Hyponatremia Evaluation And Management Form
Complete this form to document clinical evaluation and management steps for patients with hyponatremia.
Patient Initials
*
Age
*
Presenting Symptoms
*
Asymptomatic
Nausea/Vomiting
Headache
Confusion/Altered Mental Status
Seizure
Other
Duration of Hyponatremia
*
Acute (<48 hours)
Chronic (≥48 hours)
Unknown
Relevant Medical History
Heart failure
Cirrhosis
Renal disease
Recent surgery
Diuretic use
SIADH risk factors
None
Other
Recent Laboratory Results
*
Rows
Value
Units
Serum Sodium
Serum Osmolality
Urine Sodium
Urine Osmolality
Volume Status Assessment
*
Hypovolemic
Euvolemic
Hypervolemic
Likely Etiology
*
SIADH
Thiazide diuretic
Heart failure
Cirrhosis
Renal disease
Polydipsia
Other
Initial Management Plan
*
Fluid restriction
Hypertonic saline
Salt tablets
Loop diuretics
Treat underlying cause
Other
Follow-up and Monitoring Recommendations
Submit Evaluation
Should be Empty: