Hypervolemic hypotonic hyponatremia

(ie, ↑ total body Na, ↑ ↑ TBW)

• ↓ EAV → ↑ RAAS → ↑ aldosterone & ↑ adrenergic tone → ↑↑ ADH (Am J Med 2013;126:S1)

• CHF (↓ CO & renal venous congestion → ↓ EAV; UNa <10 mEq/L, FENa <1%)

• Cirrhosis (splanchnic arterial vasodilation + ascites → ↓ EAV; UNa <10 mEq/L, FENa <1%)

• Nephrotic syndrome (hypoalbuminemia → edema → ↓ EAV; UNa <10 mEq/L, FENa <1%)

• Advanced renal failure (diminished ability to excrete free H2O; UNa >20 mEq/L)

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• hyponatremia