Medical College of Wisconsin
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Point of care cardiac ultrasound in the management of hyponatremia: an enhancement to physical examination. CEN Case Rep 2022 02;11(1):6-10

Date

07/07/2021

Pubmed ID

34227056

Pubmed Central ID

PMC8811072

DOI

10.1007/s13730-021-00623-9

Scopus ID

2-s2.0-85124053372   3 Citations

Abstract

Accurate assessment of fluid status is vital to appropriate management of hyponatremia. However, conventional parameters such as physical examination, vital signs, and laboratory markers such as natriuretic peptides suffer from limitations in this regard. Point of care ultrasonography (POCUS) is a noninvasive bedside diagnostic tool that is emerging as an adjunct to physical examination in internal medicine and subspecialties including nephrology. In this manuscript, we describe a complex case of hyponatremia, where stroke volume assessment using Doppler echocardiography has helped to objectively assess fluid status and guided therapy. A 73-year-old woman was seen for worsening serum sodium. Her urine sodium was high and there was no hypotension suggestive of euvolemia. However, POCUS demonstrated low stroke volume in the presence of normal left ventricular ejection fraction, indicative of hypovolemia. She was treated with intravenous fluids based on these findings and response was evident by normalization of the stroke volume. Clinicians should adopt a multi-parametric approach integrating all the pieces of hemodynamic puzzle when evaluating complex fluid and electrolyte disorders.

Author List

Chatterjee T, Koratala A

Author

Abhilash Koratala MD Associate Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Female
Humans
Hyponatremia
Physical Examination
Point-of-Care Systems
Sodium
Stroke Volume
Ultrasonography
Ventricular Function, Left