Hyponatremia is a common electrolyte disorder defined as a serum sodium level of less than 5 meq per l. Hyponatremia endocrine and metabolic disorders msd. Hyponatremia and hypernatremia medical specialties. Hyponatremia and hypernatremia are common electrolyte disorders resulting from disorders in water homeostasis. With the development of a sensitive radioimmunoassay for the antidiuretic hormone, arginine vasopressin. Hypernatremia endocrine and metabolic disorders msd. The best approach to chronic, asymptomatic hyponatremia is often to provide no specific therapy for the hyponatremia. The treatment of hyponatremia has been controversial because of the high associated morbidity and mortality and the observation that rapid correction of hyponatremia is associated with the development of central pontine myelinolysis. Hyponatremia, hypernatremia, and mortality in patients. Hypernatremia associated with hypovolemia occurs with sodium loss accompanied by a relatively greater loss of water from the body. Pdf hyponatremia and hypernatremia are disorders of water balance and are very common especially in.
Hypernatremia most commonly indicates a deficiency of total body water relative to total body solute. Correcting chronic hyponatremia or hypernatremia too aggressively can do the same. Sodium disorders are associated with an increased risk of morbidity and mortality. Hyponatremia hyponatremia is the most common documented electrolyte abnormality in hospitalized patients. Mar 01, 2015 hyponatremia is a common electrolyte disorder defined as a serum sodium level of less than 5 meq per l. Hypernatremia also leads to central nervous system dysfunction, although goals for its correction rate are less well established. Hyponatremia is defined as serum sodium concentration and is significant when the concentration is hyponatremia is long but the diagnostic approach can be easily framed in a few simple steps.
Hypernatremia definition and epidemiology hypernatremia affects people of all ages but is one of the more common electrolyte disorders seen in children and older adults. Hyponatremia, hypernatremia, and mortality in patients with. If anything goes wrong about sodium levels, either decreased as in hyponatremia or increased as in hypernatremia, then it causes a number of disturbances which are usually attributed to a pathology. Hyponatremia and hypernatremia rosemary dineen, mark j. The concurrent administration of desmopressin and 5% dextrose in water can be given to cautiously relower the serum sodium concentration when therapeutic limits have been exceeded. Note that the ecf volume is not the same as effective. Hyponatremia reflects an excess of total body water tbw relative to total body sodium content. Physiological basis most prevalent cation in ecfnormal level of around 5 145 mmoll. Hyponatremia and hypernatremia symptom to diagnosis. Diminished plasma sodium concentration is the most common electrolyte disorder in hospitalized patients, occurring in 1530% of such patients.
This imbalance can be caused by three basic mechanisms. Overall body fluid concentration is regulated within a narrow range by the concerted action of the hypothalamicpituitary axis to influence water intake through thirst and water excretion via the effect of vasopressin, or antidiuretic hormone, on renal collecting duct water permeability. Hyponatremia is defined as serum sodium 145 meql mmoll. For which disorder will water restriction help to prevent further dilution of the plasma concentration of sodium. Hyponatremia and hypernatremia are disorders of water balance and are very common especially in hospitalized patients. Most of hyponatremia and hypernatremia cases are mild.
Psychotropicinduced hyponatremia mdedge psychiatry. Traditionally, hypernatremia has been considered to be mainly a problem of the elderly or infants with diarrhea 1,7,8. Severe hypernatremia in cystic fibrosis jama pediatrics. List the risk factors for developing cerebral demyelination following the correction of hyponatremia. Hyponatremia frequently occurs in hospitalized patients because acute illnesses often promote antidiuretic hormone adh secretion. Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. Major causes of hypernatremia or high sodium levels include reduced body water either due to loss or reduced intake, excessive intake of sodium or reduced levels of adh antidiuretic hormone which occurs as in diabetes inspidus. Evidence for managing hypernatremia american society of. Hyponatremia and hypernatremia are disorders of water balance and are very common especially in. Hypernatremia is defined as serum sodium levels going above 150 meql.
Examples of these include thiazide use suggesting diureticinduced hyponatremia, recent participation in marathon events suggesting exerciseassociated hyponatremia eah, hyperkalemia suggesting kidney disease or primary adrenal insufficiency, very low urine. There is a risk of focusing too much energy on treating the hyponatremia, and not enough energy on treating the underlying heart failure. The quantities of electrolytes lost in sweat may be of considerable magnitude, 1,2 and are dependent on sweat electrolyte concentration and volume. Adipsic hypernatremia complicated by hyponatremia pdf. Characterize the clinical manifestations of hypernatremia. Adipsic hypernatremia complicated by hyponatremia pdf free. Outside the hospital, hyponatremia can be a side effect of medications, most notably thiazide diuretics and antidepressants, and it is a common problem among alcoholics, particularly heavy beer drinkers. M edically, sodium is one of the essential minerals required for homeostasis of body, performing regulation of blood volume, blood pressure, osmotic equilibrium and ph regulation. Chapter 210 hypernatremia and hyponatremia terry mahan buttaro specialist referral is indicated for serum sodium levels of less than 125 meql or more than 155 meql.
Mar 01, 2020 hypernatremia hypocalcemia hyponatremia hypokalemia hypocalcaemia. Patients can present with nonspecific signs such as weight loss, dehydration, lethargy, and weakness. They are related to the severity and, in particular, the rapidity of the change in the serum sodium concentration. Hypercalcemia hypocalcaemia hypokalemia hypernatremia hyponatremia. Scribd is the worlds largest social reading and publishing site. Patients with hyponatremia and hypernatremia may also have complaints related to concurrent volume depletion and possible underlying neurologic diseases. Goal 46 mmoll rapidly over several hours limit 8 mmoll at 24 hours and 16 mmoll at 48 hours unless hyperacute hyponatremia. Patients with hyponatremia and hypernatremia may also have complaints related to concurrent volume depletion and possible underlying neurologic diseases that predispose to the electrolyte abnormality. Hyponatremia washington manual of medical therapeutics. Both hyponatremia and hypernatremia were associated with significantly higher shortterm mortality, independent of comorbidities such as congestive heart failure or liver disease. If severe hypernatremia occurs acutely, the patient can be at risk for seizures and coma. Major function of sodium is to maintain ecf volume and thus bp. Hyponatremia during rehydration is an unusual feature of this case, and has previously been convincingly reported in one patient with adipsic hypernatremia. Diagnosis and management of disorders of body tonicity.
Hyponatremia and hypernatremia adipsic hypernatremia complicated by hyponatremia age and gender as risk factors for hyponatremia and hypernatremia. Sodium normal vs hyponatremia vs hypernatremia medicforyou. Hyponatremia or a low blood sodium level can sometimes be corrected before it causes complications. Excessive correction usually results from the unexpected emergence of a water diuresis after resolution of the cause of water retention. The first step recognizes that a few key clinical and laboratory features occasionally point to very specific diagnoses. Common extrarenal causes include most of those that cause hyponatremia and volume depletion. In one study, patients with hypernatremia on admission were older than the general hospital population, whereas the mean age of. Effects on the central nervous system of hypernatremic and. Understanding hypernatremia fulltext american journal of. Download as ppt, pdf, txt or read online from scribd. Dx schema hyponatremia the clinical problem solvers. Frequently observed hypochloremia in patients with cf living in the new orleans area necessitates the.
The treatment of hyponatremia depends on the time course, severity, and underlying cause of the disorder. Severe hyponatremia, defined as a serum sodium concentration nas hyponatremia with acute neurological symptoms, is associated with significant morbidity and mortality, particularly in the setting of preexisting cardiac, renal, or liver disease. Instead, the primary focus of therapy should remain the heart failure. Hyponatremia is usually defined as a plasma sodium level download pdf. Which disorder may develop as a result of increased phosphate levels due to renal insufficiency, increase in phosphate intake, hyperparathyroidism, rhabdomyolysis, or as a result of cell destruction from chemotherapy. The role of desmopressin in the management of severe. Treatment of severe hyponatremia american society of. Because total body sodium content is reflected by extracellular fluid ecf volume status, hyponatremia must be considered along with status of the ecf volume. Hyponatremia is common in acutely ill patients 1,2. Hyponatremia usually results from defects in free water excretion, although increased intake may also contribute. A rapidly falling plasma sodium concentration causes cerebral edema. The sweat of patients with cystic fibrosis cf has elevated levels of sodium and chloride compared with that of nonaffected persons. Diagnosis and management of hyponatremia in acute illness. Indeed, hypernatremia is rare in noncritically ill, hospitalized patients with a prevalence of 02% for hypernatremia upon admission and 1% for patients developing it during their hospital stays 9.
Overcorrection of hyponatremia is a medical emergency. Abnormalities in water balance are manifested as sodium disturbances hyponatremia and hypernatremia. Disorders of water balance, japi vol 56, dec 2008 washington manual of medical therapeutics harrison principles of internal medicine a clinical approach to the treatment of chronic hypernatremia, am j kidney dis. Unfortunately, as is true of all electrolyte disturbances, there are no randomized trials to guide the treatment of this challenging. Hyponatremia and hypernatremia linkedin slideshare. Fluids and electrolytes objective questions and answers pdf download.
The treatment of hyponatremia has been controversial because of the high associated morbidity and mortality and the. Abnormalities in water balance are manifested as sodium disturbanceshyponatremia and hypernatremia. Hyponatremia and hypernatremia free download as powerpoint presentation. The treatment of hyponatremia is aimed at addressing the underlying cause of the condition and replenishing the blood sodium levels, without causing the blood to become too dilute. The reported frequency of the disorder is determined by a number of 112 hyponatremia and hypernatremia factors, including the definition of hyponatremia, frequency of testing, the health care setting, and the patient population. Acute hyponatremia or hypernatremia can cause brain damage. Anton helman, march 2015 hyponatremia is the most common fluid and electrolyte disorder encountered in clinical practice and is found in approximately 20% of admissions to hospital. Symptoms of hyponatremia or hypernatremia are primarily neurologic. Hyponatremia endocrine and metabolic disorders msd manual. The etiology and treatment of hyponatremia and hypernatremia are presented general principles of disorders of water balance hyponatremia and hypernatremia and sodium balance hypovolemia and edema view in chinese. Although totalbody salt content may be abnormal, the vast majority of dysnatremias arise from a primary imbalance in electrolytefree water.
Hyponatremia is a common finding in hospitalized patients with a prevalence ranging from 1530%. In general, over 50% of this hyponatremia occurs during hospitalization 2,4. Hyponatremia and hypernatremia by dr hasen ali mia 1st year pgt at nbmch 2. Sep 02, 2009 overcorrection of hyponatremia is a medical emergency. Principles of management of severe hyponatremia journal of. Either hypernatremia or hyponatremia can occur with severe volume loss, depending on the relative amounts of sodium and. Hyponatremia is considered as severe if na is hyponatremia treated with hypertonic or isotonic saline infusion, including hypovolemia with hyponatremia and absence of overt neurological manifestations, should be considered as severe because of the risks from saline infusion. Severe hyponatremia, defined as a serum sodium concentration nas download pdf copy by dr. Both hyponatremic and hypernatremic patients are commonly encountered in a wide variety of clinical situations. Hyponatremia and hypernatremia are classified based on volume status hypovolemia, euvolemia, and hypervolemia. Hyponatremia is a topic covered in the washington manual of medical therapeutics to view the entire topic, please sign in or purchase a subscription the washington manual of medical therapeutics helps you diagnose and treat hundreds of medical conditions. Dec 12, 2019 the best approach to chronic, asymptomatic hyponatremia is often to provide no specific therapy for the hyponatremia.
986 1663 592 986 586 1577 1354 841 525 196 994 277 183 394 1487 268 586 869 700 230 621 1583 1367 596 1471 1479 983 171 1438 1466