Hyponatraemia

Extract

• Assessing the severeness of hyponatraemia is based on both symptoms and the concentration of sodium in the plasma.
• The plasma sodium concentration should be checked from all acutely ill patients. In hyponatraemia, the concentration of sodium in the plasma decreases below 135 mmol/l, and in a severe condition the concentration decreases below 120 mmol/l.
• In order to assess the symptoms and the risk of developing complications resulting from the treatment, the objective is to differentiate between acute, clearly symptomatic hyponatraemia that has developed rapidly (< 48 hours) and chronic hyponatraemia that has developed slowly over several days, weeks or even months. If the duration of the condition cannot be inferred, hyponatraemia is considered chronic.
• The manifestations of acute hyponatraemia are progressive central nervous system symptoms (confusion, vomiting, seizures, unconsciousness), whereas the symptoms of chronic hyponatraemia can be very slight and more generalised (e.g. lethargy, falls, gait disturbances, muscular weakness, muscle cramps, impairment of attention).
• The urgency of treatment is always determined by the patient’s symptoms as well as the degree and duration of hyponatraemia.
• Most commonly, hyponatraemia is slow to develop and oligosymptomatic, in which case fluid restriction and preventing sodium concentration from increasing too rapidly are sufficient forms of treatment.
• In most cases, hyponatraemia is caused by excessive body water, which dilutes the sodium concentration in the extracellular fluid and plasma. The phenomenon results from conditions or drugs that increase the secretion of the antidiuretic hormone (ADH) or inhibit water diuresis in other ways (syndrome of inappropriate antidiuresis, SIAD).
• The possibility of cortisol deficiency should be kept in mind.
• Sodium depletion is far from being a common cause of hyponatraemia, but it is clinically fairly easy to identify.

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Addison Disease, Anaesthesiology, Anesthesia, Blood Glucose, Creatinine, Deamino Arginine Vasopressin, Diarrhea, E22.2, E86, E87.1, E87.7, Endocrinology, Fluid Therapy, Furosemide, Heart Failure, Congestive, Hyperglycemia, Hyperlipoproteinemia Type IV, Hyponatraemia, Hyponatremia, Hypotension, Hypovolemia, Inappropriate ADH Syndrome, Internal medicine, Intracranial Hypertension, Liver Cirrhosis, Muscle Hypotonia, Nephrotic Syndrome, Osmolar Concentration, Paraproteinemias, Potassium, Sodium, Sodium Chloride, Surgical Procedures, Operative, Thiazides, Vasopressins, Vomiting, Water Intoxication, hypervolemia, iatrogenic hyponatremia, idiopathic hyponatremia, normovolemia, polydipsia, pseudohyponatremia, renal salt loss, salt loss, sodium in 24-hour urine sample, water excess, water restriction