It can also be initiated with just a small amount of solute. Overcorrection of hyponatremia is a medical emergency. Prevalence of hyponatremia and association with mortality. Nov 15, 20 the treatment of hyponatremia involves the removal of free water, treatment of underlying causes, and use of saline infusion. Hyponatremia, the most common electrolyte disorder in hospitalized patients is usually asymptomatic.
Hyponatremia with normal serum osmolality is pseudohyponatremia a laboratory artifact. From these tables, we produced merged consensus evidence tables for. Episode 60 emergency management of hyponatremia approach. Determining if the patient is euvolaemic, hypovolaemic or hypervolaemic helps guide treatment. Results from a decrease in the aqueous fraction of plasma. Hyponatremia defined as a serum sodium level of either asymptomatic or symptomatic hyponatremia. Acute hyponatremia often involves a rapid reduction in the sodium concentration, which may potentially lead to coma because of a very fast physiologic change. In many situations, hyponatremia is corrected at unexpectedly. Clinical cardiac toxicity associated with hyponatremia has not been previously described, although it is usually difficult to single out hyponatremia as the cause of conduction defects thus,we describe a case that. Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. Hyponatremia presenting as cardiac conduction defect. Normally, the extracellularfluid and intracellularfluid compartments account for 40 and 60 percent of total body water, respectively panel a. We define acute hyponatraemia as hyponatraemia that is documented to exist of hypernatremia involve a net gain of sodium or a.
May 01, 2014 chronic hyponatremia hyponatremia lasting more than 48 hours or with an unknown duration neurological symptoms are less in gradually developing hyponatremia, brain cells compensate by cellular exit of solutes that promote water loss and lessen brain swelling not necessarily asymptomatic can cause osteoporosis due to. Justify the use of peripheral administration of hypertonic saline and vasopressin antagonists to correct hyponatremia in a critically ill patient. Clinical practice guideline on diagnosis and treatment of. The lower the sodium and the faster the fall, the more symptomatic a patient will become. Determining the cause of hyponatremia time of care. Overcorrection of hyponatremia is a medical emergency richard h. Hyponatremiadefined as a serum sodium concentration of less than 5 meql is a common and important electrolyte imbalance that can be seen in. Normal saline forms the mainstay of treatment for hypovolemic hyponatremia while 3% nacl and fluid restriction are important for euvolemic hyponatremia. Sodium disorders are associated with an increased risk. Certain drugs eg, diuretics, antidepressants, and antiepileptics. Hyponatremia is the most common electrolyte abnormality in hospitalized patients and is associated with adverse outcomes, but its prevalence and significance in the general u. Q a clinic patient of mine was recently admitted to the hospital with hyponatremia serum sodium, 115 meql.
Hyponatraemia, defined as a serum sodium concentration hyponatremia due to low solute intake eg, beer potomania, diuresis can start spontaneously after a period of food and fluid restriction. Stepwise approach to emergency management of hyponatremia. An 85 yearold male presents to the emergency room with pneumonia. The nonhypotonic hyponatremias are hypertonic or translocational hyponatremia, isotonic hyponatremia, and pseudohyponatremia. May, 2014 hyponatremia, defined as a decrease in serum sodium below 6 mmoll, is a common occurrence in both inpatients and outpatients and can be found in up to 15% of the general hospital populations. Hyponatremia is the most common electrolyte abnormality encountered in the hospitalized patient, and the reported prevalence has varied with the nature of the patient population and health care setting studied. Our aims were to determine the prevalence of hyponatremia.
The hyponatremia correction infusate rate calculator yields results for infusate rate and serum sodium na change per liter based on equation parameters that include serum na changehr, serum na, water faction, weight, iv na, iv potassium. Hyponatremia causes, pathophysiology, algorithm, correction. Hyponatremia causes, algorithm, correction and treatment. Patients with acute hyponatremia or symptomatic chronic hyponatremia will likely require treatment in the intensive care unit icu. You will be redirected to the full text document in the repository in a few seconds, if not click here. In the event of a seizure, coma or suspected cerebral herniation as a result of hyponatremia, iv 3% hypertonic saline should be administered as soon as possible according to the following guide. The antidiuretic hormone that gets released, stimulates the water retention, making the sodium into the blood diluted, thereby resulting in hyponatremia. If the urine is appropriately dilute, then the most likely cause of hyponatremia is excessive water intake or inadequate solute intake. Many medical illnesses, such as congestive heart failure, liver failure, renal failure, or pneumonia, may be associated with hyponatremia.
Hyponatremia is a low sodium concentration in the blood. Druginduced states of impaired water excretion core reader. The cause of hyponatremia can be determined in part by how the patients kidneys are responding to the condition. Nov 19, 2016 approach to a patient with hyponatremia slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. These may include seizures, impaired mental status or coma and death. Hyponatremia symptoms, causes, treatment algorithm, levels. The sodium correction rate for hyponatremia calculates recommended fluid type, rate and volume to correct hyponatremia slowly or more rapidly if seizing. Worsening weakness, lethargy, and nausea merge with progressive headache and obtundation to culminate in generalized seizures, coma, and ultimately death.
Clinical signs typically develop 3 to 4 days after correction of hyponatremia and are characterized by paraparesis or tetraparesis, dysphagia, coma, and seizures. In its severe form it has a high morbidity and mortality. The concurrent administration of desmopressin and 5% dextrose in water can be given to cautiously relower the serum sodium concentration when therapeutic. Continue with fluid restriction, keeping in mind to check serum sodium every 2 4 hrs. Acidbase and electrolyte teaching case treating profound hyponatremia. Hypervolemic hyponatremia occurs when there is an increase in total body sodium along with the increase in total body water. Inadequacy of sodium intake is rarely the cause for hyponatremia. Practical document on the management of hyponatremia in critically. The concurrent administration of desmopressin and 5% dextrose in water can be given to cautiously relower the serum sodium concentration when therapeutic limits have been exceeded. Create a free account to read full articles and access webexclusive content on. Excessive correction usually results from the unexpected emergence of a water diuresis after resolution of the cause of water retention. He has been febrile for several days and has had a cough productive of yellow sputum. Treat neurologic emergencies related to hyponatremia.
Additional resources and information can be found at ismp canadas hospitalacquired hyponatremia. It is generally defined as a sodium concentration of less than 5 mmoll 5 meql, with severe hyponatremia being below 120 meql. Fifteen to thirty percent of all hospitalized patients feature some degree of. When the sodium gets diluted, the cells swell, and this can cause many health problems. Here we present a case of a man experiencing cpm suspected to be related to the overconsumption of commonly used commercial energy drinks. Extracellularfluid and intracellularfluid compartments under normal conditions and during states of hypernatremia. Hyponatremia is the most frequently occurring electrolyte abnormality and can lead to lifethreatening complications. If you continue browsing the site, you agree to the use of cookies on this website.
Sterns, mde adivision of endocrinology and metabolism, department of medicine, georgetown university medical center, washington, district of. In patients with severe symptomatic hyponatremia, the rate of sodium correction should be 6 to 12 meq per l in the first 24 hours and 18 meq per l or less in 48 hours. Hyponatraemia is the most common electrolyte disorder. Acute hyponatremia of hyponatremia to prevent the neurologic complications associated with acute hyponatremia 35. Hyperlipidemia, hypercholestrolemia, and hyperproteinemia are conditions that could increase the solids in plasma and thus decrease the aqueous fraction.
Differet types of hyponatremia develop depending on the cause and pathophysiological mechanisms. Classification of hyponatremia, according to onset, includes acute and chronic hyponatremia. Hypertonic saline 3% nacl infusion until an increase of 46 mmoll in serum sodium concentration is achieved 3,5. However, hyponatremia occasionally may develop in the course of treatment with drugs used in everyday. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Symptoms are often vague and nonspecific presenting as headache, irritability, lethargy, confusion, agitation or unstable gait leading to a fall. If the normal body sodium levels do not change with the increase in total body water, the condition is said to be euvolemic hyponatremia. The treatment of hyponatremia is aimed at addressing the underlying cause of the condition and replenishing the blood sodium levels, without causing the blood to become too dilute. Combine different methods for the evaluation of volemia and the obtainment of a differential diagnosis of hyponatremia. She was treated with 2 l of normal saline and discharged home 48 hours later, at her baseline mental status with a serum sodium level of 2 meql.
A 36yearold righthanded white man withno prior medical historypresented withdizziness. Jun 17, 2019 hyponatremia is defined as a serum sodium level of less than 5 meql and is considered severe when the serum level is below 125 meql. In most cases, excessive correction results from the unexpected emergence of a water diuresis aft er resolution of the cause of water reten tion medications, hypovolemia, transient syndrome of inappropriate antidiuretic hormone, and so on. Sodium correction rate in hyponatremia and hypernatremia. Pham, md c predicted sodium concentrations na1 based on traditional calculations for the correction of hyponatremia often do not match treated na1, for various reasons. Hyponatremia is the most common fluid and electrolyte disorder encountered in. The cause of the hyponatraemia must be identified by clinical assessment and investigations including serum and urinary sodium and osmolality. Acute hyponatremia is characterized by onset of symptoms acute hyponatremia develop neurologic symptoms resulting from cerebral edema induced by water movement into the brain. O vercorrection of hyponatremia should be viewed as a medical emergency. Sterns, md, john kevin hix, md, and stephen silver, md an alcoholic patient presented with profound hyponatremia serum sodium concentration, 96 meql.
829 551 130 1079 1223 1063 241 192 1092 1021 631 101 641 591 1649 1243 1574 187 777 269 299 21 577 452 1499 105 83 2 896 1037 1346