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