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Hyponatriämie

Differenzialdiagnose und Therapie

Hyponatremia

Differential diagnosis and therapy

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Zusammenfassung

Die Hyponatriämie ist die häufigste Elektrolytstörung und unabhängig von der Grunderkrankung mit einer erhöhten Morbidität und Mortalität assoziiert. Trotz ihrer hohen Prävalenz wird eine Hyponatriämie nicht selten unterschätzt und in der klinischen Praxis nicht immer ausreichend wahrgenommen. In Abhängigkeit von der Entwicklungsdauer und dem Schweregrad präsentiert sich die Elektrolytstörung durch ein breites neurologisches Spektrum von Adynamie über Gangstörungen bis hin zu Synkopen und Koma. Die zugrunde liegenden Ursachen können vielfältig sein, deren Identifizierung jedoch ist wichtig für eine adäquate symptomatische und kausale Therapie. Das Syndrom der inadäquaten ADH-Sekretion (SiADH) ist mit 1/3 der Fälle die häufigste Ursache für eine Hyponatriämie und in der Regel durch Medikamente bzw. neurologische, pulmonale oder maligne Erkrankungen verursacht. Mittels einfacher klinischer und laborchemischer Untersuchungen lässt sich eine Hyponatriämie differenzialdiagnostisch einordnen und einer entsprechenden Therapie zuführen. Mit der Entwicklung der Vaptane haben sich darüber hinaus bei der Behandlung des SiADH neue therapeutische Optionen ergeben.

Abstract

Hyponatremia is the most commonly occurring electrolyte disorder and is associated with increased morbidity and mortality—independent of the underlying disease. Despite its high prevalence, hyponatremia is often underestimated and inadequately addressed in clinical routine. Depending on disease stage and severity, the electrolyte disorder can present with a wide spectrum of neurological signs and symptoms, ranging from adynamia and gait disturbances, to syncope or coma. While the underlying causes of hyponatremia may be manifold, their identification is crucial to initiating adequate therapeutic measures for symptomatic and causal therapy. The syndrome of inappropriate antidiuretic hormone (ADH) secretion (SiADH) is the most common cause of hyponatremia, present in 1/3 of hyponatremic patients and usually a result of medication, neurological, respiratory or malignant disease. A differential diagnostic approach using a simple algorithm that includes clinical and laboratory parameters is essential for identifying the underlying cause of hyponatremia and administering goal-directed therapy. The development of vaptans has provided new options in the treatment of SiADH-associated hyponatremia.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. Christian S. Haas hat Vortrags- und Beraterhonorare, Reise- und Kongresskostenübernahmen sowie finanzielle Unterstützung klinischer Forschungstätigkeiten von Otsuka Pharma GmbH bzw. Otsuka Pharma Europe Limited erhalten.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Medizinische Klinik I, Universität zu Lübeck und Universitätskrankenhaus Schleswig-Holstein – Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    C.S. Haas

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Haas, C. Hyponatriämie. Internist 55, 1427–1442 (2014). https://doi.org/10.1007/s00108-014-3609-4

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