🧠 MIGRAINE HEADACHE

Clinical Features

• Episodic attacks of moderate to severe intensity with throbbing or pounding quality, typically focal/unilateral (in children, may be bilateral/bifrontal).
• Frequently associated with nausea, vomiting, photophobia, phonophobia, and osmophobia; physical activity usually exacerbates the pain.
• Migraine without aura (most prevalent): bifrontal or temporal, intense nausea/vomiting, light-headedness, positive family history in 90% (maternal side).
• Migraine with aura subtypes include: typical (visual/sensory/dysphasic), atypical (hemiplegic/Alice in Wonderland), cyclic vomiting (recurrent severe vomiting 5x/hour lasting 1–5 days), abdominal migraine (mid-abdominal pain with anorexia, nausea, vomiting, pallor lasting 1–72 hours), hemiplegic aura (unilateral sensory or motor signs persisting for days), and basilar-type migraine (vasoconstriction of basilar and posterior cerebral arteries causing vertigo, tinnitus, diplopia, scotoma, ataxia, altered consciousness with seizures — risk in girls <4 years old).
• More common in females during adolescence; more common in males under 10 years old; >50% undergo spontaneous prolonged remission after the 10th birthday.

Diagnostic Workup

• Diagnosis is primarily clinical based on history and manifestations.
• Cranial MRI (imaging of choice) is indicated when red flags (SNOOPY) are present: abnormal neurologic exam, focal neurologic signs, seizures or very brief auras (<5 mins), unusual headaches (basilar-type, hemiplegic, atypical aura), brief cough headache, headache worse upon awakening or awakening child from sleep, migrainous headache with no family history, or headache that is progressively worsening.

Management (with doses)

• NSAIDs (mild to moderate): restrict use to not more than 2–3x/week to avoid medication overuse headache; can be repeated q3–4hr.
  • Paracetamol 15 mg/kg/dose q4–q6 (max 90 mg/kg/24h)
  • Ibuprofen 7.5 mg/kg/dose q6–q8 (max 40 mg/kg/24h)
  • Aspirin as alternative for >15 years old
• Triptans (moderate-to-severe or NSAID failure): Almotriptan or Rizatriptan; restrict to not more than 4–6 attacks/month; can be repeated q2hr; side effects include jaw/chest/finger tightness, grogginess, fatigue.
• Antiemetics (if severe and unresponsive to NSAIDs and triptans): Prochloperazine or Metoclopramide — dopaminergic antagonists.
• Fluid hydration: important due to vascular dilation as a common feature.
• Status migrainosus (persistent headache >3 days): refer to a specialist.

• Flunarizine: 5 mg OD, increased after 10 months to 10 mg OD, with a month off the drug every 4–6 months (only drug with proven level of effectiveness).
• Amitriptyline: 1 mg/kg/day (side effects: sleepiness, anticholinergic activity).
• Topiramate: 50 mg BID in adults and adolescents; dose needs to be reached slowly.
• Others: Valproic acid, beta blockers.
• Goal: Reduce frequency to 1–2 or fewer per month; reduce disability (PedMIDAS <10).

Complications (with Discharge/Follow-up)

• Status migrainosus: persistent headache >3 days — requires referral to a specialist.
• Medication overuse headache: risk if NSAIDs used >2–3x/week or triptans >4–6 attacks/month — counsel on restriction at discharge.
• Basilar-type migraine: risk of altered consciousness with seizures, particularly in girls <4 years old — warrants close monitoring.
• Hemiplegic aura: unilateral motor/sensory signs that may persist for days — good prognosis in older children and adolescents.
• Follow-up: Reassess PedMIDAS score to track disability; preventive therapy goals are a reduction to 1–2 migraines/month with PedMIDAS <10; neuroimaging follow-up if red flags are initially present.

🧠 TENSION TYPE HEADACHE (TTH)

Clinical Features

• Mild to moderate severity with a non-throbbing, diffuse (bilateral) quality — not exacerbated by physical activity.
• Nausea/vomiting is uncommon; symptoms such as nausea, photophobia, and phonophobia may occur but never all together at the same time (unlike migraine).
• No aura in typical TTH; not frequently associated with aura.
• Does not significantly impair daily activities (effect of activity: not affected).

Diagnostic Workup

• Diagnosis is clinical, based on headache characteristics and the absence of migraine features.
• Cranial MRI is the imaging of choice and is warranted if any SNOOPY red flags are present (see above — same criteria apply), particularly: abnormal neurologic exam, focal signs, progressive worsening pattern, or occipital location.

Management (with doses)

• NSAIDs are the primary treatment for acute TTH (same agents as migraine):
  • Paracetamol 15 mg/kg/dose q4–q6 (max 90 mg/kg/24h)
  • Ibuprofen 7.5 mg/kg/dose q6–q8 (max 40 mg/kg/24h)
• Restrict NSAID use to not more than 2–3 times/week to avoid medication overuse headache.
• Triptans are generally not indicated for TTH (used in migraine only).
• Biobehavioral therapy is a component of management, particularly for frequent or chronic TTH.
• Preventive therapy considerations (same agents applicable): Amitriptyline 1 mg/kg/day may be used for frequent/chronic TTH.

Complications (with Discharge/Follow-up)

• Medication overuse headache (MOH): chronic daily headache resulting from overuse of analgesics (>2–3x/week) — patient and caregiver education essential at discharge.
• Chronic TTH: if headaches occur ≥15 days/month, referral and preventive therapy (e.g., amitriptyline) should be initiated at follow-up.
• Secondary headache must be excluded: any progressive worsening, red flags (SNOOPY), or atypical features require neuroimaging (cranial MRI) and possible specialist referral before discharge.
• Follow-up: Monitor frequency and disability; if headaches are frequent (>1x/week) or disabling, escalate to preventive therapy and reassess at follow-up visits.

🧠 MIGRAINE HEADACHE

Clinical Features

• Moderate to severe, throbbing/pounding, focal/unilateral pain (may be bilateral in children)
• Associated with nausea, vomiting, photophobia, phonophobia, osmophobia; worsened by activity
• Aura may be present: typical (visual/sensory/dysphasic) or atypical (hemiplegic/Alice in Wonderland)
• More common in females during adolescence; in males if <10 years old
• Subtypes: migraine without aura (most common), cyclic vomiting, abdominal migraine, hemiplegic, basilar-type

Diagnostic Workup

• Primarily clinical diagnosis
• Cranial MRI if red flags present (SNOOPY): abnormal neuro exam, focal signs, seizures, aura <5 mins, progressive worsening, headache on awakening, no family history

Management

• Paracetamol 15 mg/kg/dose q4–6h (max 90 mg/kg/24h)
• Ibuprofen 7.5 mg/kg/dose q6–8h (max 40 mg/kg/24h) — max 2–3x/week
• Triptans (Almotriptan/Rizatriptan) if moderate-severe or NSAID fails — max 4–6 attacks/month, repeat q2h
• Antiemetics (Prochlorperazine/Metoclopramide) if severe and unresponsive
• Adequate fluid hydration

• Flunarizine 5 mg OD → 10 mg OD after 10 months (1 month off every 4–6 months)
• Amitriptyline 1 mg/kg/day
• Topiramate 50 mg BID (adults/adolescents)

Complications & Discharge/Follow-up

• Status migrainosus (>3 days) → refer to specialist
• Medication overuse headache → counsel to limit NSAIDs ≤2–3x/week
• Follow-up goal: reduce to ≤1–2 migraines/month; PedMIDAS <10

🧠 TENSION TYPE HEADACHE (TTH)

Clinical Features

• Mild to moderate, non-throbbing, diffuse bilateral pain
• Activity does not worsen it; nausea/vomiting uncommon
• Photophobia, phonophobia, nausea may occur but never all at the same time
• No aura

Diagnostic Workup

• Clinical diagnosis
• Cranial MRI only if SNOOPY red flags present (same criteria as migraine)

Management

• Paracetamol 15 mg/kg/dose q4–6h (max 90 mg/kg/24h)
• Ibuprofen 7.5 mg/kg/dose q6–8h (max 40 mg/kg/24h)
• Limit to ≤2–3x/week to prevent medication overuse
• Biobehavioral therapy for frequent episodes

• Amitriptyline 1 mg/kg/day

Complications & Discharge/Follow-up

• Medication overuse headache → educate at discharge; limit analgesic use
• Chronic TTH (≥15 days/month) → start preventive therapy at follow-up
• Exclude secondary cause if red flags present → MRI + specialist referral before discharge

• "Chronic TTH ≥15 days/month" — the images do not mention this threshold
• "Biobehavioral therapy for frequent episodes" — the image only mentions biobehavioral therapy as a general component of migraine management, not specifically for frequent TTH
• Specific discharge/follow-up language for TTH complications — the images have no dedicated complications or discharge/follow-up section for TTH
• "Exclude secondary cause before discharge" phrasing — my own addition

🧠 MIGRAINE HEADACHE

Clinical Features

• Moderate to severe, throbbing/pounding, focal/unilateral (may be bilateral/bifrontal in children)
• Associated with nausea, vomiting, photophobia, phonophobia, osmophobia; usually exacerbated by activity
• Aura may or may not be present:
  • Typical aura: visual/sensory/dysphasic
  • Atypical aura: hemiplegic/Alice in Wonderland syndrome
• More common in females during adolescence; more common in males <10 years old

• 50% undergo spontaneous remission after 10th birthday

• Subtypes:
  • Without aura: bifrontal/temporal, intense nausea/vomiting, family history in 90% (maternal)
  • Cyclic vomiting: recurrent severe vomiting 5x/hour, lasting 1–5 days, complete resolution between attacks
  • Abdominal migraine: mid-abdominal pain with ≥2 of — anorexia, nausea, vomiting, pallor; lasts 1–72 hours
  • Hemiplegic aura: unilateral sensory/motor signs persisting for days; good prognosis in older child
  • Basilar-type: vertigo, tinnitus, diplopia, scotoma, ataxia, altered consciousness/seizures; girls <4 years at risk

Diagnostic Workup

• Cranial MRI (imaging of choice) indicated if any red flag present:
  • Abnormal neurologic examination
  • Abnormal or focal neurologic signs
  • Seizures or very brief auras (<5 mins)
  • Atypical auras: basilar-type, hemiplegic
  • Brief cough headache
  • Headache worse on awakening or awakens child from sleep
  • Migrainous headache with no family history

Management

• Paracetamol 15 mg/kg/dose q4–q6 (max 90 mg/kg/24h)
• Ibuprofen 7.5 mg/kg/dose q6–q8 (max 40 mg/kg/24h)
• Aspirin — alternative for >15 years old
• NSAIDs: restrict to not more than 2–3x/week; can repeat q3–4hr
• Add Triptans (Almotriptan/Rizatriptan) if moderate-to-severe or NSAID fails
  • Restrict to not more than 4–6 attacks/month; repeat q2hr
• Antiemetics if severe and unresponsive to NSAIDs and Triptans:
  • Prochlorperazine or Metoclopramide
• Fluid hydration — important; vascular dilation is common feature
• Status migrainosus (persistent headache >3 days) → refer to specialist

• Flunarizine: 5 mg OD → increased to 10 mg OD after 10 months; 1 month off every 4–6 months (only drug with proven effectiveness)
• Amitriptyline: 1 mg/kg/day (side effects: sleepiness, anticholinergic activity)
• Topiramate: 50 mg BID in adults/adolescents; dose reached slowly
• Others: Valproic acid, beta blockers

Complications & Discharge/Follow-up

• Status migrainosus (>3 days) → refer to specialist
• Medication overuse headache → risk if NSAIDs >2–3x/week or triptans >4–6 attacks/month
• Follow-up goal: reduce frequency to 1–2 or fewer per month; PedMIDAS <10

🧠 TENSION TYPE HEADACHE (TTH)

Clinical Features

• Mild to moderate severity
• Non-throbbing character
• Diffuse location
• Not frequently associated with aura
• Nausea/vomiting: uncommon
• Photophobia, phonophobia, nausea may occur but never all together at the same time
• Physical activity: not affected

Diagnostic Workup

• ⚠️ Not provided in the images

Management

• ⚠️ Not provided in the images

Complications & Discharge/Follow-up

• ⚠️ Not provided in the images

The images contain no dedicated sections for TTH diagnostic workup, management, or complications. Only clinical features via the comparison table are available for TTH.

🧠 MIGRAINE HEADACHE

Clinical Features

• Moderate to severe, throbbing/pounding, focal/unilateral (may be bifrontal in children)
• Nausea, vomiting, photophobia, phonophobia, osmophobia; worsened by activity
• Aura: typical (visual/sensory/dysphasic) or atypical (hemiplegic/Alice in Wonderland)
• Females >adolescence; Males <10 years old
• Subtypes:
  • Without aura — bifrontal/temporal, nausea/vomiting, family history 90%
  • Cyclic vomiting — 5x/hour, lasts 1–5 days, resolves between attacks
  • Abdominal migraine — mid-abdominal pain + ≥2 of (anorexia/nausea/vomiting/pallor), lasts 1–72h
  • Hemiplegic — unilateral motor/sensory, persists for days
  • Basilar-type — vertigo, tinnitus, diplopia, ataxia, seizures; girls <4 yrs at risk

Management

• NSAIDs max 2–3x/week; repeat q3–4h
• Adequate fluid hydration
• Persistent >3 days → refer to specialist

🧠 FEBRILE SEIZURE

Clinical Features

• Most common seizure disorder in childhood; age 6–60 months; axillary temp >38°C

Fulfillment of any one complex feature classifies it as complex

Diagnostic Workup

• LP: Indicated if <6 months with fever + seizure; ill-appearing child; clinical signs of concern; PPS recommends LP for all <18 months with first febrile seizure
• EEG: NOT done if first episode and neurologically healthy; not predictive of recurrence
• Serum studies (electrolytes/CBC): NOT routine for first simple seizure; blood glucose if prolonged post-ictal obtundation or poor oral intake
• Neuroimaging: NOT recommended after first simple febrile seizure; complex febrile seizure workup to be individualized

Management

• General: Counseling, education on first aid, reassurance and emotional support for parents
• Antipyretics: Given to address fever and comfort; does NOT reduce risk of recurrence
• Anticonvulsants: Can reduce recurrence but adverse side effects do not warrant their use

Complications & Discharge/Follow-up

• Recurrence risk based on risk factors:
  • No risk factors: 12%
  • 1 risk factor: 25–50%
  • 2 risk factors: 50–59%
  • ≥3 risk factors: 73–100%
• Major risk factors: Age <1 year, fever duration <24h, fever 38–39°C
• Minor risk factors: Family history of febrile seizures/epilepsy, complex febrile seizure, daycare, male gender, hyponatremia

🧠 STATUS EPILEPTICUS (SE)

Clinical Features

• Failure of seizure termination OR initiation of abnormally prolonged seizure mechanisms
• Can cause neuronal death, neuronal injury, alteration of neuronal networks

Diagnostic Workup

• 0–5 min: Assess airway, breathing, circulation, neuro exam
• Vital signs monitoring + ECG monitoring
• Random blood sugar: if <60 mg/dL:

  • 2 years: 2 mL/kg D25W IV

  • <2 years: 4 mL/kg D12.5W IV
• Blood: Electrolytes, CBC, toxicology screen, anticonvulsant levels

Management

• ABC, oxygen via nasal cannula/face mask; consider intubation
• ECG monitoring; IV access; blood tests

• Diazepam IV 0.2 mg/kg/dose (max 10 mg); may repeat once
• Midazolam IV 10 mg if >40 kg; 5 mg if 13–40 kg; single dose
• Lorazepam IV 0.1 mg/kg/dose (max 4 mg); may repeat once

• Rectal diazepam 0.2–0.5 mg/kg/dose (max 20 mg); single dose
• Intranasal/buccal midazolam
• Phenobarbital IV 15 mg/kg/dose; single dose

• Valproic acid IV 40 mg/kg (max 3000 mg)
• Levetiracetam IV 60 mg/kg (max 4500 mg)
• If unavailable: Phenobarbital IV 15 mg/kg/dose (if not yet given)

• Repeat second-line therapy OR
• Anesthetic doses: Thiopental, Midazolam, Pentobarbital, or Propofol — all with continuous EEG monitoring

Complications & Discharge/Follow-up

• Long-term consequences: neuronal death, neuronal injury, alteration of neuronal networks
• Risk increases depending on type and duration of seizure
• If seizure stops at any phase → provide symptomatic care
• Third therapy phase: no clear evidence to guide therapy; requires anesthetic agents with continuous EEG monitoring

🧠 FEBRILE SEIZURE

Clinical Features

• Most common seizure disorder in childhood; age 6–60 months; axillary temp >38°C

Any one complex feature = classified as complex

Diagnostic Workup

• LP: Indicated if <6 months with fever + seizure; ill-appearing; clinical signs of concern; PPS recommends LP for all <18 months with first febrile seizure; option for 6–12 months if deficient in Hib/streptococcal immunization or pretreated with antibiotics
• EEG: NOT done if first episode and neurologically healthy; not predictive of recurrence
• Serum studies: Electrolytes/CBC NOT routine for first simple seizure; blood glucose if prolonged post-ictal obtundation or poor oral intake
• Neuroimaging: NOT recommended after first simple febrile seizure; complex febrile seizure workup to be individualized

Management

• General: Counseling, education on first aid; reassurance and emotional support for parents
• Antipyretics: For fever and comfort; does NOT reduce recurrence risk
• Anticonvulsants: Can reduce recurrence but adverse side effects do not warrant their use

Complications & Discharge/Follow-up

• No risk factors: 12%
• 1 risk factor: 25–50%
• 2 risk factors: 50–59%
• ≥3 risk factors: 73–100%

🧠 STATUS EPILEPTICUS (SE)

Clinical Features

• Failure of seizure termination OR mechanisms leading to abnormally prolonged seizures
• Long-term consequences: neuronal death, neuronal injury, alteration of neuronal networks

Diagnostic Workup

• Assess airway, breathing, circulation, neuro exam
• Monitor vital signs + ECG
• Random blood sugar: if <60 mg/dL:

  • 2 years: 2 mL/kg D25W IV

  • <2 years: 4 mL/kg D12.5W IV
• Blood: Electrolytes, CBC, toxicology screen, anticonvulsant levels

Management

• ABC; oxygen via nasal cannula/face mask; consider intubation
• ECG monitoring; establish IV access; collect blood tests

• Repeat second-line therapy OR
• Anesthetic doses: Thiopental, Midazolam, Pentobarbital, or Propofol
• All with continuous EEG monitoring

Complications & Discharge/Follow-up

• Long-term: neuronal death, neuronal injury, alteration of neuronal networks depending on type and duration
• If seizure stops at any phase → provide symptomatic care
• At 40–60 min: no clear evidence to guide therapy; requires anesthetic agents with continuous EEG monitoring

🧠 FEBRILE SEIZURE

Clinical Features

• Most common seizure disorder in childhood; age 6–60 months; axillary temp >38°C
• Simple: lasts few seconds to ≤15 min, generalized tonic-clonic with post-ictal drowsiness, no focal neurologic deficit, occurs only once in 24h
• Complex: lasts >15 min, focal seizure activity, may have focal neurologic deficit, repeated convulsions within 24h
• Fulfillment of any one complex feature classifies it as complex

Diagnostic Workup

• LP: Indicated if <6 months with fever + seizure; ill-appearing child; clinical signs of concern; PPS recommends LP for all <18 months with first febrile seizure; option for 6–12 months if deficient in Hib/streptococcal immunization or pretreated with antibiotics
• EEG: NOT done if first episode and neurologically healthy; not predictive of recurrence
• Serum studies: Electrolytes/CBC NOT routine for first simple seizure; blood glucose if prolonged post-ictal obtundation or poor oral intake
• Neuroimaging: NOT recommended after first simple febrile seizure; complex febrile seizure workup to be individualized

Management

• General: Counseling, education on first aid; reassurance and emotional support for parents
• Antipyretics: For fever and comfort; does NOT reduce recurrence risk
• Anticonvulsants: Can reduce recurrence but adverse side effects do not warrant their use

Complications & Discharge/Follow-up

• Recurrence risk: no risk factors 12%; 1 risk factor 25–50%; 2 risk factors 50–59%; ≥3 risk factors 73–100%
• Major risks: Age <1 year, fever duration <24h, fever 38–39°C
• Minor risks: Family history of febrile seizures/epilepsy, complex febrile seizure, daycare, male gender, hyponatremia

🧠 STATUS EPILEPTICUS (SE)

Clinical Features

• Failure of seizure termination OR mechanisms leading to abnormally prolonged seizures
• Long-term consequences: neuronal death, neuronal injury, alteration of neuronal networks
• Tonic-clonic SE: likely prolonged at 5 min; long-term consequences at 30 min
• Focal SE with impaired consciousness: likely prolonged at 10 min; long-term consequences at >60 min
• Absence SE: likely prolonged at 10–15 min; long-term consequences unknown

Diagnostic Workup

• Assess airway, breathing, circulation and neuro exam; monitor vital signs and ECG
• Random blood sugar — if <60 mg/dL: give 2 mL/kg D25W IV if >2 years old; give 4 mL/kg D12.5W IV if <2 years old
• Collect blood for electrolytes, CBC, toxicology screen, anticonvulsant levels

Management

• Assess ABC; oxygen via nasal cannula/face mask; consider intubation
• ECG monitoring; establish IV access; collect blood tests; note time of seizure onset

• Diazepam IV 0.2 mg/kg/dose (max 10 mg); may repeat once
• Midazolam IV 10 mg if >40 kg; 5 mg if 13–40 kg; single dose
• Lorazepam IV 0.1 mg/kg/dose (max 4 mg); may repeat once

• Rectal diazepam 0.2–0.5 mg/kg/dose (max 20 mg); single dose
• Intranasal/buccal midazolam
• Phenobarbital IV 15 mg/kg/dose; single dose

• Valproic acid IV 40 mg/kg (max 3000 mg)
• Levetiracetam IV 60 mg/kg (max 4500 mg)
• If unavailable: Phenobarbital IV 15 mg/kg/dose (if not yet given)

• Repeat second-line therapy OR anesthetic doses of Thiopental, Midazolam, Pentobarbital, or Propofol
• All with continuous EEG monitoring

Complications & Discharge/Follow-up

• Long-term consequences include neuronal death, neuronal injury, alteration of neuronal networks depending on type and duration of seizure
• If seizure stops at any phase → provide symptomatic care
• At 40–60 min: no clear evidence to guide therapy; requires anesthetic agents with continuous EEG monitoring

• Major Risks: Age <1 year, duration of fever <24 hours, and fever 38–39°C
• Minor Risks: Family history of febrile seizures, family history of epilepsy, complex febrile seizure, daycare, male gender, hyponatremia at presentation

• No risk factors: 12%
• 1 risk factor: 25–50%
• 2 risk factors: 50–59%
• 3 or more risk factors: 73–100%

🧠 FEBRILE SEIZURE

Clinical Features

• Most common seizure disorder in childhood; age 6–60 months; axillary temp >38°C
• Simple febrile seizure:
  • Lasts few seconds to ≤15 minutes
  • Initially generalized & tonic-clonic, then a brief period of post-ictal drowsiness
  • No focal neurologic deficit
  • Occurs only once in 24 hours
• Complex febrile seizure:
  • Lasts >15 minutes
  • Focal seizure activity
  • May have focal neurologic deficit
  • Repeated convulsions occur within 24 hours
• Fulfillment of any one complex feature classifies it as complex

Diagnostic Workup

• Lumbar Puncture (LP):
  • Indicated for all infants <6 months who present with fever & seizure
  • If child is ill-appearing
  • At any age with clinical signs or symptoms of concern
  • For children 6–12 months: LP is an option if simple febrile seizure and deficient in Hib and streptococcal immunization (or unknown immunization status), or pretreated with antibiotics
  • PPS recommends LP for all <18 months with first febrile seizure
• EEG:
  • NOT done if first episode and otherwise neurologically healthy
  • Not predictive of future recurrence of febrile seizures or epilepsy
• Serum studies:
  • Electrolytes & CBC are NOT routinely recommended for a first simple seizure
  • Blood glucose if with prolonged post-ictal obtundation or if with poor oral intake (prolonged fasting)
• Neuroimaging:
  • NOT recommended after a first simple febrile seizure (no evidence)
  • Workup of children with complex febrile seizure need to be individualized

Management

• General Aspects:
  • Counseling and education on acute management and first aid
  • Reassurance, emotional support, and allaying fears of the parents
• Antipyretics:
  • Given to address the fever and decrease the comfort
  • Does NOT reduce the risk of having a recurrent febrile seizure
• Anticonvulsants:
  • Can reduce the recurrence of febrile seizures
  • However, adverse side effects do not warrant their use

Complications & Discharge/Follow-up

• Major risks: Age <1 year, duration of fever <24 hours, fever 38–39°C
• Minor risks: Family history of febrile seizures, family history of epilepsy, complex febrile seizure, daycare, male gender, hyponatremia at presentation

• No risk factors: 12%
• 1 risk factor: 25–50%
• 2 risk factors: 50–59%
• 3 or more risk factors: 73–100%