Skip to main content

Hyponatremia

  • Chapter
  • First Online:
Evidence-Based Critical Care

Abstract

Abnormalities of the plasma sodium concentration are the most common electrolyte disorders encountered in clinical medicine. Appropriate therapy for hyponatremia should keep the patient safe from deleterious complications of hyponatremia while avoiding correction rates that risk brain injury. Skilled management of hyponatremia requires an understanding of the physiologic processes which regulate plasma sodium, the pathologic settings in which it occurs, and the ability to account for factors that affect plasma sodium concentration.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
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

References

  1. Overgaard-Steensen C. Initial approach to the hyponatremic patient. Acta Anaesthesiol Scand. 2011;55(2):139–48.

    Article  CAS  Google Scholar 

  2. Hillier TA, Abbott RD, Barrett EJ. Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med. 1999;106(4):399–403.

    Article  CAS  Google Scholar 

  3. Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013;126(10 Suppl 1):S1–42.

    Article  Google Scholar 

  4. Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol. 2014;170(3):G1–47.

    Article  CAS  Google Scholar 

  5. Yessayan L, Yee J, Frinak S, Szamosfalvi B. Treatment of severe hyponatremia in patients with kidney failure: role of continuous venovenous hemofiltration with low-sodium replacement fluid. Am J Kidney Dis. 2014;64(2):305–10.

    Article  CAS  Google Scholar 

  6. Yessayan L, Yee J, Frinak S, Szamosfalvi B. Continuous renal replacement therapy for the management of acid-base and electrolyte imbalances in acute kidney injury. Adv Chronic Kidney Dis. 2016;23(3):203–10.

    Article  Google Scholar 

  7. Verbalis JG. Brain volume regulation in response to changes in osmolality. Neuroscience. 2010;168(4):862–70.

    Article  CAS  Google Scholar 

  8. Brunner JE, Redmond JM, Haggar AM, Kruger DF, Elias SB. Central pontine myelinolysis and pontine lesions after rapid correction of hyponatremia: a prospective magnetic resonance imaging study. Ann Neurol. 1990;27(1):61–6.

    Article  CAS  Google Scholar 

  9. Edelman IS, Leibman J, O’Meara MP, Birkenfeld LW. Interrelations between serum sodium concentration, serum osmolarity and total exchangeable sodium, total exchangeable potassium and total body water. J Clin Invest. 1958;37(9):1236–56.

    Article  CAS  Google Scholar 

  10. Overgaard-Steensen C, Larsson A, Bluhme H, Tonnesen E, Frokiaer J, Ring T. Edelman’s equation is valid in acute hyponatremia in a porcine model: plasma sodium concentration is determined by external balances of water and cations. Am J Physiol Regul Integr Comp Physiol. 2010;298(1):R120–9.

    Article  CAS  Google Scholar 

  11. Sterns RH, Nigwekar SU, Hix JK. The treatment of hyponatremia. Semin Nephrol. 2009;29(3):282–99.

    Article  CAS  Google Scholar 

  12. Rose BD. New approach to disturbances in the plasma sodium concentration. Am J Med. 1986;81(6):1033–40.

    Article  CAS  Google Scholar 

  13. Sood L, Sterns RH, Hix JK, Silver SM, Chen L. Hypertonic saline and desmopressin: a simple strategy for safe correction of severe hyponatremia. Am J Kidney Dis. 2013;61(4):571–8.

    Article  CAS  Google Scholar 

  14. Liamis G, Kalogirou M, Saugos V, Elisaf M. Therapeutic approach in patients with dysnatraemias. Nephrol Dial Transplant. 2006;21(6):1564–9.

    Article  CAS  Google Scholar 

  15. Lindner G, Schwarz C, Kneidinger N, Kramer L, Oberbauer R, Druml W. Can we really predict the change in serum sodium levels? An analysis of currently proposed formulae in hypernatraemic patients. Nephrol Dial Transplant. 2008;23(11):3501–8.

    Article  CAS  Google Scholar 

  16. Clayton JA, Le Jeune IR, Hall IP. Severe hyponatraemia in medical in-patients: aetiology, assessment and outcome. QJM. 2006;99(8):505–11.

    Article  CAS  Google Scholar 

  17. Chung HM, Kluge R, Schrier RW, Anderson RJ. Clinical assessment of extracellular fluid volume in hyponatremia. Am J Med. 1987;83(5):905–8.

    Article  CAS  Google Scholar 

  18. Schrier RW. Body water homeostasis: clinical disorders of urinary dilution and concentration. J Am Soc Nephrol. 2006;17(7):1820–32.

    Article  CAS  Google Scholar 

  19. Thaler SM, Teitelbaum I, Berl T. “Beer potomania” in non-beer drinkers: effect of low dietary solute intake. Am J Kidney Dis. 1998;31(6):1028–31.

    Article  CAS  Google Scholar 

  20. Cowen LE, Hodak SP, Verbalis JG. Age-associated abnormalities of water homeostasis. Endocrinol Metab Clin N Am. 2013;42(2):349–70.

    Article  Google Scholar 

  21. 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(2):164–8.

    Article  CAS  Google Scholar 

  22. Ellison DH, Berl T. Clinical practice. The syndrome of inappropriate antidiuresis. N Engl J Med. 2007;356(20):2064–72.

    Article  CAS  Google Scholar 

  23. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43(6):1711–37.

    Article  Google Scholar 

  24. Liamis G, Milionis HJ, Elisaf M. Endocrine disorders: causes of hyponatremia not to neglect. Ann Med. 2011;43(3):179–87.

    Article  Google Scholar 

  25. Sterns RH, Riggs JE, Schochet SS Jr. Osmotic demyelination syndrome following correction of hyponatremia. N Engl J Med. 1986;314(24):1535–42.

    Article  CAS  Google Scholar 

  26. Vu T, Wong R, Hamblin PS, Zajac J, Grossmann M. Patients presenting with severe hypotonic hyponatremia: etiological factors, assessment, and outcomes. Hosp Pract (1995). 2009;37(1):128–36.

    Article  Google Scholar 

  27. Avila M. The clinical practice guideline on diagnosis and treatment of hyponatraemia: a response from Otsuka Pharmaceutical Europe Ltd. Eur J Endocrinol. 2014;171(1):L1–3.

    Article  CAS  Google Scholar 

  28. Bissram M, Scott FD, Liu L, Rosner MH. Risk factors for symptomatic hyponatraemia: the role of pre-existing asymptomatic hyponatraemia. Intern Med J. 2007;37(3):149–55.

    Article  CAS  Google Scholar 

  29. Waikar SS, Mount DB, Curhan GC. Mortality after hospitalization with mild, moderate, and severe hyponatremia. Am J Med. 2009;122(9):857–65.

    Article  CAS  Google Scholar 

  30. Wald R, Jaber BL, Price LL, Upadhyay A, Madias NE. Impact of hospital-associated hyponatremia on selected outcomes. Arch Intern Med. 2010;170(3):294–302.

    Article  CAS  Google Scholar 

  31. Funk GC, Lindner G, Druml W, Metnitz B, Schwarz C, Bauer P, et al. Incidence and prognosis of dysnatremias present on ICU admission. Intensive Care Med. 2010;36(2):304–11.

    Article  Google Scholar 

  32. Konstam MA, Gheorghiade M, Burnett JC Jr, Grinfeld L, Maggioni AP, Swedberg K, et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST outcome trial. JAMA. 2007;297(12):1319–31.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lenar Yessayan MD, MS .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Yessayan, L., Krahn, R.E. (2020). Hyponatremia. In: Hyzy, R.C., McSparron, J. (eds) Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-26710-0_48

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-26710-0_48

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-26709-4

  • Online ISBN: 978-3-030-26710-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics