Hyponatremia is decrease in serum sodium concentration < 136 mEq/L (< 136 mmol/L) caused by an excess of water relative to solute. Common causes include diuretic use, diarrhea, heart failure, liver disease, renal disease, and the syndrome of inappropriate antidiuretic hormone secretion (SIADH).
Herein, how do you approach a patient with hyponatremia?
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. A bolus of 100 to 150 mL of hypertonic 3% saline can be given to correct severe hyponatremia.
- Always evaluate hyponatremic patients with UNa and Uosm.
- Goal rate of sodium correction is 6 to 8 mEq/L in 24 hours, 12 to 14 mEq/L in 48 hours.
- Use hypertonic saline for severe symptomatic hyponatremia.
Moreover, how many cases of hyponatremia are there?
Results. The prevalence estimate for hyponatremia ranged from 3.2 million to 6.1 million persons in the U.S. on an annual basis. Approximately 1% of patients were classified as having acute and symptomatic hyponatremia, 4% acute and asymptomatic, 15%–20% chronic and symptomatic, and 75–80% chronic and asymptomatic.
Is hyponatremia hypotonic or hypertonic?
Most patients with hyponatremia have hypotonicity, but there are exceptions (table 1). Hyponatremia without hypotonicity can occur in patients with hyperglycemia, in patients who have accumulated exogenous effective osmoles, and in patients with pseudohyponatremia caused by extreme hyperlipidemia or hyperproteinemia.
What are 3 types of hyponatremia?
Hypovolemic hyponatremia: decrease in total body water with greater decrease in total body sodium. Euvolemic hyponatremia: normal body sodium with increase in total body water. Hypervolemic hyponatremia: increase in total body sodium with greater increase in total body water.
What are the causes of Pseudohyponatremia?
The most common cause of pseudohyponatremia is due to severely elevated levels of cholesterol. [2] In serum blood samples taken from patients with severe hypertriglyceridemia, the sample may appear overtly lipemic, hyper viscous, or discolored from the overwhelming presence of insoluble triglycerides.
What are the risk factors for hyponatremia?
Many possible conditions and lifestyle factors can lead to hyponatremia, including:
- Certain medications. …
- Heart, kidney and liver problems. …
- Syndrome of inappropriate anti-diuretic hormone (SIADH). …
- Chronic, severe vomiting or diarrhea and other causes of dehydration. …
- Drinking too much water. …
- Hormonal changes.
What is a critical low sodium level?
Your blood sodium level is normal if it’s 135 to 145 milliequivalents per liter (mEq/L). If it’s below 135 mEq/L, it’s hyponatremia. Your doctor will be able to tell you whether your level is too low.
What is hypertonic hyponatremia?
Patients with hypertonic hyponatremia have normal total body sodium and a dilutional drop in the measured serum sodium due to the presence of osmotically active molecules in the serum, which causes a water shift from the intracellular compartment to the extracellular compartment.
What is the pathophysiology of hyponatremia?
Pathogenesis of hyponatremia
Hyponatremia results from the inability of the kidney to excrete a water load or excess water intake. Water intake depends upon thirst mechanism. Thirst is stimulated by increase in osmolality.
What osmolality means?
Definition. Osmolality is a test that measures the concentration of all chemical particles found in the fluid part of blood. Osmolality can also be measured with a urine test .
When should we admit hyponatremia?
Admit patients with severely symptomatic hyponatremia manifested by coma, recurrent seizures, or evidence of brainstem dysfunction to an ICU and monitor serum sodium levels closely. Admit patients with a propensity toward inappropriate free water ingestion to a unit where free water access is restricted.
Which organ is most affected by hyponatremia?
Hyponatremia occurs when your blood sodium level goes below 135 mEq/L. When the sodium level in your blood is too low, extra water goes into your cells and makes them swell. This swelling can be dangerous especially in the brain, since the brain cannot expand past the skull.
Why is hyponatremia common in hospitalized patients?
Conclusions: Hyponatremia was common in hospitalized patients. The major primary diseases were malignant tumor (lung cancer), infectious diseases (pneumonia) and cerebral hemorrhage complicated with SIADH and CSWS. Use of sodium-excretion drugs increased the risk of moderate to severe hyponatremia.