Hyponatremia HISTORY_LIST serum sodium < 135 mE/L apathy confusion agitation irritability lethargy anorexia nausea vomiting headache muscle weakness muscle cramping tremor decrease output of dark yellow urine polydipsia dehydration diarrhea constipation CHRONIC DISEASE renal dz. CNS dz. pulmonary dz. heart failure cirrhosis hyperalimentation hypothyroidism hyperlipidemia SURGERY/PREVIOUS HOSPITALIZATIONS neurosurgery PREVIOUS TESTS ECG Electrolytes BUN creatnine H & H TRAUMA OR INJURIES head injury SOCIAL HISTORY smoking alcohol caffeine illicit drugs - cocaine ALLERGY medications foods seasonal FAMILY HISTORY diabetes MEDS_LAB_TESTS **** MEDS oral hypoglycemics psychotropics antineoplastics **** LAB electrolytes cholesterol triglycerides serum glucose serum protein serum albumin BUN Cr urine osmolality **** TESTS ECG CXR REVIEW_OF_SYSTEMS_1 GENERAL weight changes appetite changes anorexia difficulty sleeping fever chills polyphagia hypophagia changes in thirst sleeping habit change bowel habit change fatigue hypertension previous physical exams SKIN pigmentation changes texture changes lesions eruptions pruritis easy bruising easy bleeding unusual hair loss changes in hair distribution skin masses finger/toe nail change rashes hives striae skin atrophy uremic frost hirsutism plethora neurofibromatosis lesion HEENT head trauma skull fractures head masses hearing loss vertigo chronic ear infection ear discharge ear pain hearing aid use loss of vision recent change in vision photophobia diplopia (double vision) glaucoma exudates dry eyes eye pain cataracts eye surgery itchy eyes excessive tearing corrective lenses nose bleeds chronic sinusitis nasal fractures nasal drainage polyps changes in sense of smell edentulous (without teeth) partial plate full plate recent dental work oral lesions tonsillitis strep throat tongue problems voice changes chronic hoarseness chronic halitosis NECK neck masses enlarged thyroid gland brachial cleft cysts neck injury REVIEW_OF_SYSTEMS_2 CHEST chronic coughing sputum production hemoptysis wheezing pneumonia bronchitis TB TB exposure SOB (altered by position?) edema chest pains pacemaker HEART MI coronary artery disease heart murmur heart valve disease left ventricular hypertrophy mistral valve stenosis pericarditis palpitations DOE paroxysmal nocturnal dyspnea orthopnea edema hypertension rheumatic fever cardiomyopathy ectopic heart beats arrhythmia exercise intolerance claudication heart medications ABDOMEN abdominal pain nausea vomiting diarrhea constipation hematochezia hematemesis hemorrhoids GI x-rays GI scopings rectal bleeding ulcers bowel polyps bowel incontinence gall bladder disease gall stones hepatitis cirrhosis hepatomegaly splenomegaly GU renal insufficiency renal failure dialysis kidney stones kidney disease kidney cyst flank pain hematuria pyuria dysuria chronic cystitis nocturia anuria hesitancy enuresis change in urine color prostatitis epididymitis scrotal problems TURP pain on intercourse genital lesions genital discharge REVIEW_OF_SYSTEMS_3 OB/GYN metorrhagia menorrhagia irregular menses problems in pregnancy use of contraception breast masses nipple discharge breast skin changes changes in axillary nodes monthly breast exam breast feeding children EXTREMITIES difficulty with gait weakness joint swelling joint stiffness muscle pain muscle swelling muscle injuries sagittal plan scoliosis coronal plane scoliosis fractured bones SLE osteoarthritis rheumatoid arthritis fibromyalgia NEURO seizures head injury LOC loss of coordination difficulty in balance sciatica difficulty in fine motor skills difficulty speaking CVA (stroke) weakness in arms weakness in legs tingling in legs and feet tingling in arms PSYCHIATRIC depression bipolar disorder suicide attempts psychiatric hospitalizations personality disorders ENDOCRINE goiter exophthalmos dry skin dry hair intolerance to heat intolerance to cold changes in growth sterility impotence decreased libido LYMPHATIC AND HEMATOLOGICAL lymphadenopathy transfusion anemia PHYSICAL_EVAL_1 VITALS BP Pulse Temp GENERAL lethargy obtundation stupor SKIN turgor capillary refill hyperpigmentation moonface truncal obesity PHYSICAL_EVAL_2 NECK nuchal rigidity CHEST Cheyne-Stokes respiration crackles HEART regular rate & rhythm irregular rate & irregular rhythm S3 gallops rubs murmurs ABDOMEN hypoactive bowel sounds tenderness hepatomegaly splenomegaly ascites costovertebral angle tenderness RECTAL guaiac (occult blood) EXTREMITIES edema NEURO confusion irritability motor weakness hemiparesis ataxia Babinski's sign clonus muscle twitches hypoactive DTR's cranial nerve palsies DIFF_DIAGNOSIS PSEUDO-HYPONATREMIA NORM OSMOLALITY (200-285 mOsm/Kg) lab error hyperlipidemia hyperproteinemia venipuncture above hypotonic IV HYPER-HYPONATREMIA (>285 mOsm/Kg) hyperglycemia infusion of hypertonic substances HYPO-OSMOTIC HYPONATREMIA LOW URINE SODIUM (<10 mmol /L) EXTRARENAL LOSSES vomiting diarrhea hemorrhage pancreatitis burns peritonitis ascites nasogastric tube drainage fistula respiratory losses sweat losses cirrhosis heart failure RENAL NEPHROSIS HYPOVOLEMIC HYPO-OSMOTIC HYPONATREMIA ELEV URINE SODIUM (>20mmol /L) renal loss (diuretics) partial urinary obstruction renal injury renal tubular acidosis adrenal insufficiency salt losing nephropathy acute or chronic renal failure EUVOLEMIC HYPO-OSMOTIC HYPONATREMIA LOW URINE SODIUM (<10 mmol /L) water intoxication tap water enema psychogenic polydipsia EUVOLEMIC HYPO-OSMOTIC HYPONATREMIA ELEV URINE SODIUM (>20 mmol /L) renal failure SIADH hypothyroidism stress drug induced (narcotics glucocorticoid deficiency intrathoracic process reset osmostat