Diagnosis and Treatment of Hyponatremia: Compilation of the Guidelines

Abstract

Hyponatremia is a common water balance disorder that often poses a diagnostic or therapeutic challenge. Therefore, guidelines were developed by professional organizations, one from within the United States (2013) and one from within Europe (2014). This review discusses the diagnosis and treatment of hyponatremia, comparing the two guidelines and highlighting recent developments. Diagnostically, the initial step is to differentiate hypotonic from nonhypotonic hyponatremia. Hypotonic hyponatremia is further differentiated on the basis of urine osmolality, urine sodium level, and volume status. Recently identified parameters, including fractional uric acid excretion and plasma copeptin concentration, may further improve the diagnostic approach. The treatment for hyponatremia is chosen on the basis of duration and symptoms. For acute or severely symptomatic hyponatremia, both guidelines adopted the approach of giving a bolus of hypertonic saline. Although fluid restriction remains the first-line treatment for most forms of chronic hyponatremia, therapy to increase renal free water excretion is often necessary. Vasopressin receptor antagonists, urea, and loop diuretics serve this purpose, but received different recommendations in the two guidelines. Such discrepancies may relate to different interpretations of the limited evidence or differences in guideline methodology. Nevertheless, the development of guidelines has been important in advancing this evolving field.

Long-Term Vaptan Treatment of Idiopathic SIADH in an Octogenarian

“…Measurement of antidiuretic hormone (ADH) is not helpful to differentiate these causes. The more stable copeptin, also called C-terminal proarginine vasopressin, might be an interesting marker to differentiate SIADH from other hyponatremic states [13]. The treatment of choice in the case of hyponatremia caused by SIADH is fluid restriction.…”

Hyponatremia: Causes, Clinical Manifestations and Correction

“…3). Àëå íà ïðàêòèö³ ð³âåíü íàòð³þ íå çàâaeäè êîðåëþº ç òÿaeê³ñòþ ñèìïòîì³â, îñîáëèâî ïðè õðîí³÷í³é ã³ïîíàòð³å쳿 âíàñë³äîê àäàïòàö³¿ êë³òèí äî çì³íåíî¿ îñìîëÿðíîñò³ ÅÖÐ [30].…”

“…Ïðè õðîí³÷í³é ã³ïî-íàòð³å쳿 îáèäâà ãàéäëàéíè ðåêîìåíäóþòü îáìåaeåííÿ ïðèéîìó ð³äèíè ÿê ïåðøó ë³í³þ âåäåííÿ ïàö³ºíòà. Äðóãà ë³í³ÿ äåùî ð³çíèòüñÿ: ãàéäëàéí ÑØÀ ðåêîìåíäóº äåìåêëîöèêë³í, ñå÷îâèíó, àáî âàïòàíè, òîä³ ÿê ºâðîïåéñüêèé ãàéäëàéí ðåêîìåíäóº ñå÷îâèíó àáî ïåòëüîâ³ ä³óðåòèêè + ïåðîðàëüíî NaCl, òà íå ðåêîìåíäóº âàïòàíè (ïðè Na<130 ììîëü/ë) àáî ïðîòè âàïòàí³â (ïðè Na<125 ììîëü/ë), à òàêîae ïðîòè äåìîêëèöèêë³íó òà ë³ò³þ [30]. Ïðè íååôåêòèâíîñò³ îáìåaeåííÿ ïðèéîìó ð³äèíè ìîaeëèâèìè ë³êóâàëüíèìè çàõîäàìè äðóãî¿ ë³í³¿ ïðè õðîí³÷í³é ã³ïîíàòð³å쳿 ìîaeíà ðîçãëÿäàòè ó ÿêîñò³ àëüòåðíàòèâè ïåðîðàëüíèé ïðèéîì ñå÷îâèíè [42], ñîëîíèõ òàáëåòîê, â/â ââåäåííÿ ìàí³òîëó, ïåòëüîâèõ ä³óðåòèê³â, à òàêîae çàñòîñóâàííÿ äåìåêëîöèê-ë³íó, ïðåïàðàò³â ë³ò³þ òà âàïòàí³â [40,41].…”

Recognition and treatment of hyponatremia in psychiatric practice: Analysis of the frequency and report of case series

“…Prema dostupnim podacima, učestalost hiponatremije među hospitalizovanim adultnim pshijatrijskim bolesnicima je 6.4% [16] . Međutim, ovaj broj možda je i veći s obzirom na to da je hiponatremija često nedijagnostikovana [17] .…”