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Review
. 2008 Dec;14(6):627-34.
doi: 10.1097/MCC.0b013e32830e45e3.

Diagnosis and management of hyponatremia in acute illness

Robert W Schrier  1 , Shweta Bansal
Affiliations
Review

Diagnosis and management of hyponatremia in acute illness

Robert W Schrier et al. Curr Opin Crit Care. 2008 Dec.

Abstract

Purpose of review: Hyponatremia is the most common electrolyte disorder present in hospitalized patients. Acute and severe hyponatremia can cause significant morbidity and mortality. The present review discusses the epidemiology, causes, and a practical approach to the diagnosis and management of acute and chronic hyponatremia, including the appropriate use of hypertonic saline and potential future use of the new V2 vasopressin receptor antagonists in critically ill patients.

Recent findings: The increasing knowledge of aquaporin water channels and the role of vasopressin in water homeostasis have enhanced our understanding of hyponatremic disorders. Increased vasopressin secretion due to nonosmotic stimuli leads to decreased electrolyte-free water excretion with resulting water retention and hyponatremia. Vasopressin receptor antagonists induce electrolyte-free water diuresis without natriuresis and kaliuresis. Phase three trials indicate that these agents predictably reduce urine osmolality, increase electrolyte-free water excretion, and raise serum sodium concentration. They are likely to become a mainstay of treatment of euvolemic and hypervolemic hyponatremia.

Summary: The correct diagnosis and management of hyponatremia is complex and requires a systematic approach. Vasopressin receptor antagonists are potential tools in the management of hyponatremia. Further studies are needed to determine their role in the treatment of acute, severe, life-threatening hyponatremia as well as chronic hyponatremia.

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Figures

Figure 1
Figure 1. Nonosmotic arginine vasopressin secretion during arterial underfilling
Nonosmotic, baroreceptor-mediated release of arginine vasopressin occurs due to arterial underfilling secondary to either a decrease in cardiac output (a) or primary arterial vasodilation (b). AVP, arginine vasopressin; RAAS, rennin-angiotensin-aldosterone system; SNS, sympathetic nervous system. Adapted with permission [7,8].
Figure 2
Figure 2. The schema summarizes the diagnostic and therapeutic approach for euvolemic, hypovolemic, and hypervolemic hyponatremia
ADH, antidiuretic hormone. Adapted with permission [10].
See this image and copyright information in PMC

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