Disorders of sodium and water balance in hospitalized patients.
OBJECTIVE
To review and discuss the epidemiology, contributing factors, and approach to clinical management of disorders of sodium and water balance in hospitalized patients.


METHODS
An electronic search of the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases and a search of the bibliographies of all relevant studies and review articles for recent reports on hyponatremia and hypernatremia with a focus on critically ill patients.


RESULTS
Disorders of sodium and water balance are exceedingly common in hospitalized patients, particularly those with critical illness and are often iatrogenic. These disorders are broadly categorized as hypo-osmolar or hyper-osmolar, depending on the balance (i.e., excess or deficit) of total body water relative to total body sodium content and are classically recognized as either hyponatremia or hypernatremia. These disorders may represent a surrogate for increased neurohormonal activation, organ dysfunction, worsening severity of illness, or progression of underlying chronic disease. Hyponatremic disorders may be caused by appropriately elevated (volume depletion) or inappropriately elevated (SIADH) arginine vasopressin levels, appropriately suppressed arginine vasopressin levels (kidney dysfunction), or alterations in plasma osmolality (drugs or body cavity irrigation with hypotonic solutions). Hypernatremia is most commonly due to unreplaced hypotonic water depletion (impaired mental status and/or access to free water), but it may also be caused by transient water shift into cells (from convulsive seizures) and iatrogenic sodium loading (from salt intake or administration of hypertonic solutions).


CONCLUSIONS
In hospitalized patients, hyponatremia and hypernatremia are often iatrogenic and may contribute to serious morbidity and increased risk of death. These disorders require timely recognition and can often be reversed with appropriate intervention and treatment of underlying predisposing factors.
Bagshaw
Sean M
SM
Department of Anesthesiology and Pain Medicine, Division of Critical Care Medicine, University of Alberta Hospital, 3C1.16 Walter C. Mackenzie Centre, 8440-112 Street, Edmonton, AB, Canada, T6G 2B7. bagshaw@ualberta.ca
Townsend
Derek R
DR
McDermid
Robert C
RC
D016638:Critical Illness; D018450:Disease Progression; D006760:Hospitalization; D006801:Humans; D006955:Hypernatremia / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007010:Hyponatremia / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D009994:Osmolar Concentration; D012720:Severity of Illness Index; D012964:Sodium / Q000378:metabolism*
D012964:Sodium