Skip to main content

Physiology of Water Balance and Pathophysiology of Hyponatremia

  • Chapter
  • First Online:
Hyponatremia

Abstract

The understanding of hyponatremic disorders requires a knowledge of normal water balance and how this relates to the maintenance of normal sodium concentrations despite large variations of water intake. This chapter thus reviews the physiology of water homeostasis and describes the components of the normal renal diluting and concentrating mechanisms. The quantitation of water excretion is also reviewed in order to more appropriately approach the pathogenesis and treatment of disorders of water excretion. Emphasis is placed on the central role of vasopressin in the maintenance of water balance. Finally an overall approach to hyponatremic patients is put forth to be discussed in greater detail in forthcoming chapters.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Rose BD, Post TW. Clinical physiology of acid–base and electrolyte disorders. New York, NY: McGraw-Hill, Medical Pub. Division; 2001.

    Google Scholar 

  2. Parikh C, Kumar S, Berl T. Disorders of water metabolism. In: Floege J, Johnson RJ, Feehally J, editors. Comprehensive clinical nephrology. Philadelphia, PA: Saunders/Elsevier; 2010.

    Google Scholar 

  3. Nielsen S, Frokiaer J, Marples D, Kwon TH, Agre P, Knepper MA. Aquaporins in the kidney: from molecules to medicine. Physiol Rev. 2002;82:205–44.

    PubMed  CAS  Google Scholar 

  4. Chou SY, Porush JG, Faubert PF. Renal medullary circulation: hormonal control. Kidney Int. 1990;37:1–13.

    Article  PubMed  CAS  Google Scholar 

  5. Brown D, Nielsen S. Cell biology of vasopressin action. In: Brenner BM, Rector FC, editors. Brenner & Rector’s the kidney. Philadelphia, PA: Saunders Elsevier; 2008.

    Google Scholar 

  6. Nielsen S, Chou CL, Marples D, Christensen EI, Kishore BK, Knepper MA. Vasopressin increases water permeability of kidney collecting duct by inducing translocation of aquaporin-CD water channels to plasma membrane. Proc Natl Acad Sci USA. 1995;92:1013–7.

    Article  PubMed  CAS  Google Scholar 

  7. Thompson CJ, Selby P, Baylis PH. Reproducibility of osmotic and nonosmotic tests of vasopressin secretion in men. Am J Physiol. 1991;260:R533–9.

    PubMed  CAS  Google Scholar 

  8. Zimmerman EA, Ma LY, Nilaver G. Anatomical basis of thirst and vasopressin secretion. Kidney Int Suppl. 1987;21:S14–9.

    PubMed  CAS  Google Scholar 

  9. Mann JF, Johnson AK, Ganten D, Ritz E. Thirst and the renin-angiotensin system. Kidney Int Suppl. 1987;21:S27–34.

    PubMed  CAS  Google Scholar 

  10. Appelgren BH, Thrasher TN, Keil LC, Ramsay DJ. Mechanism of drinking-induced inhibition of vasopressin secretion in dehydrated dogs. Am J Physiol. 1991;261:R1226–33.

    PubMed  CAS  Google Scholar 

  11. Seckl JR, Williams TD, Lightman SL. Oral hypertonic saline causes transient fall of vasopressin in humans. Am J Physiol. 1986;251:R214–7.

    PubMed  CAS  Google Scholar 

  12. Thompson CJ, Burd JM, Baylis PH. Acute suppression of plasma vasopressin and thirst after drinking in hypernatremic humans. Am J Physiol. 1987;252:R1138–42.

    PubMed  CAS  Google Scholar 

  13. Kumar S, Berl T. Sodium. Lancet. 1998;352:220–8.

    Article  PubMed  CAS  Google Scholar 

  14. Anderson RJ, Chung HM, Kluge R, Schrier RW. Hyponatremia: a prospective analysis of its epidemiology and the pathogenetic role of vasopressin. Ann Intern Med. 1985;102:164–8.

    Article  PubMed  CAS  Google Scholar 

  15. Katz MA. Hyperglycemia-induced hyponatremia–calculation of expected serum sodium depression. N Engl J Med. 1973;289:843–4.

    Article  PubMed  CAS  Google Scholar 

  16. Hillier TA, Abbott RD, Barrett EJ. Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med. 1999;106:399–403.

    Article  PubMed  CAS  Google Scholar 

  17. Albrink MJ, Hald PM, Man EB, Peters JP. The displacement of serum water by the lipids of hyperlipemic serum; a new method for the rapid determination of serum water. J Clin Invest. 1955;34:1483–8.

    Article  PubMed  CAS  Google Scholar 

  18. Tarail R, Buchwald KW, Holland JF, Selawry OS. Misleading reductions of serum sodium and chloride associated with hyperproteinemia in patients with multiple myeloma. Proc Soc Exp Biol Med. 1962;110:145–8.

    PubMed  CAS  Google Scholar 

  19. Hariprasad MK, Eisinger RP, Nadler IM, Padmanabhan CS, Nidus BD. Hyponatremia in psychogenic polydipsia. Arch Intern Med. 1980;140:1639–42.

    Article  PubMed  CAS  Google Scholar 

  20. de Leon J, Verghese C, Tracy JI, Josiassen RC, Simpson GM. Polydipsia and water intoxication in psychiatric patients: a review of the epidemiological literature. Biol Psychiatry. 1994;35:408–19.

    Article  PubMed  Google Scholar 

  21. Jose CJ, Perez-Cruet J. Incidence and morbidity of self-induced water intoxication in state mental hospital patients. Am J Psychiatry. 1979;136:221–2.

    PubMed  CAS  Google Scholar 

  22. Illowsky BP, Kirch DG. Polydipsia and hyponatremia in psychiatric patients. Am J Psychiatry. 1988;145:675–83.

    PubMed  CAS  Google Scholar 

  23. Thompson CJ, Edwards CR, Baylis PH. Osmotic and non-osmotic regulation of thirst and vasopressin secretion in patients with compulsive water drinking. Clin Endocrinol (Oxf). 1991;35:221–8.

    Article  CAS  Google Scholar 

  24. Dubovsky SL, Grabon S, Berl T, Schrier RW. Syndrome of inappropriate secretion of antidiuretic hormone with exacerbated psychosis. Ann Intern Med. 1973;79:551–4.

    Article  PubMed  CAS  Google Scholar 

  25. Goldman MB, Robertson GL, Luchins DJ, Hedeker D. The influence of polydipsia on water excretion in hyponatremic, polydipsic, schizophrenic patients. J Clin Endocrinol Metab. 1996;81:1465–70.

    Article  PubMed  CAS  Google Scholar 

  26. Goldman MB, Luchins DJ, Robertson GL. Mechanisms of altered water metabolism in psychotic patients with polydipsia and hyponatremia. N Engl J Med. 1988;318:397–403.

    Article  PubMed  CAS  Google Scholar 

  27. Stuart CA, Neelon FA, Lebovitz HE. Disordered control of thirst in hypothalamic-pituitary sarcoidosis. N Engl J Med. 1980;303:1078–82.

    Article  PubMed  CAS  Google Scholar 

  28. Thaler SM, Teitelbaum I, Berl T. "Beer potomania" in non-beer drinkers: effect of low dietary solute intake. Am J Kidney Dis. 1998;31:1028–31.

    Article  PubMed  CAS  Google Scholar 

  29. Liamis G, Milionis H, Elisaf M. A review of drug-induced hyponatremia. Am J Kidney Dis. 2008;52:144–53.

    Article  PubMed  CAS  Google Scholar 

  30. Spital A. Diuretic-induced hyponatremia. Am J Nephrol. 1999;19:447–52.

    Article  PubMed  CAS  Google Scholar 

  31. Sharabi Y, Illan R, Kamari Y, Cohen H, Nadler M, Messerli FH, et al. Diuretic induced hyponatraemia in elderly hypertensive women. J Hum Hypertens. 2002;16:631–5.

    Article  PubMed  CAS  Google Scholar 

  32. Chow KM, Szeto CC, Wong TY, Leung CB, Li PK. Risk factors for thiazide-induced hyponatraemia. QJM. 2003;96:911–7.

    Article  PubMed  CAS  Google Scholar 

  33. Clark BA, Shannon RP, Rosa RM, Epstein FH. Increased susceptibility to thiazide-induced hyponatremia in the elderly. J Am Soc Nephrol. 1994;5:1106–11.

    PubMed  CAS  Google Scholar 

  34. Sonnenblick M, Friedlander Y, Rosin AJ. Diuretic-induced severe hyponatremia. Review and analysis of 129 reported patients. Chest. 1993;103:601–6.

    Article  PubMed  CAS  Google Scholar 

  35. Szatalowicz VL, Miller PD, Lacher JW, Gordon JA, Schrier RW. Comparative effect of diuretics on renal water excretion in hyponatraemic oedematous disorders. Clin Sci (Lond). 1982;62:235–8.

    CAS  Google Scholar 

  36. Fichman MP, Vorherr H, Kleeman CR, Telfer N. Diuretic-induced hyponatremia. Ann Intern Med. 1971;75:853–63.

    Article  PubMed  CAS  Google Scholar 

  37. Laragh JH. The effect of potassium chloride on hyponatremia. J Clin Invest. 1954;33:807–18.

    Article  PubMed  CAS  Google Scholar 

  38. Berl T, Rastegar A. A patient with severe hyponatremia and hypokalemia: osmotic demyelination following potassium repletion. Am J Kidney Dis. 2010;55:742–8.

    Article  PubMed  Google Scholar 

  39. Zennaro MC. Mineralocorticoid resistance. Steroids. 1996;61:189–92.

    Article  PubMed  CAS  Google Scholar 

  40. Werbel SS, Ober KP. Acute adrenal insufficiency. Endocrinol Metab Clin North Am. 1993;22:303–28.

    PubMed  CAS  Google Scholar 

  41. D’Angelo A, Mioni G, Ossi E, Lupo A, Valvo E, Maschio G. Alterations in renal tubular sodium and water transport in polycystic kidney disease. Clin Nephrol. 1975;3:99–105.

    PubMed  Google Scholar 

  42. Nzerue C, Schlanger L, Jena M, Hewan-Lowe K, Mitch WE. Granulomatous interstitial nephritis and uveitis presenting as salt-losing nephropathy. Am J Nephrol. 1997;17:462–5.

    Article  PubMed  CAS  Google Scholar 

  43. Ellison DH, Berl T. Clinical practice. The syndrome of inappropriate antidiuresis. N Engl J Med. 2007;356:2064–72.

    Article  PubMed  CAS  Google Scholar 

  44. Ecelbarger CA, Nielsen S, Olson BR, Murase T, Baker EA, Knepper MA, et al. Role of renal aquaporins in escape from vasopressin-induced antidiuresis in rat. J Clin Invest. 1997;99:1852–63.

    Article  PubMed  CAS  Google Scholar 

  45. Verbalis JG. The syndrome of inappropriate antidiuretic hormone and other hypoosmolar disorders. In: Schrier RW, editor. Diseases of the kidney & urinary tract. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2007.

    Google Scholar 

  46. Miller M. Hyponatremia: age-related risk factors and therapy decisions. Geriatrics. 1998;53:32–33, 37–38, 41–32 passim.

    Google Scholar 

  47. Goldstein CS, Braunstein S, Goldfarb S. Idiopathic syndrome of inappropriate antidiuretic hormone secretion possibly related to advanced age. Ann Intern Med. 1983;99:185–8.

    Article  PubMed  CAS  Google Scholar 

  48. Shapiro DS, Sonnenblick M, Galperin I, Melkonyan L, Munter G. Severe hyponatraemia in elderly hospitalized patients: prevalence, aetiology and outcome. Intern Med J. 2010;40:574–80.

    Article  PubMed  CAS  Google Scholar 

  49. Miller M, Morley JE, Rubenstein LZ. Hyponatremia in a nursing home population. J Am Geriatr Soc. 1995;43:1410–3.

    PubMed  CAS  Google Scholar 

  50. Misra SC, Mansharamani GG. Hyponatremia in elderly hospital in-patients. Br J Clin Pract. 1989;43:295–6.

    PubMed  CAS  Google Scholar 

  51. Helderman JH, Vestal RE, Rowe JW, Tobin JD, Andres R, Robertson GL. The response of arginine vasopressin to intravenous ethanol and hypertonic saline in man: the impact of aging. J Gerontol. 1978;33:39–47.

    Article  PubMed  CAS  Google Scholar 

  52. Hawkins RC. Age and gender as risk factors for hyponatremia and hypernatremia. Clin Chim Acta. 2003;337:169–72.

    Article  PubMed  CAS  Google Scholar 

  53. List AF, Hainsworth JD, Davis BW, Hande KR, Greco FA, Johnson DH. The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in small-cell lung cancer. J Clin Oncol. 1986;4:1191–8.

    PubMed  CAS  Google Scholar 

  54. Maurer LH, O’Donnell JF, Kennedy S, Faulkner CS, Rist K, North WG. Human neurophysins in carcinoma of the lung: relation to histology, disease stage, response rate, survival, and syndrome of inappropriate antidiuretic hormone secretion. Cancer Treat Rep. 1983;67:971–6.

    PubMed  CAS  Google Scholar 

  55. Ferlito A, Rinaldo A, Devaney KO. Syndrome of inappropriate antidiuretic hormone secretion associated with head neck cancers: review of the literature. Ann Otol Rhinol Laryngol. 1997;106:878–83.

    PubMed  CAS  Google Scholar 

  56. Breuer R, Rubinow A. Inappropriate secretion of antidiuretic hormone and mycoplasma pneumonia infection. Respiration. 1981;42:217–9.

    PubMed  CAS  Google Scholar 

  57. Pollard RB. Inappropriate secretion of antidiuretic hormone associated with adenovirus pneumonia. Chest. 1975;68:589–91.

    Article  PubMed  CAS  Google Scholar 

  58. Rosenow 3rd EC, Segar WE, Zehr JE. Inappropriate antidiuretic hormone secretion in pneumonia. Mayo Clin Proc. 1972;47:169–74.

    PubMed  Google Scholar 

  59. Farber MO, Roberts LR, Weinberger MH, Robertson GL, Fineberg NS, Manfredi F. Abnormalities of sodium and H2O handling in chronic obstructive lung disease. Arch Intern Med. 1982;142:1326–30.

    Article  PubMed  CAS  Google Scholar 

  60. Hill AR, Uribarri J, Mann J, Berl T. Altered water metabolism in tuberculosis: role of vasopressin. Am J Med. 1990;88:357–64.

    Article  PubMed  CAS  Google Scholar 

  61. Tang WW, Kaptein EM, Feinstein EI, Massry SG. Hyponatremia in hospitalized patients with the acquired immunodeficiency syndrome (AIDS) and the AIDS-related complex. Am J Med. 1993;94:169–74.

    Article  PubMed  CAS  Google Scholar 

  62. Zerbe R, Stropes L, Robertson G. Vasopressin function in the syndrome of inappropriate antidiuresis. Annu Rev Med. 1980;31:315–27.

    Article  PubMed  CAS  Google Scholar 

  63. Durr JA, Stamoutsos B, Lindheimer MD. Osmoregulation during pregnancy in the rat. Evidence for resetting of the threshold for vasopressin secretion during gestation. J Clin Invest. 1981;68:337–46.

    Article  PubMed  CAS  Google Scholar 

  64. Lindheimer MD, Barron WM, Davison JM. Osmoregulation of thirst and vasopressin release in pregnancy. Am J Physiol. 1989;257:F159–69.

    PubMed  CAS  Google Scholar 

  65. Davison JM, Shiells EA, Philips PR, Lindheimer MD. Influence of humoral and volume factors on altered osmoregulation of normal human pregnancy. Am J Physiol. 1990;258:F900–7.

    PubMed  CAS  Google Scholar 

  66. DeFronzo RA, Goldberg M, Agus ZS. Normal diluting capacity in hyponatremic patients. Reset osmostat or a variant of the syndrome of inappropriate antidiuretic hormone secretion Ann Intern Med. 1976;84:538–42.

    PubMed  CAS  Google Scholar 

  67. Feldman BJ, Rosenthal SM, Vargas GA, Fenwick RG, Huang EA, Matsuda-Abedini M, et al. Nephrogenic syndrome of inappropriate antidiuresis. N Engl J Med. 2005;352:1884–90.

    Article  PubMed  CAS  Google Scholar 

  68. Knoers NV. Hyperactive vasopressin receptors and disturbed water homeostasis. N Engl J Med. 2005;352:1847–50.

    Article  PubMed  CAS  Google Scholar 

  69. Ohara M, Cadnapaphornchai MA, Summer SN, Falk S, Yang J, Togawa T, et al. Effect of mineralocorticoid deficiency on ion and urea transporters and aquaporin water channels in the rat. Biochem Biophys Res Commun. 2002;299:285–90.

    Article  PubMed  CAS  Google Scholar 

  70. Berghorn KA, Knapp LT, Hoffman GE, Sherman TG. Induction of glucocorticoid receptor expression in hypothalamic magnocellular vasopressin neurons during chronic hypoosmolality. Endocrinology. 1995;136:804–7.

    Article  PubMed  CAS  Google Scholar 

  71. Schrier RW. Body water homeostasis: clinical disorders of urinary dilution and concentration. J Am Soc Nephrol. 2006;17:1820–32.

    Article  PubMed  CAS  Google Scholar 

  72. Linas SL, Berl T, Robertson GL, Aisenbrey GA, Schrier RW, Anderson RJ. Role of vasopressin in the impaired water excretion of glucocorticoid deficiency. Kidney Int. 1980;18:58–67.

    Article  PubMed  CAS  Google Scholar 

  73. Green HH, Harrington AR, Valtin H. On the role of antidiuretic hormone in the inhibition of acute water diuresis in adrenal insufficiency and the effects of gluco- and mineralocorticoids in reversing the inhibition. J Clin Invest. 1970;49:1724–36.

    Article  PubMed  CAS  Google Scholar 

  74. Wang W, Li C, Summer SN, Falk S, Cadnapaphornchai MA, Chen YC, et al. Molecular analysis of impaired urinary diluting capacity in glucocorticoid deficiency. Am J Physiol Renal Physiol. 2006;290:F1135–42.

    Article  PubMed  CAS  Google Scholar 

  75. Curtis RH. Hyponatremia in primary myxedema. Ann Intern Med. 1956;44:376–85.

    Article  PubMed  CAS  Google Scholar 

  76. Chinitz A, Turner FL. The association of primary hypothyroidism and inappropriate secretion of antidiuretic hormone. Arch Intern Med. 1965;116:871–4.

    Article  PubMed  CAS  Google Scholar 

  77. Chen YC, Cadnapaphornchai MA, Yang J, Summer SN, Falk S, Li C, et al. Nonosmotic release of vasopressin and renal aquaporins in impaired urinary dilution in hypothyroidism. Am J Physiol Renal Physiol. 2005;289:F672–8.

    Article  PubMed  CAS  Google Scholar 

  78. Skowsky WR, Kikuchi TA. The role of vasopressin in the impaired water excretion of myxedema. Am J Med. 1978;64:613–21.

    Article  PubMed  CAS  Google Scholar 

  79. Archambeaud-Mouveroux F, Dejax C, Jadaud JM, Vincent D, Laroumagne G, Hessel L, et al. [Myxedema coma with hypervasopressinism. 2 cases]. Ann Med Interne (Paris). 1987;138:114–8.

    CAS  Google Scholar 

  80. Emmanouel DS, Lindheimer MD, Katz AI. Mechanism of impaired water excretion in the hypothyroid rat. J Clin Invest. 1974;54:926–34.

    Article  PubMed  CAS  Google Scholar 

  81. Noakes TD, Sharwood K, Speedy D, Hew T, Reid S, Dugas J, et al. Three independent biological mechanisms cause exercise-associated hyponatremia: evidence from 2,135 weighed competitive athletic performances. Proc Natl Acad Sci USA. 2005;102:18550–5.

    Article  PubMed  CAS  Google Scholar 

  82. Freund BJ, Shizuru EM, Hashiro GM, Claybaugh JR. Hormonal, electrolyte, and renal responses to exercise are intensity dependent. J Appl Physiol. 1991;70:900–6.

    PubMed  CAS  Google Scholar 

  83. Rowe JW, Shelton RL, Helderman JH, Vestal RE, Robertson GL. Influence of the emetic reflex on vasopressin release in man. Kidney Int. 1979;16:729–35.

    Article  PubMed  CAS  Google Scholar 

  84. Kendler KS, Weitzman RE, Fisher DA. The effect of pain on plasma arginine vasopressin concentrations in man. Clin Endocrinol (Oxf). 1978;8:89–94.

    Article  CAS  Google Scholar 

  85. Baylis PH, Zerbe RL, Robertson GL. Arginine vasopressin response to insulin-induced hypoglycemia in man. J Clin Endocrinol Metab. 1981;53:935–40.

    Article  PubMed  CAS  Google Scholar 

  86. Almond CS, Shin AY, Fortescue EB, Mannix RC, Wypij D, Binstadt BA, et al. Hyponatremia among runners in the Boston Marathon. N Engl J Med. 2005;352:1550–6.

    Article  PubMed  CAS  Google Scholar 

  87. Schrier RW. Pathogenesis of sodium and water retention in high-output and low-output cardiac failure, nephrotic syndrome, cirrhosis, and pregnancy (1). N Engl J Med. 1988;319:1065–72.

    Article  PubMed  CAS  Google Scholar 

  88. Schrier RW, Gurevich AK, Cadnapaphornchai MA. Pathogenesis and management of sodium and water retention in cardiac failure and cirrhosis. Semin Nephrol. 2001;21:157–72.

    Article  PubMed  CAS  Google Scholar 

  89. Lee WH, Packer M. Prognostic importance of serum sodium concentration and its modification by converting-enzyme inhibition in patients with severe chronic heart failure. Circulation. 1986;73:257–67.

    Article  PubMed  CAS  Google Scholar 

  90. Schrier RW, Berl T, Anderson RJ. Osmotic and nonosmotic control of vasopressin release. Am J Physiol. 1979;236:F321–32.

    PubMed  CAS  Google Scholar 

  91. Xu DL, Martin PY, Ohara M, St John J, Pattison T, Meng X, et al. Upregulation of aquaporin-2 water channel expression in chronic heart failure rat. J Clin Invest. 1997;99:1500–5.

    Article  PubMed  CAS  Google Scholar 

  92. Inoue T, Ohnishi A, Matsuo A, Kawai B, Kunihiro N, Tada Y, et al. Therapeutic and diagnostic potential of a vasopressin-2 antagonist for impaired water handling in cirrhosis. Clin Pharmacol Ther. 1998;63:561–70.

    Article  PubMed  CAS  Google Scholar 

  93. Fernandez-Llama P, Jimenez W, Bosch-Marce M, Arroyo V, Nielsen S, Knepper MA. Dysregulation of renal aquaporins and Na-Cl cotransporter in CCl4-induced cirrhosis. Kidney Int. 2000;58:216–28.

    Article  PubMed  CAS  Google Scholar 

  94. Gross P, Rascher W. Vasopressin and hyponatremia in renal insufficiency. Contrib Nephrol. 1986;50:54–63.

    PubMed  CAS  Google Scholar 

  95. Kovesdy CP, Lott EH, Lu JL, Malakauskas SM, Ma JZ, Molnar MZ, et al. Hyponatremia, hypernatremia, and mortality in patients with chronic kidney disease with and without congestive heart failure. Circulation. 2012;125:677–84.

    Article  PubMed  Google Scholar 

  96. Tannen RL, Regal EM, Dunn MJ, Schrier RW. Vasopressin-resistant hyposthenuria in advanced chronic renal disease. N Engl J Med. 1969;280:1135–41.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tomas Berl .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Sirota, J.C., Berl, T. (2013). Physiology of Water Balance and Pathophysiology of Hyponatremia. In: Simon, E. (eds) Hyponatremia. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6645-1_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-6645-1_2

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6644-4

  • Online ISBN: 978-1-4614-6645-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics