University of Manitoba. Dr. Carpenter completed surgical residency and fellowship at the Universit Hyponatremia reflects an excess of total body water (TBW) relative to total body sodium content. Because total body sodium content is reflected by extracellular fluid (ECF) volume status, hyponatremia must be considered along with status of the ECF volume: hypovolemia, euvolemia, and hypervolemia (see table Principal Causes of Hyponatremia).Note that the ECF volume is not the same as effective.
Although there is no definitive classification system, hyponatremia can be classified according to severity/serum tonicity, time of onset, and/or volume status. Volume status is the most important element in determining the etiology, while the time of onset is the most important factor in determining the rate of correction and risk of cerebral. Hyponatremia gets some guidelines Background. Journal Clubs typically discuss scientific articles, the clinical practice guideline is not typically featured in these discussions but the editors of NephJC see our mission to critically appraise and critique any document that is important clinical practice guidelines, review articles, editorials or even blog posts Hyponatremia generally is defined as a plasma sodium level of less than 135 mEq per L (135 mmol per L).1, 2 This electrolyte imbalance is encountered commonly in hospital and ambulatory settings.3. #SCM16: Hyponatremia: A Novel Classification. May 1, 2016 // 2 Comments. Dr. Chandra Mauli Jha (CMJ), from the Burjeel Hospital in Abu Dhabi, United Arab Emirates,.
In this review, we focus on the diagnosis and classification of hyponatremia, current trends in its treatment in the light of guidelines, and the rationale of using vaptans in treating hyponatremia CLASSIFICATION AND DIFFERENTIAL DIAGNOSIS OF HYPONATREMIA The presence of signiﬁcant hypo-osmolality indicates ex-cess water relative to solute in the extracellular ﬂuid (ECF) compartment. Because water moves freely between the ECF and the intracellular ﬂuid (ICF) compartments, an excess o Hyponatremia (defined as a serum sodium level < 134 mmol/L) is the most common electrolyte abnormality in hospitalized patients. Certain drugs (eg, diuretics, antidepressants, and antiepileptics) have been implicated as established causes of either asymptomatic or symptomatic hyponatremia. However, hyponatremia occasionally may develop in the course of treatment with drugs used in everyday.
Classification according to Osmolality _____: (High Osm) Hyperglycemia Hypertonic infusion Glucose Mannitol (used in cerebral edema) When treating pts with overtly symptomatic hyponatremia (eg, seizures, severe neurologic deficits), _____ saline should be considered. - Hypovolemic - Euvolemic, asymptomati Introduction. Hyponatremia, defined as a serum sodium level of less than 135 mEq/L, is one of the major electrolyte disorders in acute hospitalized patients, 1 and its prevalence in patients with acute heart failure (AHF) could be as high as 25%. 2, 3, 4 It is believed that hyponatremia in AHF is usually a problem of impaired water excretion rather than sodium depletion, attributed mainly to. Hyponatremia is defined as a serum sodium concentration < 135 mEq/L. 1-3 Although the value in and of itself is not pathogenic, serum sodium concentration remains a measurable surrogate for the distribution of water across cell membranes. Classifications: Concentration and Tonicity
Severity of hyponatremia is classified as acute or chronic, differentiated by sodium levels and patient symptoms. 7 Mild-to-moderate hyponatremia is a more chronic and asymptomatic condition and is defined as a sodium concentration of 120 to 135 mEq/L. 7 Severe hyponatremia is a medical emergency and is usually defined as a sodium concentration. Hyponatremia is defined as a serum sodium concentration of less than 135 mEq/L but can vary to a small extent in different laboratories. Hyponatremia is a common electrolyte abnormality caused by an excess of total body water when compared to total body sodium content. Hyponatremia: pathophysiology, classification, manifestations and.
Classification Clinical signs; Hypervolemic. hyponatremia. Peripheral edema, ascites, pulmonary edema, raised JVP,clinical signs of underlying causes Euvolemic hyponatremia: Clinical signs of underlying causes Hypovolemic hyponatremia: Dry mucous membrane, decreased skin turgor, hypotension (orthostatic), tachycardi A rapid increase in FENa (>0.5% after 2 L of isotonic saline over 24 h), without correction of PNa, correlates with inappropriate ADH secretion. A reliable classification of the cause of hyponatremia by test infusion with isotonic saline cannot be based only on the evolution of PNa
Due to the hyperosmolality and resultant fluid shifts invoked by the presence of osmotically-active solutes, the serum sodium, as reported by laboratory assessment in these cases, is truly low. For this reason, one should not include hyperosmolar hyponatremia as a potential classification of pseudohyponatremia. Etiolog 3.2. Classification. Hyponatremia can be classified based in: Severity: this is based only in the absolute level of sNa. Mild 130-135 mmol/L, moderate 125-130 mmol/L, and severe when sNA is lower than 125 mmol/L. Time interval of development: acute-less than 48 h and chronic if more than 48 h
Classification, Differential Diagnosis, and Features of Hyponatremia According to Volume Status Hypervolemic hypernatremia - CHF - Cirrhosis - Nephrotic syndrome - Acute and chronic kidney disease Normovolemic hyponatremia - Psychogenic polydipsia - Glucocorticoid deficit - Hypokalemia - Drugs - SIADH Renal hypovolemic hyponatremia - Diuretics - Mineralocorticoid deficit - Salt-losing. Eating disorders, psychotic illnesses, and substance use disorders are some of the more common psychiatric conditions encountered in clinical practice that are associated with hyponatremia. The mechanisms that lead to hyponatremia vary, and at times hyponatremia may be a result of a drug side effect or drug-drug interaction. Additionally, hyponatremia from a non-psychiatric condition may lead.
hyponatremia is the most common electrolyte disorder in hospitalized patients, reported to occur in 10%-30% of acutely or chronically hospitalized patients 2, 4; patients at increased risk for hyponatremia include those with heart failure, severe kidney disease, cirrhosis, pneumonia, admission to intensive care unit, and those taking medications such as thiazide diuretics 2, . Available for iPhone, iPad, Android, and Web
For this analysis, a case of exertional hyponatremia was defined as 1) a hospitalization or ambulatory visit with a primary (first-listed) diagnosis of hypo-osmolality and/or hyponatremia (International Classification of Diseases, 9th Revision [ICD-9]: 276.1; International Classification of Diseases, 10th Revision [ICD-10]: E87.1) and no. Hyponatraemia is commonly defined as a serum sodium concentration below 130 mmol/L. It affects anywhere from 1-15% of hospital patients. Most cases require no treatmen The prevalence of hyponatremia in the emergency department has been reported to be 2.7% in a study from the United States (Lee et al., 2000) and 2.9% in a survey from Taiwan (Hsu et al., 2005). However, only 11 (0.8%) of 1,321 hyponatremic patients (defined as serum sodium <130 m m ) had acute symptoms of their hyponatremia in the latter survey. The primary outcome was hospitalization with hyponatremia in the 30 days following the index date, defined by evidence of International Classification of Diseases, Tenth Revision (ICD‐10) code E87.1 (hypoosmolality or hyponatremia) in any one of 25 diagnostic fields during a given hospitalization
Hypernatremia, also spelled hypernatraemia, is a high concentration of sodium in the blood. Early symptoms may include a strong feeling of thirst, weakness, nausea, and loss of appetite. Severe symptoms include confusion, muscle twitching, and bleeding in or around the brain. Normal serum sodium levels are 135-145 mmol/L (135-145 mEq/L).. . Probably the most crucial point in this classification is represented by the correct assessment of Extracellular Fluid Volume Status (i.e. hypovolemia, euvolemia, hypervolemia)
Hyponatremia is a common electrolyte disorder observed in a wide variety of malignancies and is associated with substantial morbidity and mortality. Newer cancer therapies have improved patient outcomes while contributing to new cases of hyponatremia. Patients should be monitored closely for the development of vasopressin- and non-vasopressin-mediated hyponatremia Hyponatremia is the most common electrolyte abnormality seen in general hospital patients.5 In a database of over 120,000 patients, a serum sodium level of <136mEq/L was observed in 28.2%.6 Hyponatremia is associated with selected medical conditions (especially cirrhosis and CHF), the extremes of age, and those receiving selected medications, including several that are commonly administered to. 1. Cleve Clin J Med. 2006 Sep;73 Suppl 3:S4-12. Hyponatremia: why it matters, how it presents, how we can manage it. Douglas I(1). Author information: (1)Medical Intensive Care, Denver Health Medical Center University of Colorado at Denver and Health Sciences Center Denver, CO 80204, USA. email@example.com Hyponatremia is a common electrolyte disorder among hospitalized patients and has been. If hyponatremia is chronic or serum sodium is 120 mEq/L or more, use a 0.9% isotonic solution to correct the sodium deficit; if serum sodium is less than 120 mEq/L acutely and the patient is experiencing symptoms of hyponatremia, consider correcting the deficit with a hypertonic 3% solution. Of note, some experts do not recommend the use of. Dosing: Geriatric. Refer to adult dosing. Note: The Canadian labeling recommends a maximum dose of 5 mg once daily in elderly women (≥85 years of age) of low body weight. Administration. Oral: Administer at bedtime without regard to food. Aricept 23 mg tablet: Swallow whole with water; do NOT crush or chew due to an increased rate of absorption. The 23 mg strength is provided in a unique.
Should International Classification of Diseases Codes be used to identify outpatient hyponatremia incidence? Uncover what these study authors found in a commercially insured population 1. Hypotonic hyponatremia (plasma osmolality < 280 mOsm/kg H 2 O): serum osmolality and sodium are both low due to excess water that was not excreted. This is by far the most encountered type of hyponatremia. 2. Hypertonic hyponatremia (plasma osmolality >295 mOsm/kg H 2 O): serum osmolality is high, and serum sodium is low as in hyperglycemia and administration of intravenous immune globulin. Work up volume depletion, acute renal failure, acute oliguria, and differential diagnosis of hyponatremia. 1 Division of hyponatremia into hypervolemia or not, edema or not, and urinary Na + less than or greater than 10 mmol/L provides a classification of hyponatremia. 2 History of diuretics, other drug intake, setting of osmotic diuresis or. Appropriate treatment of hyponatremia depends on the correct classification of hyponatremia, the concomitant disease state, the severity of symptoms, and the severity of hyponatremia Hyponatremia, the most common electrolyte disorder in hospitalized patients, has been associated with high rate of mortality among both this population and nonhospitalized patients. This review describes briefly the classification and pathogenesis of hyponatremia, and, in greater detail, the management of hyponatremia with a particular emphasis.
Hyponatremia Pathophysiology, Chronic Hyponatremia, Dilutional Hyponatremia, Hyponatremia Osmolality, Hyponatremia Hypovolemia, Hyponatremia Signs, Hyponatremia. Treatment variables depend on whether the hyponatremia is acute or chronic, the classification (fluid balance), and severity of the symptoms, the patients' weight (use in formulae) and the underlying cause. Further classification of hypotonic hyponatremia by extracellular fluid volume status and causes are Hyponatremia: pathophysiology, classification, manifestations and management Hyponatremia can be hypertonic, isotonic or hypotonic. Hypotonic hyponatremia has multiple etiologies, but only two general mechanisms of development, defective water excretion, usually because of elevated serum vasopressin levels, or excessive fluid intake Although several classification systems exist to describe hyponatremia, the most common scheme begins with assessment of plasma osmolality and volume status.19 The majority of hyponatremic patients present with hypotonic or hypo‐osmolar serum (eg, plasma osmolality <275 mOsm/kg). The primary causes of hyponatremia in patients with normal or. ICD-10-CM Code for Hypo-osmolality and hyponatremia E87.1 ICD-10 code E87.1 for Hypo-osmolality and hyponatremia is a medical classification as listed by WHO under the range - Endocrine, nutritional and metabolic diseases . Subscribe to Codify and get the code details in a flash
Amanda Livingstone Date: January 27, 2021 Salt pills, which are sometimes used to treat hyponatremia.. Hyponatremia is a potentially life-threatening electrolyte condition that requires immediate medical attention. Lifestyle factors and underlying medical conditions will determine the course of hyponatremia treatment options administered to the patient Hyponatremia is a rare adverse effect of ciprofloxacin, 72 rifabutin, 73 or vidarabine74, 75 therapy. SIADH is the possible underlying mechanism. A case of voriconazole-induced hyponatremia due to salt-losing nephropathy has been reported. 76. Hyponatremia following treatment with cefoperazone/sulbactam 77 and miconazole has also been described. Hyponatremia ppt .final 1. Presenter: Dr Arun Karmakar Moderator : Prof. N. Sharatkumar Hyponatremia 2. Introduction Defined as a serum [Na] below 135 mmol/L. Most common disorder of electrolytes encountered in clinical practice, occurring in 22% of hospitalized patients In those patients showing hyponatremia, this was rated according to the classification proposed by Spasovski et al. (mild, 130-134 mEq/l; moderate, 125-129 mEq/l; and severe, <125 mEq/l) . 2.1. Patients. All COPD patients aged 40 years or older, requiring hospitalization due to an exacerbation were consecutively included The Sodium Deficit in Hyponatremia Calculates sodium quantity missing in hyponatremia. The Sodium Deficit in Hyponatremia Calculates sodium quantity missing in hyponatremia. This is an unprecedented time. It is the dedication of healthcare workers that will lead us through this crisis
Hyponatremia is the most common electrolyte disorder seen in cirrhosis, and it is associated with an increased morbidity and reduced survival after LT. Hypervolemic hyponatremia develops gradually over a period of time, hence patients are often asymptomatic. Initial treatment involves fluid restriction, correcting hypokalemia, and discontinuing. Appendix 2 Classification of Hyponatraemia Hypovolaemic hyponatraemia Whole body sodium and water depletion, with renal or extra-renal sodium loss • Acute hyponatremia is defined as hyponatremia (serum Na < 135mmol/L) presenting within 48 hour Another classification of hyponatremia includes redistributive hyponatremia. This happens in cases of hyperglycemia. Hyperglycemia is an increase in immunoglobulin levels or hyperlipidemia wherein there is fluid shifting from the intracellular to the extracellular space. This shift of fluids dilutes the sodium concentration in the blood or plasma
Hypotonic Hyponatremia: Classification and Pathogenesis . Traditionally, patients with hyponatremia are divided into categories according to their body sodium content and/or intravascular volume: low body sodium content (volume depletion); high body sodium content (edematous conditions) or normal body sodium content (euvolemic hyponatremia or SIADH) Read Dr. Rondon's comprehensive review of hyponatremia in International Urology and Nephrology. Study Abstract. Defined as a serum sodium concentration of less than 135 mEq/L, hyponatremia is the most common electrolyte disorder, seen in 20 to 35 percent of hospitalized patients Dilutional hyponatremia, also known as water intoxication, is a potentially life-threatening condition which occurs when a person consumes too much water without an adequate intake of electrolytes. To put it simply, water in the body needs to contain enough salts and other ions, called electrolytes, to keep the body's cells functioning properly
Table 1. Classification of Hyponatremia (US units: mEq/L) 1, 2. So far, not horrible; Right? EPIDEMIOLOGY. We need to talk about epidemiology not because every chapter on any disease starts out this way but because it will help us down the road. So lets push on. Hyponatremia is probably the most common electrolyte abnormality 3 Hyponatremia in cirrhosis is a frequent thing in those whose condition has reached end-stage liver disease. It happens in different ways and could be more severe in some people than in others. However, experts say that it occurs in about 57% of cirrhosis patients in hospital admission Hyponatremia by definition is described as serum Na <135 meq/l and severe hyponatremia is sodium levels less than 120meq/l. It is seen up to ~30% of patients in ICU settings 1-3. Clinical presentation Development of symptoms less than 48 hours. electrolyte management: hyponatremia: [ man´ij-ment ] the process of controlling how something is done or used. acid-base management in the nursing interventions classification , a nursing intervention defined as the promotion of acid-base balance and prevention of complications resulting from acid-base imbalance. acid-base management:. Hyponatremia is a common electrolyte disorder in children. It is generally defined as plasma sodium of less than 135 mmol/l. Sodium homeostasis is essential for maintaining intravascular volume and is tightly linked to water balance. Plasma water volume is regulated mainly by the secretion of an antidiuretic hormone (ADH) and by the thirst mechanism
In the interest of providing consistent and clear classification of hyponatremia that is directly relevant for patient management, the authors provided definitions of hyponatremia based on three factors: serum sodium concentration, duration of disease, and symptoms The electrolyte disturbance hyponatremia (British hyponatraemia) exists in humans when the sodium (Natrium in Latin) concentration in the plasma falls below 135 mmol/L. At lower levels water intoxication may result, an urgently dangerous condition. Hyponatremia is an abnormality that can occur in isolation or, as most often is the case, as a complication of other medical illnesses Hyponatraemia (Hyponatremia) - Classification... Armando Hasudungan views: 1013 . Diabetes Type II - Pathophysiology. Armando Hasudungan views: 635 . Endocrinology - Calcium and Phosphate Regulat... Armando Hasudungan views: 887 . Insulin and Glucagon Overview. Armando. Careful assessment and classification is important to direct diagnosis and treatment, reduce the risk of substantial morbidity and mortality in acute severe cases, and avoid the neurological complications associated with overly rapid correction. 4 In the ICU, hyponatremia is associated most frequently with chronic conditions such as congestive.
Hyponatremia is one of the most common electrolyte abnormalities that has been described primarily in hospitalized patients; the prevalence of hyponatremia in hospitalized patients has been reported to be as high as 42% in some studies. 1,2 Hyponatremia has been associated with various adverse clinical outcomes such as increased mortality, 3. Hyponatremia is an often overlooked and undertreated electrolyte disorder with serious clinical and economic outcomes in hospitalized patients. This activity will provide an overview of hyponatremia management in hospitalized patients, including normal sodium regulation and the pathophysiology, prevalence, and outcomes associated with hyponatremia
Hyponatremia is a common water balance disorder that often poses a diagnostic or therapeutic challenge. Classification of volume status was made retrospectively after patient discharge based. Classification of hyponatremia based on sodium values and symptoms i. This type of classification helps one to determine level of care and treatment. ii. Not all hyponatremia is symptomatic 1. Generally, people with a Na > 130 are asymptomatic. iii. Mild: 125-130 1. S/S: anorexia, apathy, restlessness, nausea, lethargy, muscle cramps iv. Hyponatremia occurs because of an imbalance of water and sodium. Most frequently it occurs when excessive water dilutes the amount of sodium in the body or when not enough total sodium is present in the body. A common classification of hyponatremia is based on the amount of total body water that is present. Normal volume (euvolemic) hyponatremia Valid for Submission. E87.1 is a billable diagnosis code used to specify a medical diagnosis of hypo-osmolality and hyponatremia. The code E87.1 is valid during the fiscal year 2021 from October 01, 2020 through September 30, 2021 for the submission of HIPAA-covered transactions Patients hospitalized with a principal diagnosis of hyponatremia (n = 11 213) were compared with matched controls (n = 44 801).Linkage of national population-based registers was used to acquire data. Multivariable logistic regression adjusting for co-medications, diseases, previous hospitalizations, and socioeconomic factors was used to explore the association between hospitalization for. The volemic classification fails to include spurious (false) and/or artifactual hyponatremia, which is addressed in the osmolar classification. This includes hyponatremia that occurs in the presence of massive hypertriglyceridemia, severe hyperglycemia, and extreme elevation of immunoglobulin levels