Hyponatremia: why it matters, how it presents, how we can manage it.
Hyponatremia is a common electrolyte disorder among hospitalized patients and has been associated with increased mortality. Most patients are asymptomatic, but many do present with symptoms, usually of a generalized neurologic nature. Based-on medical history, physical examination (including volume-status assessment), and laboratory tests, patients can be classified as having either hypervolemic, euvolemic, or hypovolemic hyponatremia. Management depends on the speed of hyponatremia onset; its degree, duration, and symptoms; and whether there are risk factors for neurologic complications. The risks of overly rapid correction must be weighed against the benefits of treating hyponatremia. Traditional therapies have significant limitations. New agents that antagonize arginine vasopressin at the V2 receptor or both the V(1A) and V2 receptors show promise for treating hypervolemic and euvolemic hyponatremia, as they induce desired free water diuresis without inducing sodium excretion.
Douglas
Ivor
I
Medical Intensive Care, Denver Health Medical Center University of Colorado at Denver and Health Sciences Center Denver, CO 80204, USA. idouglas@dhha.org
D000208:Acute Disease; D000465:Algorithms; D003707:Demeclocycline / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D006801:Humans; D007010:Hyponatremia / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D018020:Lithium Compounds / Q000627:therapeutic use; D018570:Risk Assessment
D004232:Diuretics; D018020:Lithium Compounds; D003707:Demeclocycline