title: Hyponatremia in the intensive care unit: How to avoid a Zugzwang situation?
abstract: Hyponatremia is a common electrolyte derangement in the setting of the intensive care unit. Life-threatening neurological complications may arise not only in case of a severe (<120 mmol/L) and acute fall of plasma sodium levels, but may also stem from overly rapid correction of hyponatremia. Additionally, even mild hyponatremia carries a poor short-term and long-term prognosis across a wide range of conditions. Its multifaceted and intricate physiopathology may seem deterring at first glance, yet a careful multi-step diagnostic approach may easily unravel the underlying mechanisms and enable physicians to adopt the adequate measures at the patient's bedside. Unless hyponatremia is associated with obvious extracellular fluid volume increase such as in heart failure or cirrhosis, hypertonic saline therapy is the cornerstone of the therapeutic of profound or severely symptomatic hyponatremia. When overcorrection of hyponatremia occurs, recent data indicate that re-lowering of plasma sodium levels through the infusion of hypotonic fluids and the cautious use of desmopressin acetate represent a reasonable strategy. New therapeutic options have recently emerged, foremost among these being vaptans, but their use in the setting of the intensive care unit remains to be clarified.
authors.affiliation: AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, France. cedric.rafat@aphp.fr.|AP-HP, Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Paris, France. cedric.rafat@aphp.fr.
authors.forename: Cédric
authors.initials: C
authors.lastname: Rafat
authors.affiliation: AP-HP, Service de Physiologie Rénale, Hôpital Bichat, Paris, France. martin.flamant@aphp.fr.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France. martin.flamant@aphp.fr.|INSERM, U1149, Centre de Recherche sur l'Inflammation, Paris, France. martin.flamant@aphp.fr.
authors.forename: Martin
authors.initials: M
authors.lastname: Flamant
authors.affiliation: AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, France. stephane.gaudry@aphp.fr.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France. stephane.gaudry@aphp.fr.|ECEVE UMR 1123, ECEVE, Paris, France. stephane.gaudry@aphp.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Gaudry
authors.affiliation: AP-HP, Service de Physiologie Rénale, Hôpital Bichat, Paris, France. emmanuelle.vidal-petiot@aphp.fr.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France. emmanuelle.vidal-petiot@aphp.fr.|INSERM, U1149, Centre de Recherche sur l'Inflammation, Paris, France. emmanuelle.vidal-petiot@aphp.fr.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Vidal-Petiot
authors.affiliation: AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, France. jean-damien.ricard@aphp.fr.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France. jean-damien.ricard@aphp.fr.|INSERM UMR 1137, IAME, Paris, France. jean-damien.ricard@aphp.fr.
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
authors.affiliation: AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, France. didier.dreyfuss@lmr.aphp.fr.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France. didier.dreyfuss@lmr.aphp.fr.|INSERM UMR 1137, IAME, Paris, France. didier.dreyfuss@lmr.aphp.fr.
authors.forename: Didier
authors.initials: D
authors.lastname: Dreyfuss
keywords: Arginine vasopressin; Central pontine myelinolysis; Extracellular fluid volume; Hyponatremia; Hyponatremic encephalopathy; Osmotic demyelination