Diagnosis and treatment of hyponatraemia

Publication date: Available online 30 December 2015 Source:Best Practice & Research Clinical Endocrinology & Metabolism Author(s): S.G. Ball, Zohaib Iqbal Hyponatraemia is the most common electrolyte abnormality encountered by physicians in the hospital setting. It is associated with increased mortality and length of hospital stay. However, the basis of the relationship of hyponatraemia with clinical outcome is not clear. Doubt remains as to whether the relationship is causal. It may reflect the association of two independent variables both of which are linked with disease severity. Serum sodium concentration is regulated through integrated neuro-humeral mechanisms that overlap with those regulating circulating volume. A mechanistic approach to the classification of hyponatraemia can support a framework for investigation and differential diagnosis based on urine osmolality and urine sodium concentration. Such a framework is more reliable than those based on the clinical assessment of volume status. In the emergency setting, the initial management of hyponatraemia is cause-independent. In other clinical contexts, a cause-specific approach is recommended. Over-rapid correction of serum sodium risks precipitating osmotic demyelination syndrome. Avoiding over-rapid correction is critical in any approach to patient care. Sodium is the major circulating cation and thus a key determinant of overall plasma osmolality. Serum sodium concentration is maintained w...
Source: Best Practice and Research Clinical Endocrinology and Metabolism - Category: Endocrinology Source Type: research