Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Apr;193(2):1043-1046.
doi: 10.1007/s11845-023-03490-8. Epub 2023 Sep 13.

Hyponatremia and malnutrition: a comprehensive review

German Baez  1 , Martin Chirio  1 , Pedro Pisula  1 , Enrique Seminario  2 , Natalia Carasa  2 , Romina Philippi  2 , Gustavo Aroca-Martinez  3 , Carlos G Musso  4   5   6
Affiliations
Review

Hyponatremia and malnutrition: a comprehensive review

German Baez et al. Ir J Med Sci. 2024 Apr.

Abstract

Background: Hyponatremia (serum sodium lower than 135 mmol/L) is the most frequent electrolyte alteration diagnosed in medical practice. It has deleterious clinical effects, being an independent predictor of mortality. Malnutrition encompasses pathological states caused by both nutrients excess and deficiency, being frequently documented in chronic kidney disease patients. In addition, chronic hyponatremia promotes adiposity loss and sarcopenia, while malnutrition can induce hyponatremia. This pathological interaction is mediated by four main mechanisms: altered electrolyte body composition (low sodium, low potassium, low phosphorus, or high-water body content), systemic inflammation (cytokines increase), hormonal mechanisms (renin-angiotensin-aldosterone system activation, vasopressin release), and anorexia (primary or secondary).

Conclusion: Malnutrition can induce hyponatremia through hydro-electrolytic, hormonal, inflammatory, or nutritional behavior changes; while hyponatremia per se can induce malnutrition, so there is a pathophysiological feedback between both conditions.

Keywords: Hyponatremia; Malnutrition; Pathophysiology.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Pathophysiologic hyponatremia inducing mechanisms in malnourished patients. IC: intracellular compartment, IV: intravascular compartment, N: sodium, W: water, P: phosphorus, K: potassium
See this image and copyright information in PMC

References

    1. Musso CG, Vilas M. Water, electrolyte, and acid-base disorders in the elderly. In: Nephrogeriatrics Clinical., editor. Clinical Nephrogeriatrics. An Evidence-Based Guide. Cham: Springer; 2019. pp. 43–62.
    1. Kovesdy CP, Kopple JD, Kalantar-Zadeh K. Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy. Am J Clin Nutr. 2013;97(6):1163–1177. doi: 10.3945/ajcn.112.036418. - DOI - PMC - PubMed
    1. Hanna RM, Ghobry L, Wassef O, et al. A practical approach to nutrition, protein-energy wasting, sarcopenia, and cachexia in patients with chronic kidney disease. Blood Purif. 2020;49(1–2):202–211. doi: 10.1159/000504240. - DOI - PubMed
    1. Fouque D, Kalantar-Zadeh K, Kopple J, et al. A proposed nomenclature and diagnostic criteria for protein–energy wasting in acute and chronic kidney disease. Kidney Int. 2008;73(4):391–398. doi: 10.1038/sj.ki.5002585. - DOI - PubMed
    1. Carrero JJ, Thomas F, Nagy K, et al. Global prevalence of protein-energy wasting in kidney disease: a meta-analysis of contemporary observational studies from the International Society of Renal Nutrition and Metabolism. J Ren Nutr. 2018;28(6):380–392. doi: 10.1053/j.jrn.2018.08.006. - DOI - PubMed