Clinical practice guideline on diagnosis and treatment of hyponatraemia

Abstract

Hyponatraemia, defined as a serum sodium concentration !135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution-and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association -European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.

Evidence for the use of demeclocycline in the treatment of hyponatraemia secondary to SIADH : a systematic review

“…Despite this, the diagnosis and management of patients remains problematic 1, 3, particularly because of the heterogeneous nature of HN 40. In addition, treatment guidance has been generally oversimplistic, without clear consensus, and not reflective of the range of clinical issues encountered in current daily practice 1.…”

“…HN is usually associated with a disturbance in vasopressin [antidiuretic hormone (ADH)], which can be synthesised independently of serum osmolality or circulating fluid volume under specific pathological or pharmacological conditions 1. Clinical criteria for the syndrome of inappropriate antidiuretic hormone secretion (SIADH) were established by Bartter and Schwartz 2 and have remained largely unchanged ever since 1.…”

“…Hyponatraemia occurs in approximately 30% of hospitalised patients 1, 4 and is a clinical feature in 15–20% of emergency admissions 1. HN has a wide range of aetiologies across several patient populations.…”

“…Patients with euvolaemic hypo‐osmolality because of SIADH do not respond to isotonic saline, and occasionally, this causes HN to worsen 16. In chronic HN (< 135 mmol/l for > 48 h) secondary to SIADH, fluid restriction is considered first‐line treatment in patients without severe symptoms or where hypovolaemia is not suspected 1, 16. Fluid restriction between 500 and 1000 ml/day is recommended, according to HN severity 17.…”

The diagnosis and management of inpatient hyponatraemia and SIADH

“…Several guidelines for treating hyponatraemia have been proposed 4, 5; however, they often contain algorithms that are complex and impractical for use by nonspecialists. As a group of clinicians from varied specialties, but with a particular interest in hyponatraemia, we have therefore created a simple clinical algorithm that aims to maximise utility and patient safety, whilst being easy to use.…”