Problem based review: The patient presenting with hyponatraemia

Problem based review: The patient presenting with hyponatraemia

Abstract

Hyponatraemia is the most common electrolyte anomaly and is associated with significant morbidity and mortality. PatieRents with severe hyponatraemia often present to acute medical units with non-specific symptoms which can progress to overt neurological manifestations. There are many causes of hyponatriaemia, the most common being drug-induced causes, particularly thiazide diuretics, and the Syndrome of Inappropriate ADH Secretion (SIADH). Initial assessment should include a careful evaluation of the patient’s volume status, which helps to identify the most likely cause. This article utilises a recent case which presented to our AMU to illustrate the importance of a careful and systematic assessment of patients presenting to hospital with hyponatraemia. The new vasopressin receptor antagonists are explored as an option for the management of severe hyponatraemia.

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Referenes

  1. Anderson RJ, Chung HM, Kluge R, et al; Hyponatremia: a prospective analysis of its epidemiology and the pathogenetic role of vasopressin. Ann Intern Med. 1985; 102(2):164-8.
  2. Mittal R, Sheftel H, Demssie Y; Management of hyponatraemia. Br J Hosp Med (Lond). 2011; 72(2):22-5.
  3. Helwig FC, Schutz CB, Curry DE; Water intoxication. Report of a fatal case, with clinical, pathologic and experimental studies. JAMA. 1935; 104:1539-75.
  4. Arieff AI. Hyponatremia, convulsions, respiratory arrest and permanent brain damage after elective surgery in healthy women. N Engl J Med.
    1986; 314:1529-35.
  5. Moritz ML, Ayus JC, The pathophysiology and treatment of hyponatraemic encephalopathy: An update. Nephrology Dialysis Transplantation. 2003; 18 (12): 2486.
  6. Sterns RH, Nigwekar SU, Hix JK; The treatment of hyponatremia. Semin Nephrol. 2009; 29(3):282-99.
  7. Ginès P, Guevara M. Hyponatremia in cirrhosis: pathogenesis, clinical significance, and management. Hepatology. 2008, 48(3):1002-1010.
  8. Lindsay A. Profound hyponatraemia in cirrhosis: A Case Report. Cases Journal 2010, 3:77.
  9. Stephen RG, Hyponatremia and outcomes in patients with heart failure. Heart. 2012; 98:24 1761-62
  10. Thompson TJ, Crowley RK. Hyponatraemia. J R Coll Physicians. 2009 39:154-7
  11. Woo KH, Cho MH, Kim JK, et al. A Case of hyponatremia in hypothyroidism. Korean J Nephrol. 2007; 26(4):455-459.
  12. Sterns, RH. Overview of the treatment of hyponatremia. In: UpToDate, Emmett, M (Ed), UpToDate, Rochester, USA. 2013.
  13. Narayen G, Mandal SN. Vasopressin receptor antagonists and their role in clinical medicine. Indian J Endocrinol Metab. 2012; 16:183-191.
  14. Schrier RW, Gross P, Gheorgiade M et al. Tolvaptan, a selective oral vasopressin V2- receptor antagonist for hyponatremia. N Engl J Med.
    2006; 355:2099–112.
  15. Copeland PM. Diuretic abuse and central pontine myelinolysis. Psychotherapy and Psychosomatics. 1989; 52(1-3):101-5.
  16. Sonnenblick M, Friedlander Y, Rosin AJ. Diuretic-induced severe hyponatraemia, review and analysis of 129 reported patients. Clinical
    commentary. Chest. 1993; 103:601-06.
  17. Liamis G, Milionis H, Elisaf M. A review of drug-induced hyponatremia. Am J Kidney Dis. 2008. 52:144-153.
  18. Fourlanos S, Greenberg P. Managing drug-induced hyponatraemia in adults. Aust Prescr. 2003. 26:114-7.

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Problem based review: The patient presenting with hyponatraemia

8th March 2016
PMID: 24940573
Authors Affiliations
Saad A M Saeed MBChB, MSc, FRCP, AHE Consultant Physician in Acute and General Medicine Walsall Hospitals NHS Trust, Walsall, West Midlands, WS2 9PS
Saad Ahmad MBChB, CT1 in General Medicine, Alexandra Hospital, Redditch, West Midlands, B98 7UB
Amer Hayat MBBS, MRCP, Consultant Physician in Acute and Renal Medicine, Walsall Hospitals NHS Trust, Walsall, West Midlands, WS2 9PS
Marwa Saeed MBChB, FY1 Trainee, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, West Midlands, WV10 0QP

Problem based review: The patient presenting with hyponatraemia

Cite this article as:

Saeed M, Ahmad S, Hayat A, Saeed S. Problem based review: the patient presenting with hyponatraemia. Acute Med. 2014;13(2):86-9. PMID: 24940573.

Problem based review: The patient presenting with hyponatraemia

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