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Hyponatremia
Hyponatriemia
Hyponatremia is an abnormally low concentration of sodium ions in blood.

Presentation

CASE: We present a case of adenoma malignum in a 52-year-old woman who presented with substantial watery vaginal discharge and profound hyponatremia. [ncbi.nlm.nih.gov]

Entire Body System

  • Fatigue

    Our patient complained of left knee pain, fatigue, and bilateral lower limb cramps. No pertinent medical history was recorded and her vital signs were within normal limits. [ncbi.nlm.nih.gov]

    […] medical : the condition of having an abnormally low level of sodium in the blood that is typically marked by nausea, vomiting, headache, confusion, fatigue, and muscle cramps and that when severe may be life-threatening if untreated … aspirin and other [merriam-webster.com]

    When sodium levels in the blood become too low, it leads to hyponatremia, causing symptoms that include lethargy, confusion, and fatigue. [medicalnewstoday.com]

    Symptoms like nausea, vomiting, loss of appetite, headaches, weakness, fatigue and confusion characterize hyponatremia. Complications in severe cases can include brain damage due to swelling; falls; seizures and coma. [draxe.com]

  • Hypothermia

    However, he returned with hypothermia, hyponatremia, and status epilepticus resulting in intubation. [ncbi.nlm.nih.gov]

    Clinically there is muscle weakness, hypothermia and dehydration. Patient discussion about hyponatremia Q. What steps do you take when your physician says your sodium is low A. [medical-dictionary.thefreedictionary.com]

    This could be due to overdose of certain medications, hypothermia or severe anoxia (lack of oxygen). [en.wikipedia.org]

Respiratoric

  • Dyspnea

    Eventually, the fluid enters the air spaces in the lungs (pulmonary edema) reduces the amount of oxygen that can enter the blood, and causes shortness of breath (dyspnea) or enters pleural space by transudation (pleural effusion which also causes dyspnea [en.wikipedia.org]

    […] paresteziile si potasium si calciul parestezii = hiperK / hipoCalcemie Pancreatita acuta si calciul Pancreatita acuta --> HIPOcalcemie Hipocalcemie = hipotensiune abdominal pain tetany muscle cramps dyspnea perioral tingling convulsions mental status [quizlet.com]

    Box 2: Applying the results of this review in clinical practice A 60-year-old man presents with increasing dyspnea on exertion. [doi.org]

    He presented with intense dyspnea and cough with greenish expectoration. The only finding of note on physical examination was the presence of disperse rhonchi in both hemithoraxes and the absence of edema or signs of fluid overload. [archbronconeumol.org]

    CASE An 53-year-old woman was seen in an emergency department for evaluating a chest pain and dyspnea for the past two months. [scielo.br]

  • Rales

    Signs of hypervolaemia - pulmonary rales, S3 gallop (third heart sound), jugular venous distention, peripheral oedema, ascites. [patient.info]

    […] all-cause mortality and (2) readmission for HF, defined as readmission to the hospital for management of HF (defined by the presence of new symptoms of dyspnea or edema with ≥1 concurrent sign, including ventricular gallop rhythm, bilateral posttussive rales [jamanetwork.com]

  • Cheyne-Stokes Respiration

    […] symptoms[edit] Gastro-intestinal[edit] Anorexia Nausea Musculoskeletal[edit] Muscle aches Generalized muscle weakness[3] Neuro-muscular[edit] Myoclonus[3] Decreased reflexes[3] Ataxia[3] Pathological reflexes[3] Tremor[3] Asterixis[3] Respiratory[edit] Cheyne-Stokes [en.wikipedia.org]

Gastrointestinal

  • Vomiting

    Individuals with symptoms, including vomiting, seizures, or loss of consciousness, require immediate attention. They should call an ambulance or go to the nearest emergency room. [medicalnewstoday.com]

    These drinks are also helpful if you lose a lot of fluids through vomiting or diarrhea. Staying hydrated throughout the day can help manage any wild swings in blood sodium. [healthline.com]

    Sometimes the medical history (such as prolonged vomiting or excessive sweating) will suggest the diagnosis. [medicinenet.com]

    In severe cases, you may have one or more of the following: Nausea or vomiting. [kidney.org]

  • Nausea

    […] for anyone who develops severe signs and symptoms of hyponatremia, such as nausea and vomiting, confusion, seizures, or lost consciousness. [mayoclinic.org]

    […] medical : the condition of having an abnormally low level of sodium in the blood that is typically marked by nausea, vomiting, headache, confusion, fatigue, and muscle cramps and that when severe may be life-threatening if untreated … aspirin and other [merriam-webster.com]

    Seek emergency care if you have: Vomiting or nausea Confusion Seizures Loss of consciousness or coma Hyponatremia Causes There are a lot of reasons your sodium level might get too low. These include: Medications. [webmd.com]

  • Loss of Appetite

    […] of appetite Irritability Restlessness Sluggishness Confusion Muscle twitching Hallucinations Seizures Diagnosis You will be asked about your symptoms and health history. [winchesterhospital.org]

    A 69-year-old previously well Sinhalese man presented with lethargy, loss of appetite, vomiting, and altered behavior of 1 week's duration. An examination revealed Glasgow Coma Scale of 13/15 and marginally low blood pressure. [ncbi.nlm.nih.gov]

    They include: headache nausea, loss of appetite, vomiting malaise lethargy weakness poor coordination muscle cramps somnolence disorientation personality change Physical Exam Volume status assessment is important to determine cause. [sharinginhealth.ca]

    Symptoms like nausea, vomiting, loss of appetite, headaches, weakness, fatigue and confusion characterize hyponatremia. Complications in severe cases can include brain damage due to swelling; falls; seizures and coma. [draxe.com]

  • Hiccup

    […] treatment of schizophrenia, bipolar disorder and other affective psychoses, but also in other neuropsychiatric disorders (such as dementia and autism), symptomatic treatment of acute confusional symptoms and other conditions not psychiatric (nausea, hiccups [intechopen.com]

    Signs and symptoms include2: Nausea, vomiting Headache Confusion Seizures Abnormal somnolence, coma Cardiorespiratory distress Hiccups Ataxia, falls Slow decision making Brain cells adjust to hyponatremia within 24-48 hours by reducing intracellular concentration [canadiem.org]

Cardiovascular

  • Hypotension

    After several weeks of suffering from gastroenteritis with vomiting, she presented with disturbance of consciousness, hypotension, dehydration, and severe hyponatremia (108 mEq/L) and a markedly increased serum vasopressin concentration (45.5 pg/mL). [ncbi.nlm.nih.gov]

    Hypovolemia or Hypotension: For patients who develop hypovolemia or hypotension while receiving VAPRISOL, VAPRISOL should be discontinued, and volume status and vital signs should be monitored. [vaprisol.com]

    Udgivelsesdato: 2008-Dec-8 AB - Acute adrenal insufficiency is a life threatening disease with dehydration, hypotension, cerebral dysfunction and gastrointestinal symptoms accompanied by low plasma sodium and high plasma potassium. [pure.au.dk]

  • Orthostatic Hypotension

    Patients presenting with orthostatic hypotension and normal plasma sodium concentrations are frequently admitted to the hospital with a diagnosis of dehydration. [doi.org]

    同时专家们还提出了两个新概念,我觉得也很有意思: 起始体位性低血压(initial orthostatic hypotension) Initial orthostatic hypotension is defined as a transient blood pressure decrease (40 mmHg systolic blood pressure and/or 20 mmHg diastolic blood pressure) within 15 s of standing. [news.medlive.cn]

    ADVERSE REACTIONS The most common adverse reactions (incidence ≥10%) reported in clinical trials were infusion site reactions (including phlebitis), pyrexia, hypokalemia, headache and orthostatic hypotension. [vaprisol.com]

    POINTS TO REMEMBER Primary adrenal insufficiency can present without pigmentation, orthostatic hypotension, hyperkalemia, hypoglycaemia, and hypercalcemia. [academic.oup.com]

  • Jugular Venous Distention

    Signs of hypervolaemia - pulmonary rales, S3 gallop (third heart sound), jugular venous distention, peripheral oedema, ascites. [patient.info]

    venous distention, edema), elevated B-type natriuretic peptide level, echocardiography, urinary sodium < 20 mEq per L Diuretics, angiotensin-converting enzyme inhibitors, beta blockers Hepatic failure/cirrhosis Elevated liver function tests, ascites, [aafp.org]

Musculoskeletal

  • Muscle Cramp

    […] medical : the condition of having an abnormally low level of sodium in the blood that is typically marked by nausea, vomiting, headache, confusion, fatigue, and muscle cramps and that when severe may be life-threatening if untreated … aspirin and other [merriam-webster.com]

    And contrary to popular belief, muscle cramps and fatigue aren't caused by dehydration but from pushing too hard. If an athlete starts to experience these symptoms, he should be allowed to sit it out for a few minutes. [mnn.com]

    Anthropomorphic characteristics, exercise time, and post-exercise ratings of thermal sensation, perceived exertion and muscle cramp were similar for LC, AM and CON. [ncbi.nlm.nih.gov]

  • Muscle Weakness

    A 52-year-old Sri Lankan man presented with anorexia, nausea, fatigue, generalized muscle weakness, and cramps for 1 week. The onset of his illness had been preceded by vomiting and diarrhea for 1 day which he attributed to food poisoning. [ncbi.nlm.nih.gov]

    Muscle weakness. Poor appetite that does not improve. Shortness of breath, chest pain or discomfort; should be evaluated immediately. [chemocare.com]

    Severe symptoms may include: vomiting muscle weakness, spasms, and twitching lethargy disorientation Doctors also associate mild chronic hyponatremia with the following complications: attention deficit gait instability osteoporosis fractures Without adequate [medicalnewstoday.com]

  • Muscle Hypotonia

    Motor delays and waddling gait have been attributed to muscle hypotonia. In severe cases, impaired hearing can develop over time. [biodonsys.com]

Neurologic

  • Seizure

    Individuals with symptoms, including vomiting, seizures, or loss of consciousness, require immediate attention. They should call an ambulance or go to the nearest emergency room. [medicalnewstoday.com]

    It can cause: overactive reflexes loss of consciousness seizures coma and in the most severe cases, death If you or someone you know seems to be losing consciousness or is having a seizure, call 911 immediately. [healthline.com]

    PURPOSE: To evaluate the safety of eslicarbazepine acetate (ESL) in new onset elderly poststroke seizure patients, especially with respect to hyponatremia. [ncbi.nlm.nih.gov]

    In serious cases, it can cause seizures, a coma, or even death. Hyponatremia is not a disease. It is a problem caused by something else, such as medicines or exercising for a long time in hot weather. [myhealth.alberta.ca]

  • Confusion

    Cognitive impairment (eg, short-term memory loss, disorientation, confusion, depression). Focal or generalised seizures. [patient.info]

    Confusion, or coma, with a significant drop in blood sodium levels. Things You Can Do For Hyponatremia: Follow your healthcare provider's instructions regarding increasing your blood sodium level. [chemocare.com]

    […] medical : the condition of having an abnormally low level of sodium in the blood that is typically marked by nausea, vomiting, headache, confusion, fatigue, and muscle cramps and that when severe may be life-threatening if untreated … aspirin and other [merriam-webster.com]

    When sodium levels in the blood become too low, it leads to hyponatremia, causing symptoms that include lethargy, confusion, and fatigue. [medicalnewstoday.com]

    Therefore, symptoms of brain dysfunction, such as sluggishness (lethargy) and confusion, occur first. If the sodium level in blood falls quickly, symptoms tend to develop rapidly and be more severe. [msdmanuals.com]

  • Headache

    It can cause nausea, vomiting, and headaches. Or you may not feel hungry. In serious cases, it can cause seizures, a coma, or even death. Hyponatremia is not a disease. [myhealth.alberta.ca]

    […] medical : the condition of having an abnormally low level of sodium in the blood that is typically marked by nausea, vomiting, headache, confusion, fatigue, and muscle cramps and that when severe may be life-threatening if untreated … aspirin and other [merriam-webster.com]

    Symptoms can be very nonspecific and can include: headache, confusion or altered mental state, seizures, and decreased consciousness, which can proceed to coma and death. [rxlist.com]

    Common symptoms of hyponatremia include: weakness fatigue or low energy headache nausea vomiting muscle cramps or spasms confusion irritability Severe symptoms of hyponatremia Losing sodium quickly is a medical emergency. [healthline.com]

  • Lethargy

    When sodium levels in the blood become too low, it leads to hyponatremia, causing symptoms that include lethargy, confusion, and fatigue. [medicalnewstoday.com]

    Patients may complain of headache, nausea and vomiting, lethargy, and confusion. If the sodium concentration drops quickly to critical levels, seizures, coma, and death may occur. [emedicinehealth.com]

    Thirteen months later, he was hospitalized for lethargy and hyponatremia of 108 mEq/L, with an antidiuretic hormone level of 2.5 pg/mL, which suggested syndrome of inappropriate antidiuretic hormone secretion (SIADH). [ncbi.nlm.nih.gov]

  • Altered Mental Status

    Her serum [Na] and altered mental status corrected slowly over the next 48 hours with furosemide, hypertonic saline, and fluid restriction. [ncbi.nlm.nih.gov]

    mental status, or coma. [aafp.org]

    mental status seizures a coma Certain factors increase the risk of developing hyponatremia, including: older age having specific conditions, such as SIADH or kidney, heart, or liver disease taking certain diuretics, antidepressants, or pain medications [medicalnewstoday.com]

Workup

Yield of performed workup for hypothyroidism and hypoadrenalism in euvolemic hyponatremia was low. [ncbi.nlm.nih.gov]

After a thorough workup, he was diagnosed to have reset osmostat. Reset osmostat is an uncommon and under recognised cause of hyponatremia which does not require any treatment. [hindawi.com]

Your provider will do a diagnostic workup if your blood sodium is low. The workup will include measuring urine sodium, potassium and creatinine concentrations. [my.clevelandclinic.org]

Simon EE, Hamrahian SM, Teran FJ.Hyponatremia workup. http://emedicine.medscape.com/article/242166-workup#a0719. Accessed December 10, 2013. 37. Agrawal V, Agarwal M, Joshi SR, Ghosh AK. Hyponatremia and hypernatremia: disorders of water balance. [journals.lww.com]

That diagnostic workup is important because isotonic (0.9%) saline therapy is ineffective for treating hyponatremia associated with SIADH, as the 2013 expert panel recommendations note. [acphospitalist.org]

Urine

  • Urine Sodium Decreased

    Additionally, urine osmolality increased from 365 mOsm/kg (IQR, 361–561) to 546 mOsm/kg (IQR, 542–602; P=0.13), whereas urine sodium decreased from 75 mEq/L (IQR, 42–105) to 50 mEq/L (IQR, 37–76; P=0.06). [cjasn.asnjournals.org]

Treatment

Treatment for hyponatremia involves restoring sodium levels and addressing what has caused them. [medicalnewstoday.com]

What diets and treatment guidelines are used for hyponatremia (low blood sodium)? Mild chronic hyponatremia may not require treatment other than adjustments in diet, lifestyle, or medications. [rxlist.com]

[…] to colonoscopy, treatment with IV cyclophosphamide, amphetamine use, recently started treatment with ADH analogues. [empendium.com]

Few studies have evaluated the treatment of hyponatremia in heart failure. [uscjournal.com]

Prognosis

In general, this neurological disorder has a fatal prognosis. We observed a 30-year-old woman with a history of chronic alcohol abuse but without evidence of hyponatremia, who developed severe pontine central myelinolysis. [ncbi.nlm.nih.gov]

Conclusions We demonstrated that hyponatremia was significantly associated with poorer prognosis in SCLC regardless of extensive or limited stage. The value of hyponatremia in SCLC is as a candidate prognosis factor in clinical practice. [tcr.amegroups.com]

Etiology

The most common etiology of hypopituitarism was non-functioning pituitary macro adenoma (NFPA) (n = 128, 49.2%). [ncbi.nlm.nih.gov]

The diverse etiologies and comorbidities associated with hyponatremia pose substantial challenges in managing this disorder. [pubmed.ncbi.nlm.nih.gov]

Epidemiology

This review focuses on the epidemiology, pathogenesis, and therapy of exercise-associated hyponatremia. [ncbi.nlm.nih.gov]

Pathophysiology

The AVP activity combines with other dilutional pathophysiologies to result in hyponatremia. Pathophysiology of hyponatremia in cirrhosis 3 Multiple factors lead to the development of hyponatremia in cirrhotic patients. [vaprisol.com]

Because age-related changes and chronic diseases are often associated with impairment of water metabolism in elderly patients, it is absolutely essential for clinicians to be aware of the pathophysiology of hyponatremia and hypernatremia in the elderly [ncbi.nlm.nih.gov]

Exploration of the development of new drugs that can effectively resolve the pathophysiology of systemic vasodilation in patients with cirrhosis is an additional avenue for study. [aasldpubs.onlinelibrary.wiley.com]

The precise pathophysiology is mostly unknown. [revportcardiol.org]

Prevention

Abstract Symptomatic exercise-associated hyponatremia (EAH) is known to be a potential complication from overhydration during exercise, but there remains a general belief that sodium supplementation will prevent EAH. [ncbi.nlm.nih.gov]

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