Causes and Management of Hyponatremia

@article{Palmer2003CausesAM,
  title={Causes and Management of Hyponatremia},
  author={Biff F. Palmer and John R. Gates and Malcolm Harold Lader},
  journal={Annals of Pharmacotherapy},
  year={2003},
  volume={37},
  pages={1694 - 1702}
}
OBJECTIVE: To review clinical information on the incidence and causes of hyponatremia (defined as a serum sodium level <130 mEq/L), the most common electrolyte abnormality seen in general hospital patients, and to discuss the diagnosis and treatment of hyponatremia in relation to these factors. DATA SOURCES: Primary sources and review articles were identified via MEDLINE (1981–July 2003) for entries on hyponatremia. We limited the search to specific topics including incidence, risk factors… 

Figures and Tables from this paper

Hyponatremia Induced by Drugs
TLDR
Proper diagnostic approach of patients with low serum sodium concentrations should involve a detailed medical history with special attention to the use of culprit medications, and discontinuation of therapy with these agents and avoidance of readministration is fully warranted.
Hyponatremia in Neurologic Patients: Consequences and Approaches to Treatment
TLDR
The optimal treatment of hyponatremia is controversial, but appropriate treatment must be determined according to the osmolality and volume status of the patient.
Clinical management of SIADH
  • P. Gross
  • Medicine
    Therapeutic advances in endocrinology and metabolism
  • 2012
TLDR
Vaptans appear advantageous to patients because there is no need for fluid restriction and the correction of hyponatremia can be achieved comfortably and within a short time, and appear to be beneficial for physicians and staff because of their efficiency and reliability.
Role of tolvaptan in the management of hyponatremia in patients with lung and other cancers: current data and future perspectives
TLDR
A brief review of the epidemiology of hyponatremia and its pathophysiology and diagnostic approaches and of the pharmacokinetics of tolvaptan and its clinical efficacy, safety, and compliance is provided.
Hyponatremia in Hospitalized Patients: The Potential Role of Tolvaptan
TLDR
Tolvaptan is an orally active, selective V2-receptor antagonist that blocks the effects of arginine vasopressin in the renal collecting duct to promote aquaresis without increasing sodium or potassium excretion, and increases serum sodium in a controlled manner.
Mechanisms, Risks, and New Treatment Options for Hyponatremia
TLDR
The AVP receptor antagonists are a new class of agents that have been shown to normalize serum [Na+] by promoting aquaresis – the electrolyte-sparing excretion of free water.
Hyponatremia Associated with Selective Serotonin-Reuptake Inhibitors in Older Adults
TLDR
Practicalers should be on the alert for this potentially life-threatening adverse event, especially in older adults with other risk factors for developing hyponatremia.
Consequences of Inadequate Management of Hyponatremia
Dilutional hyponatremia is a commonly observed disorder in hospitalized patients. It represents an excess of water in relation to prevailing sodium stores and is most often associated with a high
Tolvaptan for the treatment of hyponatremia secondary to the syndrome of inappropriate antidiuretic hormone secretion
TLDR
Current data shows that vaptans may safely correct mild or moderate hyponatremia in patients with SIADH, however, further clinical trials are needed to determine the optimal dosing, proper monitoring and adequate precautions for the use of vaptan in this patient population.
Economic Impact of Hyponatremia in Hospitalized Patients: A Retrospective Cohort Study
TLDR
Interventions or pharmacotherapies for the prompt treatment of hyponatremia could potentially reduce morbidity and LOS, thereby reducing the utilization of health care resources.
...
...

References

SHOWING 1-10 OF 75 REFERENCES
Diuretic-induced severe hyponatremia. Review and analysis of 129 reported patients.
TLDR
In the majority of the patients who received thiazides, excess antidiuretic hormone activity, hypokalemia, and excess water intake were accompanying findings which, singly or together, appeared to contribute to the development of hyponatremia.
Evidence-Based Case Reviews: Hyponatremia
TLDR
A 72-year-old woman from a nursing home presents to the emergency department with a change in her mental state over the past few hours, and a regimen of intravenous isotonic sodiumchloride solution is started at a rate of 84 mL per hour in the first 24hours.
Treatment of severe hyponatremia: conventional and novel aspects.
TLDR
The modalities of treatment of severe hyponatremia have so far consisted of infusions of hypertonic saline plus fluid restriction and vasopressin antagonists, but preliminary experience has already demonstrated their efficiency of inducing a sustained water diuresis and a correction of hypon atremia.
Severe symptomatic hyponatremia: treatment and outcome. A study of 64 cases.
  • R. Sterns
  • Medicine
    Annals of internal medicine
  • 1987
TLDR
Among 62 patients with 64 episodes of severe hyponatremia, the mortality rate was only 8%, and most deaths were caused by underlying diseases; with a serum sodium concentration of 105 mmol/L or less, the deaths rate was 5%.
Severe hyponatraemia: complications and treatment.
  • S. Ellis
  • Medicine
    QJM : monthly journal of the Association of Physicians
  • 1995
To observe the incidence of complications in severely hyponatraemic hospitalized patients and relate outcome to rate of correction, all patients admitted to a tertiary referral hospital in New York
Hyponatremia Associated with Carbamazepine and Oxcarbazepine Therapy: A Review
TLDR
Hyponatremia, an electrolyte disturbance usually without clinical significance, may sometimes lead to serious complications when overlooked or not treated appropriately, as well as in rare cases, water intoxication has been reported.
Hyponatremia in intracranial disorders.
Syndromes of excess antidiuretic hormone release.
The treatment of severe hyponatremia.
TLDR
Severe chronic symptomatic acute hyponatremia should be treated promptly and rapidly, using hypertonic saline, to initially reach a mildly hyp onatremic level, and severe chronic asymptomatic hyponatsia may be treated sufficiently by a fluid restriction.
Mechanisms of hyponatraemia in alcohol patients.
TLDR
It is concluded that hyponatraemia is a frequently observed electrolyte disorder in hospitalized alcoholic patients and is related to various pathophysiological mechanisms.
...
...