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The most recent aspects of diagnosis and therapy of hyponatraemia


Authors: Igor Šturdík;  Monika Adamcová;  Juraj Payer
Authors‘ workplace: V. interná klinika LF UK a UN Bratislava, Slovenská republika, prednosta prof. MUDr. Juraj Payer, PhD., FRCP
Published in: Vnitř Lék 2015; 61(3): 209-2018
Category: Review

Overview

Hyponatraemia is the most common electrolyte disbalance in clinical practice, which is associated with increased patients morbidity and mortality. At present the pathophysiology of hyponatraemia is explored in more details, antidiuretic hormone and osmoregulation play the major roles. This article informs about relatively new classification of hyponatraemia for clinical practice based on the severity of clinical symptoms and based on the effective serum osmolality. It also offers diagnostic and treatment guidelines of hyponatraemia, which are based on current recommendations of the world experts and on the evidence based medicine.

Key words:
diagnosis – hyponatraemia – pathophysiology – treatment


Sources

1. Whelan B, Bennett K, O’Riordan D et al. Serum sodium as a risk factor for in-hospital mortality in acute unselected general medical patients. QJM 2009; 102(3): 175–182.

2. Sturdik I, Adamcova M, Kollerova J et al. Hyponatraemia is an independent predictor of in-hospital mortality. Eur J Intern Med 2014; 25(4): 379–382.

3. Rudnay M, Lazurova I. Prevalence of hyponatremia in patients on department of internal medicine. Vnitř Lék 2013; 59(19): 876–879.

4. Verbalis JG, Goldsmith SR, Greenberg A et al. Diagnosis, Evaluation, and Treatment of Hyponatremia: Expert Panel Recommendations. Am J Med 2013; 126(10 Suppl 1): S1-S42.

5. Serste T, Gustot T, Rautou PE et al. Severe hyponatremia is a better predictor of mortality than MELDNa in patients with cirrhosis and refractory ascites. J Hepatol 2012; 57(2): 274–280.

6. Wald R, Jaber BL, Price LL et al. Impact of hospital-associated hyponatremia on selected outcomes. Arch Intern Med 2010; 170(3): 294–302.

7. Cardenas A, Gines P. Management of patients with cirrhosis awaiting liver transplantation. Gut 2011; 60(3): 412–421.

8. Chawla A, Sterns RH, Nigwekar SU et al. Mortality and serum sodium: do patients die from or with hyponatremia? Clin J Am Soc Nephrol 2011; 6(5): 960–965.

9. Baran D, Hutchinson TA. The outcome of hyponatremia in a general hospital population. Clin Nephrol 1984; 22(2): 72–76.

10. Saeed BO, Beaumont D, Handley GH et al. Severe hyponatraemia: investigation and management in a district general hospital. J Clin Pathol 2002; 55(12): 893–896.

11. Spasovski G, Vanholder R, Allolio B et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol 2014; 170(3): G1-G47.

12. Verbalis JG. Disorders of body water homeostasis. Best Pract Res Clin Endocrinol Metab 2003; 17(4): 471–503.

13. Bourque CW. Central mechanisms of osmosensation and systemic osmoregulation. Nat Rev Neurosci 2008; 9(7): 519–531.

14. Lechner SG, Markworth S, Poole K et al. The molecular and cellular identity of peripheral osmoreceptors. Neuron 2011; 69(2): 332–344.

15. Sharif Naeini R, Witty MF, Seguela P et al. An N-terminal variant of Trpv1 channel is required for osmosensory transduction. Nat Neurosci 2006; 9(1): 93–98.

16. Ciura S, Bourque CW. Transient receptor potential vanilloid 1 is required for intrinsic osmoreception in organum vasculosum lamina terminalis neurons and for normal thirst responses to systemic hyperosmolality. J Neurosci 2006; 26(35): 9069–9075.

17. Norsk P. Influence of low- and high-pressure baroreflexes on vasopressin release in humans. Acta Endocrinol (Copenh) 1989; 121(Suppl 1): 3–27.

18. Robertson GL. Thirst and vasopressin function in normal and disordered states of water balance. J Lab Clin Med 1983; 101(3): 351–371.

19. Zhang Z, Bourque CW. Amplification of transducer gain by angiotensin II-mediated enhancement of cortical actin density in osmosensory neurons. J Neurosci; 28(38): 9536–9544.

20. Schwartz WB, Bennett W, Curelop S et al. A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 1957; 23(4): 529–542.

21. Turchin A, Seifter JL, Seely EW. Clinical problem-solving. Mind the gap. N Engl J Med 2003; 349(15): 1465–1469.

22. Hillier TA, Abbott RD, Barrett EJ. Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med 1999; 106(4): 399–403.

23. Desmond J. Serum osmolality and plasma electrolytes in patients who develop dilutional hyponatremia during transurethral resection. Can J Surg 1970; 13(2): 116–121.

24. Aviram A, Pfau A, Czaczkes JW et al. Hyperosmolality with hyponatremia, caused by inappropriate administration of mannitol. Am J Med 1967; 42(4): 648–650.

25. Carlotti AP, Bohn D, Mallie JP et al. Tonicity balance, and not electrolyte-free water calculations, more accurately guides therapy for acute changes in natremia. Intensive Care Med 2001; 27(5): 921–924.

26. Hoorn EJ, Carlotti AP, Costa LA et al. Preventing a drop in effective plasma osmolality to minimize the likelihood of cerebral edema during treatment of children with diabetic ketoacidosis. J Pediatr 2007; 150(5): 467–473.

27. Friedman E, Shadel M, Halkin H et al. Thiazide-induced hyponatremia. Reproducibility by single dose rechallenge and an analysis of pathogenesis. Ann Intern Med 1989; 110(1): 24–30.

28. Sonnenblick M, Friedlander Y, Rosin AJ. Diuretic-induced severe hyponatremia. Review and analysis of 129 reported patients. Chest 1993; 103(2): 601–606.

29. Sherlock M, O’Sullivan E, Agha A et al. Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients. Postgrad Med J 2009; 85(1002): 171–175.

30. Hamdi T, Latta S, Jallad B et al. Cisplatin-induced renal salt wasting syndrome. South Med J 2010; 103(8): 793–799.

31. Verbalis JG. Whole-body volume regulation and escape from antidiuresis. Am J Med 2006; 119(7 Suppl 1): S21-S29.

32. Dedinska I, Manka V, Sagova I et al. Hyponatremia – carbamazepine medication complications. Vnitř Lék 2012; 58(1): 72–75.

33. Tian W, Fu Y, Garcia-Elias A et al. A loss-of-function nonsynonymous polymorphism in the osmoregulatory TRPV4 gene is associated with human hyponatremia. Proc Natl Acad Sci USA 2009; 106(33): 14034–14039.

34. Faustini-Fustini M, Anagni M. Beyond semantics: defining hyponatremia in secondary adrenal insufficiency. J Endocrinol Invest 2006; 29(3): 267–269.

35. Warner MH, Holding S, Kilpatrick ES. The effect of newly diagnosed hypothyroidism on serum sodium concentrations: a retrospective study. Clin Endocrinol (Oxf) 2006; 64(5): 598–599.

36. Musch W, Xhaet O, Decaux G. Solute loss plays a major role in polydipsia-related hyponatraemia of both water drinkers and beer drinkers. QJM 2003; 96(6): 421–426.

37. Goldberg A, Hammerman H, Petcherski S et al. Hyponatremia and long-term mortality in survivors of acute ST-elevation myocardial infarction. Arch Intern Med 2006; 166(7): 781–786.

38. Goland S, Naugolny V, Korbut Z et al. Appropriateness and complications of the use of spironolactone in patients treated in a heart failure clinic. Eur J Intern Med 2011; 22(4): 424–427.

39. Jiskra J. Hyponatremie: diagnostický postup a nové léčebné možnosti. Hyponatremia: diagnostic process and new therapeutic approaches. Interní Med 2012; 14(8 a 9): 312–317.

40. Renneboog B, Musch W, Vandemergel X et al. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med 2006; 119(1): 71. e1-e8.

41. Hoorn EJ, Halperin ML, Zietse R. Diagnostic approach to a patient with hyponatraemia: traditional versus physiology-based options. QJM; 2005; 98(7): 529–540.

42. Schrier RW. Pathogenesis of sodium and water retention in high-output and low-output cardiac failure, nephrotic syndrome, cirrhosis, and pregnancy (1). N Engl J Med 1988; 319(16): 1065–1072.

43. Fenske W, Stork S, Koschker AC et al. Value of fractional uric acid excretion in differential diagnosis of hyponatremic patients on diuretics. J Clin Endocrinol Metab 2008; 93(8): 2991–2997.

44. Rozen-Zvi B, Yahav D, Gheorghiade M et al. Vasopressin receptor antagonists for the treatment of hyponatremia: systematic review and meta-analysis. Am J Kidney Dis 2010; 56(2): 325–337.

45. Jaber BL, Almarzouqi L, Borgi L et al. Short-term efficacy and safety of vasopressin receptor antagonists for treatment of hyponatremia. Am J Med 2011; 124(10): 977. e1-e9. Dostupné z DOI: <http://dx.doi.org/10.1016/j.amjmed.2011.04.028>.

46. De Troyer A. Demeclocycline. Treatment for syndrome of inappropriate antidiuretic hormone secretion. JAMA 1977; 237(25): 2723–2726.

47. Carrilho F, Bosch J, Arroyo V et al. Renal failure associated with demeclocycline in cirrhosis. Ann Intern Med 1977; 87(2): 195–197.

Labels
Diabetology Endocrinology Internal medicine

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Internal Medicine

Issue 3

2015 Issue 3

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