Hyponatremia in Heart Failure and Ventricular Assist Device Patients
Hyponatremia is commonly seen in heart failure (HF) patients and is a poor prognostic marker of HF mortality. The more severe the hyponatremia, the greater the association with poor outcomes. Although hyponatremia can be caused by multiple mechanisms, in HF patients the hyponatremia is most commonly categorized as hypo-osmolal hyponatremia with hypervolemia. The pathogenesis of hyponatremia in HF is due to cardiac dysfunction which results in a reduced glomerular filtration rate and an increase in vasopressin (ADH) secretion. Most HF patients with hyponatremia are asymptomatic and can be managed by limiting water intake and using diuretics. However if the plasma sodium level is <125 mEq/L or if symptoms of hyponatremia are present, then more active management of this electrolyte abnormality is necessary. Diuretics are the principal treatment for both hyponatremia and HF since they result in hypotonic fluid losses. Recently, selective and nonselective vasopressin antagonists have become available. However, despite demonstrated efficacy in producing a water diuresis and a correction of hyponatremia, vasopressin antagonists are not commonly used in HF patients. Vasopression antagonists have not been shown to affect mortality, have some potentially serious adverse reactions, and are costly.
KeywordsHyponatremia Electrolyte disorder Heart failure Hypo-osmolal hyponatremia Central pontine myelinolysis Osmotic demyelination Loop diuretics Vasopressin antagonists Renin–angiotensin–aldosterone blockade Antidiuretic hormone Edema
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