Hyponatraemia – presentations and management

Abstract

Hyponatraemia is the most common electrolyte disturbance encountered in clinical practice. It is associated with signifi cant morbidity and mortality, thus appropriate investigation and treatment is essential. Hyponatraemia presents with a spectrum of clinical presentations ranging from no symptoms to life-threatening neurological sequelae. Hyponatraemia has multiple aetiologies and distinguishing the underlying aetiology facilitates appropriate treatment. This review provides an overview of the presentations and approaches to management of this common clinical condition. IntroductionHyponatraemia (defined as serum sodium <135 mmol/L) is the most common electrolyte abnormality and is encountered in all areas of clinical practice.1 Hyponatraemia is associated with increased morbidity and mortality.2 The assessment of patients with hyponatraemia can pose a clinical challenge and strategies for its management are often suboptimal. In recent years, expert guidance and recommendations have been published that provide an evidence-based approach to diagnosis and treatment of hyponatraemia 3,4 although it should be highlighted that highquality evidence is lacking for many aspects of hyponatraemia management. Additionally, new therapies have emerged promising a more targeted approach to regulating body water and sodium balance in certain patients with hyponatraemia. EpidemiologyHyponatraemia occurs in approximately 15-30% of hospitalised patients, with 1-2% of patients having a serum sodium level <125 mmol/L. 5,6 In addition, hyponatraemia is often underreported in the hospital setting. 7 In the intensive care unit, approximately 25-30% of patients will have a serum sodium <134 mmol/L. 8,9 In neurosurgical units, hyponatraemia is reported in up to 50% of patients with subarachnoid haemorrhage in retrospective 2 and prospective studies.10 Hyponatraemia is also a common occurrence in ABSTRACT Hyponatraemia -presentations and management heart failure with an incidence of approximately 20% in patients hospitalised for heart failure. 11 Age-related changes and chronic diseases are often associated with abnormalities in water homeostasis. Miller et al 12 have reported that more than 50% of nursing home residents had at least one episode of hyponatraemia over a 12-month study period. Morbidity and mortality associated with hyponatraemiaHyponatraemia is associated with increased morbidity and mortality. Acute severe symptomatic hyponatraemia is a medical emergency that carries a high mortality rate if not addressed acutely. A recent prospective observational study found a positive correlation of serum sodium and mortality, with a serum sodium <125 mmol/L associated with a substantial 1-year mortality, recurrence of hyponatraemia and rehospitalisation rate.13 'Asymptomatic' chronic mild hyponatraemia has previously been thought to be clinically insignificant; however, recent evidence shows that mild chronic 'asymptomatic' hyponatraemia, particularly in an older population, may contribute to impaired cognition, 14 increased risk o...

Hyponatremia in Infectious Diseases—A Literature Review

“…Hyponatremia may occur as a result of numerous disorders [ 6 ]. These include common infectious diseases as well as endocrine, nutritional, metabolic, cardiovascular, renal or hepatic pathologies.…”

“…Sodium and potassium are the main osmotically active inorganic substances and their plasma concentrations are maintained within a narrow range [ 6 , 10 ]. The water transfers between intra and extracellular compartments are driven by an osmotic pressure gradient exerted by osmotically active solutes, including sodium.…”

Symptomatic hyponatremia during the diabetic ketoacidosis in 5 years old child with new onset diabetes – own experience

“…The clinical features are headache, nausea, vomiting, seizures, resulting from the brain oedema. Early diagnosis, differential between acute vs. chronic hyponatremia and introduction the optimal treatment can prevent developing cerebral demyelination and lethal outcome [7,8]. The presented case shows how sudden and severe might be the course of hyponatremia together with the diagnostic dif-ficulties.…”

“…In this case the most likely diagnosis were considered, including congenital adrenal hyperplasia, secondary adrenal insufficiency and Addison's disease. Normal levels of the cortisol, ACTH, the urine steroid profile and negative antibodies against adrenal cortex allowed to exclude disorders related to the disturbed production of the steroids [8].…”

Neuro-psycho disorders and Hyponatremiain a Renal Carcinoma patient revealed as Anti-LGI1 Encephalitis and Renal Salt Wasting: a Case Report

“…There is increasing awareness that most or all patients with hyponatremia are symptomatic. The presentations of hyponatremia could be confusion, weakness, in coordination with increased falls and fractures, increasing osteoporosis, irritability, seizures and even death [28]. The recommendation to treat virtually all hyponatremic patients creates a therapeutic dilemma, because untreated patients may suffer the consequences of falls and fractures whereas too rapid correction of > 6 mmol/L/24hrs can lead to osmotic demyelination [29].It is presently in a state of confusion because the outmoded volume approach has failed to bring clarity to establishing proper diagnosis and thus treatment of this syndrome with multiple etiologies and diverse therapeutic goals.…”