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Old 01-01-2013
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Default Diabetics & Sodium levels

I really hate hyper/hyponatremia... how is it possible that DM can cause both hypo and hypernatermia? Step to Med 3rd ed on pages 305 & 307. I mean lots of glucose means I am urinating more water than Na so fine you are hypernatermia, yet glucose draws water in to ECF causing hyponatermia due to dilution.
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Old 01-01-2013
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My understanding is that the Hyponatremia of DM is not a true Hyponatremia since the total body Na remains normal/high but it can certainly leads to Hypernatremia at a later stage due you loss of H2O (more than Na) in the urine by osmotic diuresis.
The point is that they are not occurring as separate events but simultaneously depending on the body's response and other factors.
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Old 01-01-2013
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DM has excess glucose. so there should be glycosuria----->water loss (glucose is osmotically active, so pt has polyuria, polydipsia). now, water loss in excess will also lose Na( its a relative thing, coz the body senses that ADH isnt working. so it tries to retain water, at this point the urinary Na is high and serum Na is low)..
however in response to it as a compensatory mech, it will increase ADH to replenish H20 and in turn increase Na.

so initially therez Hyponatremia and later its hypernatremia.
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Old 01-02-2013
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In the initial stages, glycosuria causes more water to be lost from the urine in the form of polyuria, which leaves back a high concentration of sodium in the ECF causing hypernatremia.......and when the diabetic pt. is drinking excess of water due to polydipsia, shouldn't that be causing hyponatremia( due to the dilutional effect)....
so how is it HYPOnatremia in the initial stages??
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well like u read before its almost a simultaneous process. with excess urination, adh is low so Na is low and then compensatory when the body tries to retain water Na increases.
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Quote:
Originally Posted by Dr.Hunny View Post
In the initial stages, glycosuria causes more water to be lost from the urine in the form of polyuria, which leaves back a high concentration of sodium in the ECF causing hypernatremia.......and when the diabetic pt. is drinking excess of water due to polydipsia, shouldn't that be causing hyponatremia( due to the dilutional effect)....
so how is it HYPOnatremia in the initial stages??
Hyponatremia in DM is not due to patient drinking excess water. It is mainly due to the hyperosmolarity of the intravascular fluid due to hyperglycemia drawing water into the intravascular compartment due to osmosis.
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