Hyponatremia: endocrinologic causes and consequences of therapy.
Hyponatremia is a relatively common medical disorder frequently of endocrinologic origin. Although the neurologic signs and symptoms associated with hyponatremia are well known, recent clinical and experimental studies have shown that rapid correction of hyponatremia can in some cases cause a brain-demyelinating disease that can lead to consequences just as severe as those of hyponatremia itself. Understanding the physiologic mechanisms by which the brain adapts to hypoosmolar conditions has led to a better appreciation of the pathogenesis of neurologic dysfunction during both hyponatremia and its therapy, and this in turn has allowed the establishment of rational guidelines for safe therapy of hyponatremic patients. In cases such as this, however, in which a spontaneous rapid water diuresis occurs following a change in hormonal therapy, the rate and magnitude of the increase in serum [Na+J may exceed these guidelines unless active intervention is undertaken to interrupt the induced diuresis.
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J G
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Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA.