Differential Diagnosis of Hyponatremia in a Patient With No History of Cardiac, Renal or Neurologic Disease

Hospital Consultations in Hyponatremia: Appropriate Diagnosis and Effective Treatment to Improve Patient Outcomes
0.5 AMA PRA Category 1 Credit(s)
Launch Date:
August 20, 2013
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Endocrinologists, Hospitalists, Nephrologists, Primary Care Physicians, Urologists

Relevant Terms:

Chronic Kidney Disease, Hyponatremia

Gary L. Robertson, MD

Gary L. Robertson, MD
Emeritus Professor of Medicine
Feinberg School of Medicine
Northwestern University
Chicago, Illinois

Dr. Robertson was born in Spokane, Washington and grew up in Coeur d'Alene, Idaho. After finishing public high school, he attended Harvard College and then Harvard Medical School. It was while at Harvard that his interest in medical research developed, particularly in the area of fluid and electrolyte disorders including hypernatremia, hyponatremia, diabetes insipidus (DI), and related diseases. From Harvard he went on to the National Institutes of Health (NIH) were he joined the effort in progress to develop an assay for vasopressin. That assay was successfully developed during his 2 years at the NIH. He took advantage of the unique opportunity this new tool offered and focused his investigative efforts in this area.
Dr. Robertson strongly feels that there is not enough emphasis being placed on the distinctions between the various forms of DI. While improved techniques for differential diagnosis of DI are available, they are not widely known and utilized. Without proper diagnosis, optimal treatment is not possible.
The most significant advance affecting the management of DI, in Dr. Robertson's opinion, was the development of an assay for plasma vasopressin as well as identification of the genes that encode the vasopressin prohormone, the V2 receptor, and the aquaporin water channels that mediate the antidiuretic effect of the hormone. The latter made possible the discovery of many genetic mutations responsible for the various types of familial DI, thereby improving diagnosis and offering the real possibility of developing better methods of treatment in coming decades.
When not in his lab, Dr. Robertson enjoys fly fishing, travelling, and opera. In fact, one of his reasons for choosing to work at University Hospitals in Chicago was the opportunity to attend the opera performances in the city.
1. Diagnose hyponatremia in hospitalized patients appropriately based on the presenting signs and symptoms and lab results
2. Incorporate  therapeutic agents that improve outcomes and minimize risk based on their ability to address the underlying pathophysiological problems in patients with hyponatremia

Estimated time to complete this program
30 minutes

Target Audience     
This activity has been designed to meet the educational needs of hospitalists, nephrologists, endocrinologists, primary care physicians, urologists, and other healthcare professionals involved in the care of patients with hyponatremia.
Program Overview
Hyponatremia is regarded as the most common electrolyte disorder in clinical practice as it occurs in 15-40% of hospitalized patients and is estimated to be as high as 30-40% in patients admitted in the intensive care unit (ICU). An estimated 18-49% of patients admitted for cirrhosis have hyponatremia; 18-25% admitted for congestive heart failure have hyponatremia; and 8-28% who have community acquired pneumonia have hyponatremia. Hyponatremia has been shown to result in neurological problems, neuromuscular problems, osteoporosis, and gait dysfunction, and more disturbingly, it increases the risk of mortality during hospitalization and even 1-5 years after hospitalization. Diagnosis and subsequent effective management of hyponatremia in patients is complex as the signs and symptoms that result in hyponatremia overlap with a number of other diseases or conditions. Misdiagnosis has been reported to be common, and a recent report indicates that the current algorithm for hyponatremia may lead to misclassification of patients with hyponatremia as having primary polydipsia. In addition to improper diagnosis, a recent report showed that a significant percentage of patients developed hyponatremia in the hospital, and in a small percentage of patients, hospitalization aggravated hyponatremia highlighting the fact that the disorder is not appropriately managed. Additionally, the traditional therapies that have been available until recently do not even address the known pathophysiology of hyponatremia. Thus, using a case-based presentation, this educational activity will provide practical strategies that will enable the participants to effectively diagnose and manage patients with hyponatremia using appropriate pharmacological therapies that best address the underlying pathophysiological problems to improve outcomes while minimizing adverse events.

Program Agenda
Diagnosing Hyponatremia in a Patient with Chronic Kidney Disease: A Case Study

Physician Contintuing Medical Education
Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Postgraduate Institute for Medicine and ACCELMED. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.
Credit Designation
The Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy.  PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
Gary L. Robertson, MD
Contracted Research:
Otsuka America Pharmaceutical, Inc.
The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
The following PIM planners and managers, Laura Excell, ND, NP, MS, MA, LPC, NCC, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CCMEP, and Jan Schultz, RN, MSN, CCMEP, hereby state that they or their spouse/life partners do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.
The following ACCELMED planner and manager, James M. Westbrooks, PhD, hereby states that he or his spouse/life partner has no relationships with commercial interests.

Method of Participation and Request for Credit
There are no fees for participating and receiving CME credit for this activity. During the period August 20, 2013 through August 20, 2014, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation following the activity. Upon registering and successfully completing the post-test with a score of 70% or better and the activity evaluation, your certificate will be made available immediately.  Processing credit requests online will reduce the amount of paper used by nearly 100,000 sheets per year.

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners.  Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

This activity is supported by an educational grant from Otsuka America Pharmaceutical, Inc.