Am J Med. Hyponatremia occurs when the concentration of sodium in your blood is abnormally low.
Neville KA, Sandeman DJ, Rubinstein A, Henry GM, McGlynn M, Walker JL. Clin Chim Acta. Enter 0.9% solution of sodium chloride with the calculated rate until the disappearance of symptoms of hypovolemia.
[Medline]. 2009 Jul. Obtain a thorough history and physical examination, assessing the patient's medications, neurologic state, and extracellular fluid volume status. Arch Dis Child.
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[Medline]. Clin J Am Soc Nephrol. The etiology of hyponatremia is often multifactorial. Gerontology.
Patients typically will have signs of dehydration and findings of prerenal azotemia due to the contraction of the total plasma volume. [Medline]. 2007 Nov. 120(11 Suppl 1):S1-21. [Medline]. [Medline]. 2013 Apr. [Medline]. 55 (4):742-8. Vasopressin-receptor antagonists: a new class of agents for the treatment of hyponatremia. Hoorn E, Lindemans J, Zietse R. Hyponatremia in hospitalized patients epidemiology, etiology and symptomatology. Sodium disorders in the emergency department: a review of hyponatremia and hypernatremia.
Lindner G, Schwarz C. An update on the current management of hyponatremia. Evaluation of copeptin and commonly used laboratory parameters for the differential diagnosis of profound hyponatraemia in hospitalized patients: 'The Co-MED Study'. samsca-jynarque-tolvaptan-999103 15:561(A). When this happens, your body's water levels rise, and your cells begin to swell. [Medline]. Prevention of hyponatremia during maintenance intravenous fluid administration: a prospective randomized study of fluid type versus fluid rate. Frizelle FA, Colls BM.
Howard A Bessen, MD Professor of Medicine, Department of Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Program Director, Harbor-UCLA Medical Center [Medline]. [Medline]. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. 60 (3):384-5. Cole CD, Gottfried ON, Liu JK, Couldwell WT. J Am Soc Nephrol.
Hyporvolemic hyponatremia is a condition which includes low blood sodium levels symptoms due to the decrease in total body sodium. Clinical features, outcome and cost of hyponatremia-associated admission and hospitalization in elderly and very elderly patients: a single-center experience in Turkey. Minerva Pediatr. 2015 Jul. Upadhyay A, Jaber BL, Madias NE. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly93d3cubWVkc2NhcGUuY29tL2Fuc3dlcnMvNzY3NjI0LTExMjE0OS93aGF0LWlzLWh5cG92b2xlbWljLWh5cG9uYXRyZW1pYQ==. 2009 Jan. 94(1):123-9.
High urine sodium (>40 mEq/L) suggests: Euvolemic hyponatremia (SIADH, hypothyroidism, or adrenal insufficiency). 2014 Feb. 9 (2):229-37. [Medline].
Howard A Bessen, MD is a member of the following medical societies: American College of Emergency PhysiciansDisclosure: Nothing to disclose. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Baldrighi M, Castello LM, Bartoli E. Copeptin in hyponatremia: is there a role for this biomarker in the diagnostic workup?. Fast Five Quiz: What Do You Know About Hyponatremia? Swiss Med Wkly. Total body water (TBW) decreases; total body sodium (Na+) decreases to a greater extent. J Clin Endocrinol Metab. Hypovolemic hyponatremia should be ruled out before initiating therapy. [Medline]. … 146:w14385.
[Medline]. J Pediatr . Hypervolemic hyponatremia occurs when extracellular sodium is normal or even slightly elevated, but extracellular fluid is greatly elevated.
Am J Emerg Med. Endocr Metab Immune Disord Drug Targets.
Hyponatremia is an important electrolyte abnormality with the potential for significant morbidity and mortality. [Medline].
Verbalis JG, Goldsmith SR, Greenberg A, Schrier RW, Sterns RH. Fenske W, Störk S, Blechschmidt A, Maier SG, Morgenthaler NG, Allolio B. Copeptin in the differential diagnosis of hyponatremia. 16(4):E9. Drugs. 2008 Mar. Murase T, Sugimura Y, Takefuji S, et al. Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. With hypovolemic hyponatremia, total body water also decreases.When this occurs, low blood sodium side effects such as headaches, restlessness, confusion, muscle cramping and spasms, and a lack of energy can be experienced.
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[Medline]. Influence of hypoxia and sex on hyponatremic encephalopathy.
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Sood L, Sterns RH, Hix JK, Silver SM, Chen L. Hypertonic saline and desmopressin: a simple strategy for safe correction of severe hyponatremia. Eur J Intern Med.
Am J Kidney Dis. Incidence and prevalence of hyponatremia. Perianayagam A, Sterns RH, Silver SM, et al.
Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations.
These objective methods may add insight into volume status to help better classify the suspected hyponatremia. 2009 Jul. 86 (3):456-62. Hypovolemic hyponatremia is a result of fluid losses either from the kidneys (most commonly due to iatrogenic overdiuresis) or from the gastrointestinal tract (i.e., diarrhea). 122(7):679-86. Sotorasib Is a 'Triumph of Drug Discovery'in Cancer, Selpercatinib 'Poised to Alter the Landscape' of RET+ve Cancers, Fecal Transplant Shows Promise in Reducing Alcohol Craving, Leukoencephalopathies: (White) Matters of Concern, Plant-Based Diet Finally on the Menu for Patients on Dialysis, DAPA-CKD: SGLT2 Inhibitors 'The Beta-Blockers for the Kidneys', The Kidney and COVID-19: What We Know so Far, No Virus Found in Injured Kidneys of COVID-19 Patients, Acute Kidney Injury in COVID-19 Varies, but It Is Deadly.
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Hyponatremia can be classified according to the volume status of the patient as hypovolemic, hypervolemic, or euvolemic. [Medline]. Hypervolemic hyponatemia (e.g. Neth J Med. Pfennig CL, Slovis CM. [Medline].
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2017 Jan 19. [Medline]. Brouns SH, Dortmans MK, Jonkers FS, Lambooij SL, Kuijper A, Haak HR. Woitok BK, Funk GC, Walter P, Schwarz C, Ravioli S, Lindner G. Dysnatremias in emergency patients with acute kidney injury: A cross-sectional analysis. Saline is our friend. Diseases & Conditions, 2002 Clin J Sport Med. [Medline]. Choong K, Kho ME, Menon K, Bohn D. Hypotonic versus isotonic saline in hospitalised children: a systematic review. [Medline]. 2014 Jul. Prevention of hyponatremia during maintenance intravenous fluid administration: a prospective randomized study of fluid type versus fluid rate.
Turgutalp K, Ozhan O, Gok Oguz E, et al. Mild hyponatremia carries a poor prognosis in community subjects.
The extracellular fluid (ECF) volume is decreased. [Medline]. FDA drug safety communication - FDA Limits Duration and Usage Due To Possible Liver Injury Leading to Organ Transplant or Death. Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, Endocrine SocietyDisclosure: Nothing to disclose. Hyponatraemia in elderly emergency department patients: a marker of frailty. These patients have signs of clinical hypervolemia, such as pitting edema or ascites. Diseases & Conditions, 2002 Endocrine. [Medline]. Intermediate urine sodium (~20-40 mEq/L) This represents a grey zone, provides no clear information. Hyponatremia treatment guidelines 2007: expert panel recommendations. 2005 Feb. 48(2):393-6. [Medline].
Sandy Craig, MD Residency Program Director, Carolinas Medical Center; Associate Professor, Department of Emergency Medicine, University of North Carolina at Chapel Hill School of Medicine J Am Soc Nephrol. 1994 Feb. 4 (8):1522-30. http://www.medscape.com/viewarticle/847443, http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm350185.htm, Emergency Medicine Residents' Association, American Association of Clinical Endocrinologists. Mechanisms and therapy of osmotic demyelination.
[Medline]. Profound hyponatraemia in the emergency department: seasonality and risk factors.
McCarthy K, Conway R, Byrne D, Cournane S, O'Riordan D, Silke B. Hyponatraemia during an emergency medical admission as a marker of illness severity & case complexity. Sodium is an electrolyte, and it helps regulate the amount of water that's in and around your cells.
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