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Review
. 2023 Jan 10;13(1):140.
doi: 10.3390/jpm13010140.

Management of Hyponatremia in Heart Failure: Practical Considerations

Victoriţa Şorodoc  1 , Andreea Asaftei  2 , Gabriela Puha  1 , Alexandr Ceasovschih  1 , Cătălina Lionte  3 , Oana Sîrbu  3 , Cristina Bologa  1 , Raluca Ecaterina Haliga  3 , Mihai Constantin  1 , Adorata Elena Coman  1 , Ovidiu Rusalim Petriș  1 , Alexandra Stoica  1 , Laurenţiu Şorodoc  1   3
Affiliations
Review

Management of Hyponatremia in Heart Failure: Practical Considerations

Victoriţa Şorodoc et al. J Pers Med. .

Abstract

Hyponatremia is commonly encountered in the setting of heart failure, especially in decompensated, fluid-overloaded patients. The pathophysiology of hyponatremia in patients with heart failure is complex, including numerous mechanisms: increased activity of the sympathetic nervous system and the renin-angiotensin-aldosterone system, high levels of arginine vasopressin and diuretic use. Symptoms are usually mild but hyponatremic encephalopathy can occur if there is an acute decrease in serum sodium levels. It is crucial to differentiate between dilutional hyponatremia, where free water excretion should be promoted, and depletional hyponatremia, where administration of saline is needed. An inappropriate correction of hyponatremia may lead to osmotic demyelination syndrome which can cause severe neurological symptoms. Treatment options for hyponatremia in heart failure, such as water restriction or the use of hypertonic saline with loop diuretics, have limited efficacy. The aim of this review is to summarize the principal mechanisms involved in the occurrence of hyponatremia, to present the main guidelines for the treatment of hyponatremia, and to collect and analyze data from studies which target new treatment options, such as vaptans.

Keywords: arginine vasopressin; conivaptan; dilutional; heart failure; hypertonic saline; hyponatremia; loop diuretics; osmotic demyelination syndrome; tolvaptan; vaptans.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Effects of AVP in heart failure—the vicious cycle.
Figure 2
Figure 2
Effects of chronic hyponatremia.
Figure 3
Figure 3
Diagnosis algorithm in heart failure associated hyponatremia.
Figure 4
Figure 4
2021 European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic failure.
See this image and copyright information in PMC

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