Hyponatraemia: clinical approach and therapy
Keywords:
congestive heart failure, hepatic cirrhosis, hyponatraemia, hypovolaemia, polydipsia, syndrome of inappropriate anti-diuretic hormone secretion (SIADH), vasopressin receptor antagonistsAbstract
Hyponatraemia is the most common electrolyte
disturbance in hospitalised patients and it reflects a
water balance disturbance with associated hypo-osmolality. There are several associated conditions:
fluid losses, oedematous states (heart failure, hepatic
cirrhosis, nephrotic syndrome), syndrome of
inappropriate anti-diuretic hormone secretion
(SIADH), primary polydipsia and endocrine
diseases. Initial evaluations to reach an aetiologic
diagnosis should include: measurement of plasmatic
and urinary osmolality, the plasma concentration of
sodium, and clinical assessment of the extracellular
compartment. Two basic principles are involved in
the treatment of hyponatraemia: raising plasma
sodium concentration at a safe rate and treating the
underlying cause. However, treatment of this
disorder also requires balancing the risks of
hypotonicity against those of therapy, in order to
avoid central osmotic demyelination. A new class of
promising agents, the vasopressin receptor
antagonists, has been described, and it seems
reasonable to expect improvement in the treatment
of hyponatraemia associated with heart failure,
hepatic cirrhosis and SIADH.
This article focuses on the causes, differential
diagnosis and treatment of this electrolyte disorder.
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