Hyponatremia in neurologic disorders is a phenomenon to behold! 💫⭐️💫
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@CPSolvers @rabihmgeha @DxRxEdu @AaronLBerkowitz @caseyalbin @LyellJ @nihardesai7 @DrCindyCooper @ASanchez_PS @rav7ks @Sharminzi @MariaMjaleman @gabifpucci
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Pathophysiology and brain centers
/ Anteromedial hypothalamus: Paraventricular and Supraoptic nuclei ➡️ADH release
/ Circumventricular organs: TRPV4-AQP4 complex, ion channels & osmoregulation
/ Spinal cord autonomic innervation of vessels and kidneys
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/ Anteromedial hypothalamus: Paraventricular and Supraoptic nuclei ➡️ADH release
/ Circumventricular organs: TRPV4-AQP4 complex, ion channels & osmoregulation
/ Spinal cord autonomic innervation of vessels and kidneys
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Common scenarios
Osmoreceptor dysregulation ➡️ disinhibition & excess ADH release
Spinal cord disorders ->⬇️Sympath discharge to kidneys->⬇️renin release -> ⬇️Na retention, ⬇️H20 loss
Spinal cord disorders -> ⬇️sympa discharge to vessels orthostatic hypotension->ADH release
Osmoreceptor dysregulation ➡️ disinhibition & excess ADH release
Spinal cord disorders ->⬇️Sympath discharge to kidneys->⬇️renin release -> ⬇️Na retention, ⬇️H20 loss
Spinal cord disorders -> ⬇️sympa discharge to vessels orthostatic hypotension->ADH release
Rare scenario- CSW
/ ⬇️Central sympathetic discharge-> ⬇️RAAS-> ⬇️Na resabso in PCT
/ ⬆️BNP-ANP -> ⬆️GFR, Antagonism of AVP and AT-2 receptors-> Natriuresis
Eventually-> ⬇️volume-> appropriate ADH
CSW vs SIADH (persistent ⬇️Uric acid & hypoV in CSW)
Rx: Fluid vs Fluid restr
/ ⬇️Central sympathetic discharge-> ⬇️RAAS-> ⬇️Na resabso in PCT
/ ⬆️BNP-ANP -> ⬆️GFR, Antagonism of AVP and AT-2 receptors-> Natriuresis
Eventually-> ⬇️volume-> appropriate ADH
CSW vs SIADH (persistent ⬇️Uric acid & hypoV in CSW)
Rx: Fluid vs Fluid restr
Classic entities
1. LGI1 encephalitis: Facio-brachio-dystonic seizures + hypoNa
2. NMOSD: Demyelination of hypothalamus, CVOs & Area postrema syndrome-> ADH
3. Hypothalamus: Tumors, demyelination and encephalitis
4. Acute intermittent porphria: HypoNa & seizures
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1. LGI1 encephalitis: Facio-brachio-dystonic seizures + hypoNa
2. NMOSD: Demyelination of hypothalamus, CVOs & Area postrema syndrome-> ADH
3. Hypothalamus: Tumors, demyelination and encephalitis
4. Acute intermittent porphria: HypoNa & seizures
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5. SAH: SIADH & CSW
6. Pituitary: Post adenoma resection, Apoplexy (-> ⬇️cortisol & subarachnoid irritation)
7. Pyschogenic polydipsia: Schizoprenia
8. Reset Osmostat: TB, pregnancy, SCLC
9. Infections: Abscess , meningoencephalitis
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6. Pituitary: Post adenoma resection, Apoplexy (-> ⬇️cortisol & subarachnoid irritation)
7. Pyschogenic polydipsia: Schizoprenia
8. Reset Osmostat: TB, pregnancy, SCLC
9. Infections: Abscess , meningoencephalitis
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10. Demyelination: ADEM, MS, NMOSD MOG
11. GBS & dysautonomia
12. Autoimmune encephalitis: LGI1, Morvan/Caspr2, AMPAR, SCLC associated antibodies
13. Structural: SDH, Cerebral atrophy, Hydrocephalus
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11. GBS & dysautonomia
12. Autoimmune encephalitis: LGI1, Morvan/Caspr2, AMPAR, SCLC associated antibodies
13. Structural: SDH, Cerebral atrophy, Hydrocephalus
Thanks for reading! Appreciate suggestions
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