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. Hyponatraemia is present in 15–20 % of emergency admissions to hospital and occurs in up to 20 % of critically ill patients. Symptomatology may vary from subtle to severe or even life threatening. Despite this, the management of patients remains problematic. Against this background, the European Society of Intensive Care Medicine, the European Society of Endocrinology and the European Renal Association–European Dialysis and Transplant Association, represented by European Renal Best Practice have developed a 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.
Similar content being viewed by others
References
Funk GC, Lindner G, Druml W et al (2010) Incidence and prognosis of dysnatremias present on ICU admission. Intens Care Med 36:304–311
Beukhof CM, Hoorn EJ, Lindemans J, Zietse R (2007) Novel risk factors for hospital-acquired hyponatraemia: a matched case-control study. Clin Endocrinol 66:367–372
Upadhyay A, Jaber BL, Madias NE (2009) Epidemiology of hyponatremia. Semin Nephrol 29:227–238
Hoorn EJ, Lindemans J, Zietse R (2006) Development of severe hyponatraemia in hospitalized patients: treatment-related risk factors and inadequate management. Nephrol Dial Transpl 21:70–76
Waikar SS, Mount DB, Curhan GC (2009) Mortality after hospitalization with mild, moderate, and severe hyponatremia. Am J Med 122:857–865
Doshi SM, Shah P, Lei X, Lahoti A, Salahudeen AK (2012) Hyponatremia in hospitalized cancer patients and its impact on clinical outcomes. Am J Kidney Dis 59:222–228
Sterns RH (1987) Severe symptomatic hyponatremia: treatment and outcome. A study of 64 cases. Ann Intern Med 107:656–664
Gill G, Huda B, Boyd A et al (2006) Characteristics and mortality of severe hyponatraemia—a hospital-based study. Clin Endocrinol 65:246–249
Arieff AI, Llach F, Massry SG (1976) Neurological manifestations and morbidity of hyponatremia: correlation with brain water and electrolytes. Medicine 55:121–129
Halberthal M, Halperin ML, Bohn D (2001) Lesson of the week: acute hyponatraemia in children admitted to hospital: retrospective analysis of factors contributing to its development and resolution. BMJ 322:780–782
Darmon M, Diconne E, Souweine B et al (2013) Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change. Crit Care 17:R12
Sakr Y, Rother S, Ferreira AMP et al (2013) Fluctuations in serum sodium level are associated with an increased risk of death in surgical ICU patients. Crit Care Med 41:133–142
Stelfox HT, Ahmed SB, Khandwala F, Zygun D, Shahpori R, Laupland K (2008) The epidemiology of intensive care unit-acquired hyponatraemia and hypernatraemia in medical-surgical intensive care units. Crit Care 12:R162
Pirzada NA, Ali II (2001) Central pontine myelinolysis. Mayo Clin Proc 76:559–562
Arieff AI (1986) Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. N Engl J Med 314:1529–1535
Ayus JC, Wheeler JM, Arieff AI (1992) Postoperative hyponatremic encephalopathy in menstruant women. Ann Intern Med 117:891–897
Nzerue CM, Baffoe-Bonnie H, You W, Falana B, Dai S (2003) Predictors of outcome in hospitalized patients with severe hyponatremia. J Natl Med Assoc 95:335–343
Arieff AI, Ayus JC, Fraser CL (1992) Hyponatraemia and death or permanent brain damage in healthy children. BMJ 304:1218–1222
Verbalis JG, Drutarosky MD, Ertel RJ, Vollmer RR (1989) Adaptive responses to sustained volume expansion in hyponatraemic rats. J Endocrinol 122:421–431
Verbalis JG, Gullans SR (1991) Hyponatremia causes large sustained reductions in brain content of multiple organic osmolytes in rats. Brain Res 567:274–282
Sterns RH, Silver SM (2006) Brain volume regulation in response to hypo-osmolality and its correction. Am J Med 119:S12–S16
Melton JE, Patlak CS, Pettigrew KD, Cserr HF (1987) Volume regulatory loss of Na, Cl, and K from rat brain during acute hyponatremia. Am J Physiol 252:F661–F669
Sterns RH, Thomas DJ, Herndon RM (1989) Brain dehydration and neurologic deterioration after rapid correction of hyponatremia. Kidney Int 35:69–75
Verbalis JG, Martinez AJ (1991) Neurological and neuropathological sequelae of correction of chronic hyponatremia. Kidney Int 39:1274–1282
Videen JS, Michaelis T, Pinto P, Ross BD (1995) Human cerebral osmolytes during chronic hyponatremia. A proton magnetic resonance spectroscopy study. J Clin Invest 95:788–793
Hoorn EJ, Zietse R (2008) Hyponatremia revisited: translating physiology to practice. Nephron Physiol 108:46–59
Hsu Y-J, Chiu J-S, Lu K-C, Chau T, Lin S-H (2005) Biochemical and etiological characteristics of acute hyponatremia in the emergency department. J Emerg Med 29:369–374
Sterns RH (1994) Treating hyponatremia: why haste makes waste. South Med J 87:1283–1287
Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G (2006) Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med 119(71):e71–e78
Fazekas AS, Funk G-C, Klobassa DS et al (2012) Evaluation of 36 formulas for calculating plasma osmolality. Intens Care Med 39:302–308
Adrogue HJ, Madias NE (2000) Hyponatremia. N Engl J Med 342:1581–1589
Hoorn EJ, Halperin ML, Zietse R (2005) Diagnostic approach to a patient with hyponatraemia: traditional versus physiology-based options. Q J Med 98:529–540
Chung HM, Kluge R, Schrier RW, Anderson RJ (1987) Clinical assessment of extracellular fluid volume in hyponatremia. Am J Med 83:905–908
McGee S, Abernethy WB 3rd, Simel DL (1999) The rational clinical examination. Is this patient hypovolemic? JAMA 281:1022–1029
Hillier TA, Abbott RD, Barrett EJ (1999) Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med 106:399–403
Schwartz WB, Bennett W, Curelop S, Bartter FC (1957) A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 23:529–542
Janicic N, Verbalis JG (2003) Evaluation and management of hypo-osmolality in hospitalized patients. Endocrinol Metab Clin N Am 32:459–481 vii
Aviram A, Pfau A, Czaczkes JW, Ullmann TD (1967) Hyperosmolality with hyponatremia, caused by inappropriate administration of mannitol. Am J Med 42:648–650
Desmond J (1970) Serum osmolality and plasma electrolytes in patients who develop dilutional hyponatremia during transurethral resection. Can J Surg 13:116–121
Lindner G, Zapletal B, Schwarz C, Wisser W, Hiesmayr M, Lassnigg A (2012) Acute hyponatremia after cardioplegia by histidine–tryptophane–ketoglutarate—a retrospective study. J Cardiothorac Surg 7:52
Sirken G, Raja R, Garces J, Bloom E, Fumo P (2004) Contrast-induced translocational hyponatremia and hyperkalemia in advanced kidney disease. Am J Kidney Dis 43:e31–e35
Palevsky PM, Rendulic D, Diven WF (1993) Maltose-induced hyponatremia. Ann Intern Med 118:526–528
Oster JR, Singer I (1999) Hyponatremia, hyposmolality, and hypotonicity: tables and fables. Arch Intern Med 159:333–336
Lai M-Y, Lin C-C, Chung S-L, Wu C-H, Yang W-C, Tseng Y-T (2009) Milky plasma, diabetes, and severe hyponatremia. Kidney Int 75:996
Lawn N, Wijdicks EF, Burritt MF (1998) Intravenous immune globulin and pseudohyponatremia. N Engl J Med 339:632
Vaswani SK, Sprague R (1993) Pseudohyponatremia in multiple myeloma. South Med J 86:251–252
Sherlock M, O’Sullivan E, Agha A et al (2006) The incidence and pathophysiology of hyponatraemia after subarachnoid haemorrhage. Clin Endocrinol 64:250–254
Brimioulle S, Orellana-Jimenez C, Aminian A, Vincent JL (2008) Hyponatremia in neurological patients: cerebral salt wasting versus inappropriate antidiuretic hormone secretion. Intensive Care Med 34:125–131
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Spasovski, G., Vanholder, R., Allolio, B. et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Intensive Care Med 40, 320–331 (2014). https://doi.org/10.1007/s00134-014-3210-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-014-3210-2