title: Ten pitfalls in the proper management of patients with hyponatremia.
abstract: Hyponatremia (serum sodium <135 mEq/L) is a common electrolyte disorder in community or hospitalized patients. Serum sodium levels should be corrected at a proper rate in patients with hyponatremia, since overcorrection of serum sodium levels is related to devastating neurologic consequences, such as the osmotic demyelination syndrome (ODS). However, a number of pitfalls, which could lead to undercorrection or overcorrection of hyponatremia, are common during the treatment of hyponatremic patients. Hereby, we describe ten common pitfalls that are observed during the correction of serum sodium concentration in hyponatremic patients. These refer to pitfalls in the goals and limits of the correction rate of serum sodium, pitfalls in the means (e.g. solutions but also drugs) and formulas used for achieving the desired correction rate and pitfalls associated with inadequate management or overcorrection. The knowledge of these common-in-clinical-practice pitfalls could assist clinicians in the proper management of patients with hyponatremia.
authors.affiliation: a Department of Internal Medicine, School of Medicine , University of Ioannina , Ioannina , Greece.
authors.forename: Theodosios D
authors.initials: TD
authors.lastname: Filippatos
authors.affiliation: a Department of Internal Medicine, School of Medicine , University of Ioannina , Ioannina , Greece.
authors.forename: George
authors.initials: G
authors.lastname: Liamis
authors.affiliation: a Department of Internal Medicine, School of Medicine , University of Ioannina , Ioannina , Greece.
authors.forename: Moses S
authors.initials: MS
authors.lastname: Elisaf
mesh_terms: D000208:Acute Disease; D065092:Antidiuretic Hormone Receptor Antagonists / Q000627:therapeutic use; D002908:Chronic Disease; D004232:Diuretics / Q000627:therapeutic use*; D054796:Drug Dosage Calculations; D005440:Fluid Therapy / Q000009:adverse effects; D005665:Furosemide / Q000627:therapeutic use; D006801:Humans; D007010:Hyponatremia / Q000097:blood* / Q000209:etiology / Q000628:therapy*; D020896:Hypovolemia / Q000150:complications / Q000628:therapy; D007177:Inappropriate ADH Syndrome / Q000150:complications / Q000628:therapy; D055641:Mathematical Concepts; D019300:Medical Errors; D012964:Sodium / Q000097:blood*; D049971:Thiazides / Q000627:therapeutic use
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D004232:Diuretics; D049971:Thiazides; D005665:Furosemide; D012964:Sodium
keywords: Sodium; formulas; hyponatremia; overcorrection; syndrome of inappropriate antidiuretic hormone secretion; treatment; vaptans