Initial approach to the hyponatremic patient

Acta Anaesthesiologica Scandinavica

Volumn 55, Issue 2, 2011, Pages 139-148

  Overgaard Steensen, C ^a  

^a AARHUS UNIVERSITY HOSPITAL   (Denmark)

Author keywords

[No Author keywords available]

Indexed keywords

CATION; DESMOPRESSIN; HYPERTONIC SOLUTION; PARACETAMOL; SODIUM CHLORIDE; WATER;

AGITATION; BRAIN EDEMA; COMA; CONFUSION; DEATH; DIURESIS; FLUID BALANCE; HEADACHE; HOMEOSTASIS; HUMAN; HYPONATREMIA; LETHARGY; MUSCLE CRAMP; MUSCLE SPASM; MUSCLE WEAKNESS; NAUSEA AND VOMITING; PRIORITY JOURNAL; RESPIRATORY ARREST; RESPIRATORY DISTRESS; REVIEW; SEIZURE; SODIUM BLOOD LEVEL; SYSTEMATIC REVIEW;

ADAPTATION, PHYSIOLOGICAL; ALGORITHMS; BRAIN CHEMISTRY; BRAIN EDEMA; HUMANS; HYPONATREMIA; INAPPROPRIATE ADH SYNDROME; SODIUM; WATER-ELECTROLYTE BALANCE;

EID: 78651495378     PISSN: 00015172     EISSN: 13996576     Source Type: Journal    
DOI: 10.1111/j.1399-6576.2010.02311.x     Document Type: Review

References (79)

1. Upadhyay A, Jaber BL, Madias NE., Epidemiology of hyponatremia. Semin Nephrol 2009; 29: 227-38.
2. Boscoe A, Paramore C, Verbalis JG., Cost of illness of hyponatremia in the United States. Cost Eff Resour Alloc 2006; 4: 10-20.
3. Ayus JC, Achinger SG, Arieff A., Brain cell volume regulation in hyponatremia: role of sex, age, vasopressin, and hypoxia. Am J Physiol Renal Physiol 2008; 295: F619-24.
4. Sterns RH, Nigwekar SU, Hix JK., The treatment of hyponatremia. Semin Nephrol 2009; 29: 282-99.
5. Verbalis JG, Goldsmith SR, Greenberg A, Schrier RW, Sterns RH., Hyponatremia treatment guidelines 2007: expert panel recommendations. Am J Med 2007; 120: S1-21.
6. Movig KL, Leufkens HG, Lenderink AW, Egberts AC., Validity of hospital discharge International Classification of Diseases (ICD) codes for identifying patients with hyponatremia. J Clin Epidemiol 2003; 56: 530-5.
7. Hoorn EJ, Lindemans J, Zietse R., Development of severe hyponatraemia in hospitalized patients: treatment-related risk factors and inadequate management. Nephrol Dial Transplant 2006; 21: 70-6.
8. Siddique H, Kahal H, Tahrani AA, Chikura B, Shankland R, Anders J, Kaja R, Hardy K, Daggett P., The management of hyponatraemia at two district general hospitals in the UK. J Eval Clin Pract 2010 Jul [Epub ahead of print].
9. Walker MR, Fuhr PG, Koyle MA., Fatal hyponatremia in a 7-year-old girl with cloacal exstrophy after cystoscopy for a bladder stone. J Pediatr Urol 2008; 4: 231-3.
10. Cansick J, Rees L, Koffman G, Van't Hoff W, Bockenhauer D., A fatal case of cerebral oedema with hyponatraemia and massive polyuria after renal transplantation. Pediatr Nephrol 2009; 24: 1231-4.
11. Sjoblom E, Hojer J, Ludwigs U, Pirskanen R., Fatal hyponatraemic brain oedema due to common gastroenteritis with accidental water intoxication. Intensive Care Med 1997; 23: 348-50.
12. Berl T., Treating hyponatremia: damned if we do and damned if we don't. Kidney Int 1990; 37: 1006-18.
13. Adrogue HJ, Madias NE., Hyponatremia. N Engl J Med 2000; 342: 1581-9.
14. Edelman IS, Leibman J, O'Meara MP, Birkenfeld LW., Interrelations between serum sodium concentration, serum osmolarity and total exchangeable sodium, total exchangeable potassium and total body water. J Clin Invest 1958; 37: 1236-56.
15. Kurtz I, Nguyen MK., A simple quantitative approach to analyzing the generation of the dysnatremias. Clin Exp Nephrol 2003; 7: 138-43. (Pubitemid 36898691)
16. Nguyen MK, Kurtz I., A new quantitative approach to the treatment of the dysnatremias. Clin Exp Nephrol 2003; 7: 125-37. (Pubitemid 36898690)
17. Boling EA, Lipkind JB., Body composition and serum electrolyte concentrations. J Appl Physiol 1963; 18: 943-9.
18. Engquist A, Brandstrup B., Elektrolytforandringer og deres behandling, In:, Engquist A, Brandstrup B, eds. Rationel vÃ∥ske-, elektrolytbehandling og ernÃ∥ring. Copenhagen: Munksgaard Danmark, 2004: 81-128.
19. Joffe P, Brandstrup B, Fogh B., Ãndringer i vÃ∥ske- og elektrolytbalancen. In:, Pedersen C, ed. Medicin.dk 2010. Copenhagen: Infomatum. 2009: 162-4.
20. Overgaard-Steensen C, Larsson A, Bluhme H, Tonnesen E, Frokiaer J, Ring T., Edelman's equation is valid in acute hyponatremia in a porcine model: plasma sodium concentration is determined by external balances of water and cations. Am J Physiol Regul Integr Comp Physiol 2010; 298: R120-9.
21. Rose BD., New approach to disturbances in the plasma sodium concentration. Am J Med 1986; 81: 1033-40.
22. Mallie JP, Ait-Djaffer Z, Laroche F, Mario J, Perrier JC, Voltz C, Halperin ML., Variations in plasma sodium concentration in post-operative patients depend on an electrolyte-free water balance, part of a tonicity balance. Clin Nephrol 1998; 49: 287-92.
23. Hillier TA, Abbott RD, Barrett EJ., Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med 1999; 106: 399-403.
24. Hilden T, Svendsen TL., Electrolyte disturbances in beer drinkers: a specific "hypo-osmolality syndrome". Lancet 1975; 306: 245-6.
25. Sanghvi SR, Kellerman PS, Nanovic L., Beer potomania: an unusual cause of hyponatremia at high risk of complications from rapid correction. Am J Kidney Dis 2007; 50: 673-80.
26. Smith D, Moore K, Tormey W, Baylis PH, Thompson CJ., Downward resetting of the osmotic threshold for thirst in patients with SIADH. Am J Physiol Endocrinol Metab 2004; 287: E1019-23.
27. McKinley MJ, Johnson AK., The physiological regulation of thirst and fluid intake. News Physiol Sci 2004; 19: 1-6.
28. Feldman BJ, Rosenthal SM, Vargas GA, Fenwick RG, Huang EA, Matsuda-Abedini M, Lustig RH, Mathias RS, Portale AA, Miller WL, Gitelman SE., Nephrogenic syndrome of inappropriate antidiuresis. N Engl J Med 2005; 352: 1884-90.
29. Fenske W, Stork S, Blechschmidt A, Maier SG, Morgenthaler NG, Allolio B., Copeptin in the differential diagnosis of hyponatremia. J Clin Endocrinol Metab 2009; 94: 123-9.
30. Kumar S, Berl T., Sodium. Lancet 1998; 352: 220-8.
31. Schrier RW, Bansal S., Diagnosis and management of hyponatremia in acute illness. Curr Opin Crit Care 2008; 14: 627-34.
32. Dvir D, Beigel R, Hoffmann C, Tsarfati G, Farfel Z, Pauzner R., Hyponatremic brain edema: correlation with serial computed tomography scans. Isr Med Assoc J 2009; 11: 442-3.
33. Mount DB, Krahn TA., Hyponatremia: case vignettes. Semin Nephrol 2009; 29: 300-17.
34. Dubowitz DJ, Dyer EA, Theilmann RJ, Buxton RB, Hopkins SR., Early brain swelling in acute hypoxia. J Appl Physiol 2009; 107: 244-52.
35. Arieff AI, Llach F, Massry SG., Neurological manifestations and morbidity of hyponatremia: correlation with brain water and electrolytes. Medicine (Baltimore) 1976; 55: 121-9.
36. Ayus JC, Armstrong D, Arieff AI., Hyponatremia with hypoxia: effects on brain adaptation, perfusion, and histology in rodents. Kidney Int 2006; 69: 1319-25.
37. Holliday MA, Kalayci MN, Harrah J., Factors that limit brain volume changes in response to acute and sustained hyper- and hyponatremia. J Clin Invest 1968; 47: 1916-28.
38. Melton JE, Nattie EE., Brain and CSF water and ions during dilutional and isosmotic hyponatremia in the rat. Am J Physiol 1983; 244: R724-32.
39. Olson JE, Mishler L, Dimlich RV., Brain water content, brain blood volume, blood chemistry, and pathology in a model of cerebral edema. Ann Emerg Med 1990; 19: 1113-21.
40. Olson JE, Katz-Stein A, Reo NV, Jolesz FA., Evaluation of acute brain edema using quantitative magnetic resonance imaging: effects of pretreatment with dexamethasone. Magn Reson Med 1992; 24: 64-74.
41. Overgaard-Steensen C, Stodkilde-Jorgensen H, Larsson A, Broch-Lips M, Tonnesen E, Frokiaer J, Ring T., Regional differences in osmotic behavior in brain during acute hyponatremia: an in vivo MRI-study of brain and skeletal muscle in pigs. Am J Physiol Regul Integr Comp Physiol 2010; 299: R521-32.
42. Verbalis JG, Gullans SR., Hyponatremia causes large sustained reductions in brain content of multiple organic osmolytes in rats. Brain Res 1991; 567: 274-82.
43. Vexler ZS, Ayus JC, Roberts TP, Fraser CL, Kucharczyk J, Arieff AI., Hypoxic and ischemic hypoxia exacerbate brain injury associated with metabolic encephalopathy in laboratory animals. J Clin Invest 1994; 93: 256-64.
44. Hew-Butler T, Ayus JC, Kipps C, Maughan RJ, Mettler S, Meeuwisse WH, Page AJ, Reid SA, Rehrer NJ, Roberts WO, Rogers IR, Rosner MH, Siegel AJ, Speedy DB, Stuempfle KJ, Verbalis JG, Weschler LB, Wharam P., Statement of the Second International Exercise-Associated Hyponatremia Consensus Development Conference, New Zealand, 2007. Clin J Sport Med 2008; 18: 111-21.
45. Baran D, Hutchinson TA., The outcome of hyponatremia in a general hospital population. Clin Nephrol 1984; 22: 72-6.
46. Sterns RH, Thomas DJ, Herndon RM., Brain dehydration and neurologic deterioration after rapid correction of hyponatremia. Kidney Int 1989; 35: 69-75.
47. Restuccia T, Gomez-Anson B, Guevara M, Alessandria C, Torre A, Alayrach ME, Terra C, Martin M, Castellvi M, Rami L, Sainz A, Gines P, Arroyo V., Effects of dilutional hyponatremia on brain organic osmolytes and water content in patients with cirrhosis. Hepatology 2004; 39: 1613-22.
48. Videen JS, Michaelis T, Pinto P, Ross BD., Human cerebral osmolytes during chronic hyponatremia. A proton magnetic resonance spectroscopy study. J Clin Invest 1995; 95: 788-93.
49. Tomlinson BE, Pierides AM, Bradley WG., Central pontine myelinolysis. Two cases with associated electrolyte disturbance. Q J Med 1976; 45: 373-86.
50. Sterns RH, Riggs JE, Schochet SS Jr., Osmotic demyelination syndrome following correction of hyponatremia. N Engl J Med 1986; 314: 1535-42.
51. Brunner JE, Redmond JM, Haggar AM, Kruger DF, Elias SB., Central pontine myelinolysis and pontine lesions after rapid correction of hyponatremia: a prospective magnetic resonance imaging study. Ann Neurol 1990; 27: 61-6.
52. Sterns RH, Cappuccio JD, Silver SM, Cohen EP., Neurologic sequelae after treatment of severe hyponatremia: a multicenter perspective. J Am Soc Nephrol 1994; 4: 1522-30.
53. Mount DB., The brain in hyponatremia: both culprit and victim. Semin Nephrol 2009; 29: 196-215.
54. Lien YH., Role of organic osmolytes in myelinolysis. A topographic study in rats after rapid correction of hyponatremia. J Clin Invest 1995; 95: 1579-86.
55. Gankam KF, Soupart A, Pochet R, Brion JP, Decaux G., Re-induction of hyponatremia after rapid overcorrection of hyponatremia reduces mortality in rats. Kidney Int 2009; 76: 614-21.
56. Martin RJ., Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes. J Neurol Neurosurg Psychiatry 2004; 75 (Suppl. 3): iii22-8.
57. Moritz ML, Ayus JC., 100 cc 3% sodium chloride bolus: a novel treatment for hyponatremic encephalopathy. Metab Brain Dis 2010; 25: 91-6.
58. Bissram M, Scott FD, Liu L, Rosner MH., Risk factors for symptomatic hyponatraemia: the role of pre-existing asymptomatic hyponatraemia. Intern Med J 2007; 37: 149-55.
59. Ayus JC, Krothapalli RK, Arieff AI., Changing concepts in treatment of severe symptomatic hyponatremia. Rapid correction and possible relation to central pontine myelinolysis. Am J Med 1985; 78: 897-902.
60. Cheng JC, Zikos D, Skopicki HA, Peterson DR, Fisher KA., Long-term neurologic outcome in psychogenic water drinkers with severe symptomatic hyponatremia: the effect of rapid correction. Am J Med 1990; 88: 561-6.
61. Lin CM, Po HL., Extrapontine myelinolysis after correction of hyponatremia presenting as generalized tonic seizures. Am J Emerg Med 2008; 26: 632-36.
62. Ayus JC, Krothapalli RK, Arieff AI., Treatment of symptomatic hyponatremia and its relation to brain damage. A prospective study. N Engl J Med 1987; 317: 1190-5.
63. Verbalis JG, Martinez AJ., Neurological and neuropathological sequelae of correction of chronic hyponatremia. Kidney Int 1991; 39: 1274-82.
64. Schrier RW., Does 'asymptomatic hyponatremia' exist? Nat Rev Nephrol 2010; 6: 185.
65. Battison C, Andrews PJ, Graham C, Petty T., Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury. Crit Care Med 2005; 33: 196-202.
66. Sarnaik AP, Meert K, Hackbarth R, Fleischmann L., Management of hyponatremic seizures in children with hypertonic saline: a safe and effective strategy. Crit Care Med 1991; 19: 758-62.
67. Worthley LI, Thomas PD., Treatment of hyponatraemic seizures with intravenous 29.2% saline. Br Med J (Clin Res Ed) 1986; 292: 168-70.
68. Liamis G, Kalogirou M, Saugos V, Elisaf M., Therapeutic approach in patients with dysnatraemias. Nephrol Dial Transplant 2006; 21: 1564-9.
69. Ring T, Overgaard C., Correcting hypervolaemic hypernatraemia. Nephrol Dial Transplant 2008; 23: 3366-8.
70. Perianayagam A, Sterns RH, Silver SM, Grieff M, Mayo R, Hix J, Kouides R., DDAVP is effective in preventing and reversing inadvertent overcorrection of hyponatremia. Clin J Am Soc Nephrol 2008; 3: 331-6.
71. Fenske W, Maier SK, Blechschmidt A, Allolio B, Stork S., Utility and limitations of the traditional diagnostic approach to hyponatremia: a diagnostic study. Am J Med 2010; 123: 652-7.
72. Chung HM, Kluge R, Schrier RW, Anderson RJ., Clinical assessment of extracellular fluid volume in hyponatremia. Am J Med 1987; 83: 905-8.
73. Berl T, Quittnat-Pelletier F, Verbalis JG, Schrier RW, Bichet DG, Ouyang J, Czerwiec FS., Oral tolvaptan is safe and effective in chronic hyponatremia. J Am Soc Nephrol 2010; 21: 705-12.
74. McGee S, Abernethy WB III, Simel DL., The rational clinical examination. Is this patient hypovolemic? J Am Med Assoc 1999; 281: 1022-9.
75. Fenske W, Stork S, Koschker AC, Blechschmidt A, Lorenz D, Wortmann S, Allolio B., Value of fractional uric acid excretion in differential diagnosis of hyponatremic patients on diuretics. J Clin Endocrinol Metab 2008; 93: 2991-7.
76. Maesaka JK, Imbriano LJ, Ali NM, Ilamathi E., Is it cerebral or renal salt wasting? Kidney Int 2009; 76: 934-8.
77. Decaux G., The syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Semin Nephrol 2009; 29: 239-56.
78. Kahn T., Reset osmostat and salt and water retention in the course of severe hyponatremia. Medicine (Baltimore) 2003; 82: 170-6.
79. Park CW, Shin YS, Ahn SJ, Kim SY, Choi EJ, Chang YS, Bang BK., Thyroxine treatment induces upregulation of renin-angiotensin-aldosterone system due to decreasing effective plasma volume in patients with primary myxoedema. Nephrol Dial Transplant 2001; 16: 1799-806.