Differential diagnosis of hyponatraemia

Czech version

Authors: J. Čáp
Authors‘ workplace: IV. interní hematologická klinika LF UK a FN Hradec Králové
Published in: Kardiol Rev Int Med 2015, 17(2): 178-180
Category: Internal Medicine

Overview

Hyponatraemia is common in clinical practice. This article summarises the principal mechanisms of natremia regulation and causes of decreased sodium level. The diagnostic approach in patients with hyponatraemia is discussed and basic principles of its treatment are summarised.

Keywords:
hyponatraemia – differential diagnosis – treatment

Sources

1. Sterns RH. Disorders of plasma sodium – causes, consequences, and correction. N Engl J Med 2015; 372: 55– 65. doi: doi:10.1056/ NEJMra1404489.

2. Upadhyay A, Jaber BL, Madias NE. Epidemiology of hyponatremia. Semin Nephrol 2009; 29: 227– 238. doi: 10.1016/ j.semnephrol.2009.03.004.

3. Spasovski G, Vanholder R, Allolio B et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol 2014; 170: G1– G47. doi: 10.1530/ EJE‑ 13‑ 1020.

4. Strange K. Cellular volume homeostasis. Adv Physiol Educ 2004; 28: 155– 159.

5. Gankam Kengne F, Nicaise C, Soupart A et al. Astrocytes are an early target in osmotic demyelination syndrome. J Am Soc Nephrol 2011; 22: 1834– 1845. doi: 10.1681/ ASN.2010111127.

6. Friedman E, Shadel M, Halkin H et al. Thiazide‑induced hyponatremia. Reproducibility by single dose rechallenge and an analysis of pathogenesis. Ann Intern Med 1989; 110: 24– 30.

7. Verbalis JG. Whole‑ Body volume regulation and escape from antidiuresis. Am J Med 2006; 119 (Suppl 1): S21– S29. doi: 10.1016/ j.amjmed.2006.05.004.

8. Schwartz WB, Bennett W, Curelop S et al. A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 1957; 23: 529– 542. doi: 10.1016/ 0002‑ 9343(57)90224‑ 3.

9. Gheorghiade M, Abraham WT, Albert NM et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE‑ HF registry. Eur Heart J 2007; 28: 980– 988. doi: 10.1093/ eurheartj/ ehl542.

10. Kim WR, Biggins SW, Kremers WK et al. Hyponatremia and mortality among patients on the liver‑ transplant waiting list. N Engl J Med 2008; 359: 1018– 1026. doi: 10.1056/ NEJMoa0801209.

11. Fenske W, Stork S, Koschker AC et al. Value of fractional uric acid excretion in differential diagnosis of hyponatremic patients on diuretics. J Clin Endocrinol Metab 2008; 93: 2991– 2997. doi: 10.1210/ jc.2008‑ 0330.

12. Nagler EV, Vanmassenhove J, van der Veer SN et al. Diagnosis and treatment of hyponatremia: a systematic review of clinical practice guidelines and consensus statements. BMC Med 2014; 12: 1. doi: 10.1186/ s12916‑ 014‑ 0231‑ 1.

13. Sterns RH, Silver SM. Salt and water: read the package insert. QJM 2003; 96: 549– 552.

14. Sood L, Sterns RH, Hix JK et al. Hypertonic saline and desmopressin: a simple strategy for safe correction of severe hyponatremia. Am J Kidney Dis 2013; 61: 571– 578. doi: 10.1053/ j.ajkd.2012.11.032.

15. Konstam MA, Gheorghiade M, Burnett JC et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: The everest outcome trial. JAMA 2007; 297: 1319– 1331. doi: 10.1001/ jama.297.12.1319.

16. Gilotra NA, Russell SD. Arginine vasopressin as a target in the treatment of acute heart failure. World J Cardiol 2014; 6: 1252– 1261. doi: 10.4330/ wjc.v6.i12.1252.