Laboratory Data

1. Electrolytes, including BUN, creatinine, and glucose.

2. Serum osmolality as compared with urine osmolality and urine sodium and creatinine.

3. Consider serum pH, determination of anion gap, liver function tests, thyroid function tests, cortisol levels, and aldosterone levels.

4. Plasma triglycerides are useful in identifying pseudohypona-tremia. Serum glucose dilutes serum sodium because it is hyperosmolar and pulls free water into the intravascular space (hyponatremia with hypertonicity).

C. Radiographic and Other Studies. Radiographic studies typically are not helpful unless clinician suspects an underlying malignancy participating in the cause of hyponatremia.

1. Chest x-ray. Helps to rule out heart failure, as well as identify heart size as a factor in determining volume status.

2. CT scan of head. May help rule out intracranial mass, hemorrhage, or sinus thrombosis; however MRI is more sensitive for most tumor masses.

3. CT scan or ultrasound of abdomen. May be helpful to determine ascites, portal hypertension, or renal or adrenal masses.

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