Point‐of‐care Doppler ultrasound in the management of hyponatremia: Another string to nephrologists' Bow

Abstract

Objective assessment of fluid status is vital for the appropriate management of patients with hyponatremia. Conventional physical examination suffers from several limitations in this regard, and point‐of‐care Doppler ultrasonography can be used as an adjunct to clinical and laboratory data in evaluating these patients.

Use of Venous Excess UltraSound (VExUS) score in hyponatraemia management in critically ill patient

“…As an inapparent hypervolaemic state was brought to light by POCUS, this was likely a congestive heart failure (HF) with preserved ejection fraction-like scenario behaving as dilutional hyponatraemia. A few more cases of venous doppler ultrasound management of dilutional hyponatraemia have been described 4 12 13. In patients with HF, hyponatraemia occurs more frequently in an impaired water excretion context than due to sodium depletion.…”

Venous Excess Doppler Ultrasound for the Nephrologist: Pearls and Pitfalls

“…In addition to quantification of congestion and prognostic significance, serial monitoring of these waveforms provides a real-time appraisal of the efficacy of decongestive therapy, as reported in multiple case studies. 39 , 40 , 41 , 42 , 43 , 44 , 45 Following are 2 case examples from our practice.…”

“…In our practice, we have noticed that the portal vein waveform tends to improve or normalize despite chronically abnormal IVC or hepatic and kidney parenchymal waveforms in such patients. 40 , 41 Nevertheless, larger studies are needed to test this clinical observation.…”

Demystifying hyponatremia: A clinical guide to evaluation and management

“…In such cases, being able to estimate stroke volume and identify the presence or absence of venous congestion at the bedside, using POCUS, guides appropriate management, thus minimizing empiric interventions. Moreover, solely relying on physical findings such as pedal edema, skin turgor, and even lung crackles may lead to incorrect diagnosis 17,18 . Table 1 summarizes case studies in which POCUS aided in clinical decision making in patients with hyponatremia.…”

“…A thorough physical examination focusing on features supportive of hypovolemia is imperative. Point-of-care ultrasonography (POCUS) is a helpful adjunct to physical examination to guide volume assessment in hyponatremia, 17,18 and this will be discussed later in the article.…”