A 73-year-old with altered level of consciousness, DM, HTN, IHD, liver cirrhosis.

Explanation

Core Concept: Hypervolemic hyponatremia occurs in conditions with increased total body water and sodium, such as liver cirrhosis and heart failure. The effective arterial blood volume is low, triggering ADH release and water retention.

Clinical Presentation:

• Altered mental status, confusion, lethargy (due to cerebral edema).
• Ascites, peripheral edema, elevated JVP.

Diagnosis:

• First-line tool: Serum sodium (low), serum osmolality (low), urine sodium (very low, <20 mEq/L).
• Gold standard: Clinical assessment of volume status combined with laboratory findings.

Management:

• Acute: Fluid restriction and loop diuretics (e.g., Furosemide) to promote free water clearance. Hypertonic saline is reserved for severe, life-threatening symptoms (seizures, coma) but must be used with extreme caution in cirrhosis.
• Long-term/Definitive: Treat underlying cirrhosis/heart failure; consider vasopressin receptor antagonists (vaptans) in refractory cases.