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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]
  • CASE PRESENTATION: A 52-year-old Sri Lankan man presented with anorexia, nausea, fatigue, generalized muscle weakness, and cramps for 1 week.[ncbi.nlm.nih.gov]
  • OBJECTIVE: To present a case with 4 different potential causes of hyponatremia.[ncbi.nlm.nih.gov]
  • Abstract We present a case of Cushing's syndrome that presented with hyponatremia. A 64-year-old obese woman presented to the hospital emergency service complaining of a high fever, hypertension, and generalized oedema.[ncbi.nlm.nih.gov]
  • If these measures fail, as in the case presented here, it is essential to rapidly eliminate any free water and to normalize the sodium levels.[ncbi.nlm.nih.gov]
Fatigue
  • CASE PRESENTATION: A 52-year-old Sri Lankan man presented with anorexia, nausea, fatigue, generalized muscle weakness, and cramps for 1 week.[ncbi.nlm.nih.gov]
  • Frequent clinical symptoms were nausea (n 130, 44%), acute vomiting (n 91, 30%), generalized weakness (n 205, 69%), fatigue (n 175, 59%), gait disturbance (n 92, 31%), recurrent falls (n 47, 16%), and acute falls (n 60, 20%).[ncbi.nlm.nih.gov]
  • […] hy·po·na·tre·mia \ ˌhī-pō-nā-ˈtrē-mē-ə \ variants: or chiefly British hyponatraemia 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[merriam-webster.com]
  • Cramps may be more associated with neuromuscular fatigue than dehydration/electrolyte losses, and mild dehydration is not associated with increased cramping (3).[diabetesincontrol.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]
Antipsychotic Agent
  • In these cases a tendency to hyponatremia will be unmasked and enhanced by a concurrent (even mild) impairment in water excretion. 13, 14, 15 This occurs in the setting of central nervous system dysfunction and in patients receiving antipsychotic agents[ncbi.nlm.nih.gov]
Rales
  • Signs of hypervolaemia - pulmonary rales, S3 gallop (third heart sound), jugular venous distention, peripheral oedema, ascites.[patient.info]
Dyspnea
  • Box 2: Applying the results of this review in clinical practice A 60-year-old man presents with increasing dyspnea on exertion.[doi.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 changes[quizlet.com]
Vomiting
  • Laboratory investigations revealed severe hyponatremia possibly triggered by vomiting and diarrhea. 24 hours after correction of hyponatremia she developed diffuse myalgias and marked hyperCKemia.[ncbi.nlm.nih.gov]
  • CLINICAL PRESENTATION AND INTERVENTION: The patient presented with the following symptoms: nausea, vomiting, diarrhea, and dark urine after drinking large amounts of fluids that included alcohol and caffeine.[ncbi.nlm.nih.gov]
  • 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]
  • Abstract A 41 year old Jordanian gentleman known case of osteogenesis imperfecta presented with vomiting, decreased oral intake followed by confusion. At presentation he was found to have signs of hypogonadism with severe hyponatremia.[ncbi.nlm.nih.gov]
  • METHODS: An 8-y boy presented with headache, vomiting, and diplopia. Magnetic resonance imaging of the brain confirmed a mass in the pineal region. Pathology report demonstrated a mixed germ cell tumor with a yolk sac component.[ncbi.nlm.nih.gov]
Nausea
  • CLINICAL PRESENTATION AND INTERVENTION: The patient presented with the following symptoms: nausea, vomiting, diarrhea, and dark urine after drinking large amounts of fluids that included alcohol and caffeine.[ncbi.nlm.nih.gov]
  • […] for anyone who develops severe signs and symptoms of hyponatremia, such as nausea and vomiting, confusion, seizures, or lost consciousness.[mayoclinic.com]
  • CASE: A 17-year-old boy was admitted to the emergency department with abdominal pain, nausea and vomiting, asthenia, and weight loss.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: A 52-year-old Sri Lankan man presented with anorexia, nausea, fatigue, generalized muscle weakness, and cramps for 1 week.[ncbi.nlm.nih.gov]
  • Frequent clinical symptoms were nausea (n 130, 44%), acute vomiting (n 91, 30%), generalized weakness (n 205, 69%), fatigue (n 175, 59%), gait disturbance (n 92, 31%), recurrent falls (n 47, 16%), and acute falls (n 60, 20%).[ncbi.nlm.nih.gov]
Loss of Appetite
  • 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]
  • Signs and symptoms of hyponatremia include nausea and vomiting, headache, short-term memory loss, confusion, lethargy, fatigue, loss of appetite, irritability, muscle weakness, spasms or cramps, seizures, and decreased consciousness or coma.[en.wikipedia.org]
  • 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]
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]
  • He was in poor general condition, hypotensive, and he had dry mucous membranes and skin as well as mucosa hyperpigmentation. The laboratory findings showed severe hyponatremia, hyperkalemia, and renal dysfunction.[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]
  • […] or with postural hypotension or tachycardia.[doi.org]
  • Patients presenting with orthostatic hypotension and normal plasma sodium concentrations are frequently admitted to the hospital with a diagnosis of dehydration.[doi.org]
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]
  • 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]
Jugular Venous Distention
  • Signs of hypervolaemia - pulmonary rales, S3 gallop (third heart sound), jugular venous distention, peripheral oedema, ascites.[patient.info]
Muscle Cramp
  • RESULTS: 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]
  • 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]
  • […] hy·po·na·tre·mia \ ˌhī-pō-nā-ˈtrē-mē-ə \ variants: or chiefly British hyponatraemia 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[merriam-webster.com]
  • The milder symptoms include nausea, vomiting , and muscle cramps and spasms. The danger is that these are similar to the symptoms of dehydration, and if you misdiagnose yourself and start drinking more fluids, you'll make the problem more serious.[health.howstuffworks.com]
Muscle Weakness
  • CASE PRESENTATION: A 52-year-old Sri Lankan man presented with anorexia, nausea, fatigue, generalized muscle weakness, and cramps for 1 week.[ncbi.nlm.nih.gov]
  • Other symptoms include: Fatigue Convulsions Headache Muscle weakness or spasms Nausea and vomiting Restlessness Confusion Decreased consciousness Treatment of Hyponatremia Under no circumstances should the individual be given hypotonic or isotonic fluids[sportsinjuryclinic.net]
  • Muscle weakness. Poor appetite that does not improve. Shortness of breath, chest pain or discomfort; should be evaluated immediately.[chemocare.com]
  • Symptoms Hyponatremia signs and symptoms may include: Nausea and vomiting Headache Confusion Loss of energy, drowsiness and fatigue Restlessness and irritability Muscle weakness, spasms or cramps Seizures Coma When to see a doctor Seek emergency care[mayoclinic.com]
Kidney Failure
  • Hypercalcemia and hypercalciuria are important electrolyte imbalances resulting from sarcoidosis and sometimes they may cause nephrolitiasis and kidney failure.[ncbi.nlm.nih.gov]
  • Hypervolemic hyponatremia Hypervolemic hyponatremia occurs when the level of water in the body is too high, which is often caused by kidney failure, liver failure or heart failure.[news-medical.net]
  • Some causes that may be related to kidney disease include: Kidney failure - the kidneys cannot get rid of extra fluid from the body Congestive heart failure - excess fluid builds up in the body Diuretics (water pills) - makes the body get rid of more[kidney.org]
  • High volume hyponatremia can occur from heart failure, liver failure, and kidney failure.[en.wikipedia.org]
  • This type of hyponatremia can be the result of chronic conditions such as kidney failure (when excess fluid cannot be efficiently excreted) and congestive heart failure , in which excess fluid accumulates in the body.[medicinenet.com]
Seizure
  • 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]
  • Abstract We report a 26-year-old woman admitted to our hospital for generalized tonic seizure.[ncbi.nlm.nih.gov]
  • The patient developed acute symptomatic seizures and coma. Gradual normalization of the sodium level led to a recovery of consciousness. CONCLUSION: Treatment with hypertonic sodium, fluid restriction, and antibiotics led to a complete recovery.[ncbi.nlm.nih.gov]
  • Post-transplant seizures are uncommon in young kidney transplant recipients but can be harbingers of devastating outcomes such as cerebral edema and death.[ncbi.nlm.nih.gov]
  • Abstract A 37-year-old woman presented to the emergency department with severe headache, which quickly progressed to altered mental status and seizure activity in hospital. Her initial serum sodium concentration ([Na]) was 126 mmol/L.[ncbi.nlm.nih.gov]
Confusion
  • During the examination, the patient suddenly became confused and lost consciousness. She was admitted to the intensive care unit. In addition, blood was drawn to measure the cortisol and ACTH levels, and urine samples were sent for analysis.[ncbi.nlm.nih.gov]
  • Abstract A 41 year old Jordanian gentleman known case of osteogenesis imperfecta presented with vomiting, decreased oral intake followed by confusion. At presentation he was found to have signs of hypogonadism with severe hyponatremia.[ncbi.nlm.nih.gov]
  • Cognitive impairment (eg, short-term memory loss, disorientation, confusion, depression). Focal or generalised seizures.[patient.info]
  • In more serious instances, the brain swells, and confusion and dementia can set it as it presses against the skull.[health.howstuffworks.com]
Lethargy
  • 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]
  • The symptoms can also be accompanied by headaches, lethargy and fatigue as the body fights to correct the sodium imbalance. In more serious instances, the brain swells, and confusion and dementia can set it as it presses against the skull.[health.howstuffworks.com]
  • Therefore, medical care should be sought when individuals develop altered mental status, confusion, or lethargy; have had a seizure ; or cannot be wakened.[emedicinehealth.com]
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]
  • He was eventually admitted to the hospital with altered mental status and was noted to have hyponatremia with serum sodium of 121 mEq/L.[ncbi.nlm.nih.gov]
  • SUMMARY: An 82-year-old woman presented to the emergency department with altered mental status thought to be due to complicated cystitis and was treated with TMP-SMX 160 mg/800 mg orally twice daily for 7 days.[ncbi.nlm.nih.gov]
  • Less common but still belonging in the differential are pseudohyponatremia secondary to alcohol-induced severe hypertriglyceridemia and cerebral salt wasting syndrome. 2,3 Beer potomania usually manifests as altered mental status, weakness, and gait disturbance[mdedge.com]
  • Therefore, medical care should be sought when individuals develop altered mental status, confusion, or lethargy; have had a seizure ; or cannot be wakened.[emedicinehealth.com]
Agitation
  • On admission, the patient was agitated and had slurred speech. Treatment with hypertonic saline lead to full recovery. A brisk aquaresis confirmed acute dilutional hyponatremia.[ncbi.nlm.nih.gov]
  • He was evaluated at a community hospital emergency department and given lorazepam due to agitation and combativeness before discharge. However, he returned with hypothermia, hyponatremia, and status epilepticus resulting in intubation.[ncbi.nlm.nih.gov]
  • On arrival in the ED she was confused and agitated. Her oral temperature is 36.6 C, her chest is clear with SaO2 98% on air, she appears to have bitten her tongue and she has oedematous ankles.[lifeinthefastlane.com]
  • Symptoms are often vague and non-specific presenting as headache, irritability, lethargy, confusion, agitation or unstable gait leading to a fall. Approach to Emergency Management of Hyponatremia Conceived by Dr.[emergencymedicinecases.com]

Workup

  • Yield of performed workup for hypothyroidism and hypoadrenalism in euvolemic hyponatremia was low.[ncbi.nlm.nih.gov]
  • Copeptin in hyponatremia: is there a role for this biomarker in the diagnostic workup?. Endocrine. 2018 Jun. 60 (3):384-5. [Medline]. [Full Text]. Lindner G, Schwarz C. An update on the current management of hyponatremia.[emedicine.medscape.com]
  • See Workup for more detail. Management Hypotonic hyponatremia accounts for most clinical cases of hyponatremia and can be treated with fluids. Acute hyponatremia (duration 48 hours) can be safely corrected more quickly than chronic hyponatremia.[emedicine.medscape.com]

Treatment

  • Current HN treatment varies widely, with no consensus. This study recorded treatment practices currently used for patients hospitalized with acute heart failure and HN.[ncbi.nlm.nih.gov]
  • Expert opinion: Several pharmacological options are available for the treatment of hyponatremia, but data from trials examining and comparing these treatments are missing.[ncbi.nlm.nih.gov]
  • The risk for hyponatremia was lower during ongoing treatment. Lamotrigine and gabapentin had the lowest risk both during initiation and ongoing treatment and may be advantageous in patients at risk of developing hyponatremia.[ncbi.nlm.nih.gov]
  • Oral trimethoprim/sulfamethoxazole treatment led to severe hyponatremia; therefore, long-term treatment with parenteral amikacin and minocycline was initiated.[ncbi.nlm.nih.gov]
  • To investigate the temporal aspects of drug-induced hyponatremia, antidepressant exposure was divided into patients with newly initiated and ongoing treatment.[ncbi.nlm.nih.gov]

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]
  • The prognosis and possible association with hyponatremia was investigated. RESULTS: The incidence rate of hyponatremia in SCLC was 46.56% (149/320).[ncbi.nlm.nih.gov]
  • Hyponatremia in acute decompensated heart failure (HF) is indicative of a poor prognosis and predicts morbidity and mortality.[ncbi.nlm.nih.gov]
  • Physicians should raise awareness to improve the prognosis of hyponatremia.[ncbi.nlm.nih.gov]
  • And cancer and tuberculosis were further suspected, although the exact nature at last was not clearly determined due to the unfavorable prognosis.[ncbi.nlm.nih.gov]

Etiology

  • The most common etiology of hypopituitarism was non-functioning pituitary macro adenoma (NFPA) (n   128, 49.2%).[ncbi.nlm.nih.gov]
  • Thus, the etiology, predisposing factors, and recommendations for prevention are vague-except for advice to avoid excessive drinking.[ncbi.nlm.nih.gov]
  • The diverse etiologies and comorbidities associated with hyponatremia pose substantial challenges in managing this disorder.[ncbi.nlm.nih.gov]
  • Abstract Hyponatremia is the most common electrolyte abnormality in clinical practice, and a differential diagnosis of the etiologic disorders is crucial because hyponatremia is associated with many different disease states including malignancies.[ncbi.nlm.nih.gov]
  • Cases of secondary PRES developing for several etiological reasons have been reported in induction therapy, but no pediatric cases of PRES developing secondary to hyponatremia despite being normotensive while receiving chemotherapy in acute lymphoblastic[ncbi.nlm.nih.gov]

Epidemiology

  • This review focuses on the epidemiology, pathogenesis, and therapy of exercise-associated hyponatremia.[ncbi.nlm.nih.gov]
  • Epidemiological, comorbidity and admis sion-related data were collected, including type of solution received, sodium and chlorine values in the first 72 hours of hospitalization and the incidence of extravasation of peripheral intravenous lines.[ncbi.nlm.nih.gov]
  • RESULTS: Epidemiology of falls: Twenty-six patients (21.3%) of 122 were admitted for falls, compared with only 5.3% of the control patients (adjusted odds ratio: 67; 95% confidence: 7.5-607; P CONCLUSIONS: Mild chronic hyponatremia induces a high incidence[ncbi.nlm.nih.gov]
  • Biomedical Research Unit in Cardiovascular Disease at Royal Brompton & Harefield, NHS Foundation Trust and Imperial College London, London, United Kingdom. 2 National Heart and Lung Institute, Imperial College London, London, United Kingdom. 3 Genetic Epidemiology[ncbi.nlm.nih.gov]
  • Author information 1 Stichting Epilepsie Instellingen Nederland (SEIN), Zwolle, The Netherlands. 2 Department of Epidemiology, Medical School Twente, Enschede, The Netherlands. 3 Department of Research Methodology, Measurement and Data Analysis, University[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • Additionally, we review all previously reported studies of hyponatremia in patients with NMOSDs and propose several potential pathophysiological mechanisms of hyponatremia.[ncbi.nlm.nih.gov]
  • This review focuses on the clinical and pathophysiological aspects of hyponatremia and highlights the causes, presentation and treatment recommendations for hyponatremic patients with HIV/AIDS. KEYWORDS: AIDS; HIV; hyponatremia[ncbi.nlm.nih.gov]
  • We reviewed relevant literature on extrapontine myelinolysis in suprasellar tumors and the pathophysiology. Hypopituitarism is an underrecognized cause of hyponatremia.[ncbi.nlm.nih.gov]
  • The pathophysiology underlying this phenomenon has been widely regarded as a mere sequela of excessive arginine vasopressin (AVP) release.[ncbi.nlm.nih.gov]

Prevention

  • We evaluated published studies on the efficacy and safety of current preventative and treatment strategies for hyponatremia in patients with SAH.[ncbi.nlm.nih.gov]
  • Although there are various suggested treatment strategies in the setting of a medical ward or intensive care unit, reports of intraoperative management to prevent rapid increases in serum sodium are lacking.[ncbi.nlm.nih.gov]
  • 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]
  • Early diagnosis and treatment of this syndrome is important in terms of preventing neurological sequelae.[ncbi.nlm.nih.gov]
  • While relatively less probable to occur compared to dehydration, prevention is key to avoid hyponatremia related illness. Hyponatremia FAQs How do you prevent hyponatremia? Know thyself.[guenergy.com]

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Last updated: 2014-05-06 22:04