Hyponatremia with Dr. Joel Topf

You are in for a treat as Dr. Joel Topf, aka @kidney_boy, gives us the low down on hyponatremia. Dr. Topf discusses this condition in a way that is helpful for nurses by reviewing clinical concepts without getting into unneeded nitty gritty.

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Important clinical concept: Serum sodium is measuring the amount of sodium in the body in relation to the amount of water. Just because a patient it hyponatremic doesn’t mean their overall sodium levels are low.

Types of Hyponatremia

Dr. Tom Fadial https://twitter.com/thame

Hyponatremia is categorized by the overall volume status of the patient.


Ex: Gastroenteritis

The problem with these patients is that they are not producing enough urine. An isotonic fluid bolus will often fix the hyponatremia.


Ex: CHF, cirrhosis

There is an overall excess amount of sodium in the body, however, there is little urine output.


Ex: SIADH, excessive water intake (psychogenic polydipsia, water drinking contents), beer potomania/tea-and-toast syndrome, iatrogenic

Treatment for SIADH

  • Fluid restrictions. Dr. Topf points out that this method is often ineffective.
  • Hypertonic saline. Saved for emergent cases, when there is concern for seizures. Presents risk of osmotic demyelination syndrome (ODS).
  • Sodium, Potassium, or Urea tabs. The goal with these is to increase urine volume, not to replace electrolytes
  • Tolvaptan. Blocks ADH. Very effective; very expensive.
  • Loops Diuretics. Increase urine output, thus increasing serum sodium concentration.

Conflicts of Interest from Dr. Joel Topf

“Takeda Oncology made a donation to MM4MM the program that took me to Mount Everest in 2018.

In 2020, I participated in multiple advisory boards for Bayer. I am also part of subgroup advising them on social media strategies.

In June 2020, I participated in an advisory board for Tricida.

I am the president of NephJC, a 503c organization that supports social media in medical education. NephJC has multiple industry and academic supporters.”