Defined as a serum sodium concentration of <135 mEq/L.
Most common electrolyte disorder encountered in clinical practice.
Can occur in settings of volume depletion, volume overload, or euvolemia.
Serum osmolality, urine osmolality, and urine sodium concentration help to determine the underlying cause.
Cerebral edema is a medical emergency and occurs more frequently when hyponatremia develops over <48 hours. Patients should be treated promptly with hypertonic 3% saline.
Other treatment depends on the underlying cause and may include fluid restriction and stopping causative medications.
Overly rapid correction of serum sodium concentration can lead to the life-threatening complication of myelinolysis and should be avoided.
Hyponatremia is defined as a serum sodium concentration of <135 mEq/L (normal serum sodium concentration is in the range of 135-145 mEq/L). It is a disorder of water balance reflected by an excess of total body water relative to electrolytes (total body sodium and potassium) leading to low plasma osmolality (i.e., <275 mOsm/kg). Hyponatremia is generally caused by an increase in renal water reabsorption due to release of vasopressin (arginine vasopressin also known as antidiuretic hormone) along with water intake, and can occur in situations of volume depletion, volume overload, or normal volume. (It should be noted that loss of sodium is minor compared with gains in water in most types of hyponatremia.)
This topic principally focuses on hypotonic (hypo-osmolar) hyponatremia, the most common type of hyponatremia.
History and exam
- high fluid intake
- fluid losses
- history of diabetes mellitus
- history of cirrhosis, nephrosis, congestive heart failure
- mild cognitive symptoms
- altered mental status, seizures, coma
- low urine output
- weight changes
- orthostatic hypotension
- abnormal jugular venous pressure
- poor skin turgor
- dry mucus membranes
- absence of axillary sweat
- rales or crackles on lung auscultation
- serum sodium concentration
- serum electrolytes, BUN, creatinine, and glucose
- serum osmolality
- urine sodium concentration
- urine osmolality
- urine electrolytes
- urine flow rate
- electrolyte-free water excretion
- fractional excretion of sodium
- thyroid-stimulating hormone
- serum cortisol level and/or adrenocorticotropic hormone test
- serum lipids and serum protein electrophoresis
Judith H. Veis, MD
MedStar Washington Hospital Center
JHV declares that she has no competing interests.
Gregor Lindner, MD
Department of Internal & Emergency Medicine
Hirslanden Klinik Im Park
GL is an author of a number of references cited in this topic.
Michael E. Ullian, MD
Professor of Medicine
Division of Nephrology
Department of Medicine
Medical University of South Carolina
MEU declares that he has no competing interests.
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