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Hyponatremia

Low Sodium

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


Presentation

  • 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]
  • Craniopharyngiomas are rare intracranial tumors commonly presenting with neurological symptoms. Reports of severe hyponatremia as a presenting manifestation of a craniopharyngioma and hyponatremia-induced myopathy are rare.[ncbi.nlm.nih.gov]
  • Mercury (Hg) poisoning is considered a rare disease by the National Institutes of Health and the diagnosis can present great challenges to clinicians.[ncbi.nlm.nih.gov]
  • 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]
  • It may present with bilateral hilar lymphadenopathy, skin lesions, eye and musculoskeletal system involvement.[ncbi.nlm.nih.gov]
Fatigue
  • 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]
  • […] 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]
  • On the other hand, people slowed down by fatigue or those out of shape, should limit fluid intake, probably to less than two large water bottles per hour.[drmirkin.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]
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]
  • 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]
  • 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]
  • 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
  • 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]
  • 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]
  • Breathlessness, depressiveness, nausea, vomiting, poor appetite, constipation, and weakness were significantly more frequent in patients with hyponatremia.[ncbi.nlm.nih.gov]
  • 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]
  • His small-bowel obstruction, abdominal pain, and nausea resolve. In acute hyponatremia, the serum sodium level drops abruptly over less than 24 hours. The most common causes are nausea, vomiting, and diarrhea.[americannursetoday.com]
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]
  • 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]
  • The economic costs of hyponatremia are estimated at 2.6 billion in the United States. [9] Signs and symptoms [ edit ] Signs and symptoms of hyponatremia include nausea and vomiting , headache , short-term memory loss , confusion , lethargy , fatigue , loss[en.wikipedia.org]
Orthostatic Hypotension
  • 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]
  • hypotension have been observed it Iponatriemia Molto raramente con l uso di mirtazapina è stata riportata iponatriemia , probabilmente dovuta ad inappropriata secrezione di ormone antidiuretico (SIADH en Hyponatraemia Hyponatraemia , probably due to[it.glosbe.com]
  • hypotension More common : nausea, pollakiuria, polyuria, thirst, xerostomia Less common : anemia, atrial fibrillation, confusion, constipation, dehydration, diarrhea, dry mouth, electrocardiographic abnormalities, erythema, headache, hematuria, hyperglycemia[aafp.org]
Muscle Cramp
  • 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
  • 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]
  • 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]
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]
  • A low sodium level has many causes, including consumption of too many fluids, kidney failure, heart failure, cirrhosis, and use of diuretics. Symptoms result from brain dysfunction.[merckmanuals.com]
  • 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]
  • failure liver disease heart problems, including congestive heart failure adrenal gland disorders, such as Addison’s disease , which effects your adrenal glands' ability to regulate the balance of sodium, potassium, and water in your body hypothyroidism[healthline.com]
Seizure
  • To evaluate the safety of eslicarbazepine acetate (ESL) in new onset elderly poststroke seizure patients, especially with respect to hyponatremia.[ncbi.nlm.nih.gov]
  • 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. Treatment with hypertonic sodium, fluid restriction, and antibiotics led to a complete recovery.[ncbi.nlm.nih.gov]
  • Before the liver transplant, it is critical to correct severe hyponatremia to an appropriate level to reduce the risks of perioperative complications such as central pontine myelinolysis, cerebral edema, and seizures.[ncbi.nlm.nih.gov]
  • 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]
  • 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]
  • In more serious instances, the brain swells, and confusion and dementia can set it as it presses against the skull.[health.howstuffworks.com]
  • 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]
  • Cognitive impairment (eg, short-term memory loss, disorientation, confusion, depression). Focal or generalised seizures.[patient.info]
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]
  • 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]
  • 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]
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]
  • 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]
Somnolence
  • This lady’s urgent admission to hospital was prompted by somnolence following an intentional overdose (7,500 mg) of her sodium valproate medication.[acutecaretesting.org]
  • 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]
  • The patient was noted to be somnolent and confused. Table 1 summarizes the patient's laboratory data on admission. Table 1. Patient's laboratory results at time of admission.[clinchem.aaccjnls.org]

Workup

  • Yield of performed workup for hypothyroidism and hypoadrenalism in euvolemic hyponatremia was low.[ncbi.nlm.nih.gov]
  • Most likely the indication to determine TSH was either the presence of symptoms reflecting thyroid disease or the need for biochemical workup in the context of hyponatremia.[dx.doi.org]
  • 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]
  • The diagnostic workup should include a history and physical examination with specific attention to cardiac, cancer, pulmonary, surgical, endocrine, gastrointestinal, neurologic, and renal histories ( Table 1 ) . 11 – 13 Diuretics, carbamazepine (Tegretol[aafp.org]
Slowing
  • A total of 178 patients with severe symptomatic hyponatremia will be enrolled and randomly assigned to receive either rapid intermittent bolus or slow continuous infusion management with hypertonic saline.[ncbi.nlm.nih.gov]
  • On the other hand, people slowed down by fatigue or those out of shape, should limit fluid intake, probably to less than two large water bottles per hour.[drmirkin.com]
  • Hyponatremia began to be more of an issue at marathons and other long races 10 to 15 years ago, as average finishing times slowed and runners who were out on the course for several hours heeded all too well cautions about dehydration.[runnersworld.com]
  • The study [9] revealed that the risk factors for Hyponatremia in marathons include A slow finish time ( 4 hour) Consumption of 6 pints (3 liters) of water during the race BAA suggests a 'slight build' is also a risk factor The key to preventing Hyponatremia[fellrnr.com]
  • Second, slow initial therapy will still leave the patient at high risk of overcorrection (explained further below). . .[emcrit.org]

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]
  • 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]
  • In contrast, there was no evidence that ongoing treatment with antidepressants increases the risk for hospitalization due to hyponatremia.[ncbi.nlm.nih.gov]
  • We restrospectively reviewed our database on tolvaptan as an add-on treatment in hypervolemic patients admitted to our clinic due to deterioration of HF and having hyponatremia resistant to standard therapy.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis and possible association with hyponatremia was investigated. The incidence rate of hyponatremia in SCLC was 46.56% (149/320).[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]
  • Factors that might associate with prognosis of RN were collected. Multivariable logistic regression analyses were used to identify potential predictors.[ncbi.nlm.nih.gov]
  • Hyponatremia (HN) occurs commonly in patients with acute heart failure and confers a worse prognosis. Current HN treatment varies widely, with no consensus.[ncbi.nlm.nih.gov]
  • Correcting hyponatremia timely and appropriately could improve SCLC patients' 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]
  • 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]
  • The child was initially managed in the outpatient setting, and the investigation was mainly targeted toward infectious etiology, including Rocky Mountain spotted fever and Lyme disease.[ncbi.nlm.nih.gov]

Epidemiology

  • 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. 111 children[ncbi.nlm.nih.gov]
  • Here we evaluate the epidemiology and mortality of hyponatremia in general medical hospitalized patients in China. This is a cohort study of 154,378 adults who were hospitalized between 2008 and 2012 at a teaching hospital in Beijing.[ncbi.nlm.nih.gov]
  • Affiliations K Kalantar-Zadeh is an Associate Professor of Medicine and Pediatrics and Director of the Dialysis Expansion Program and Epidemiology at Harbor-UCLA Division of Nephrology and Hypertension, MK Nguyen (co-primary author) is an Assistant Professor[nature.com]
  • Epidemiology Hyponatraemia is the most common electrolyte abnormality encountered in clinical practice. An accurate incidence of mild hyponatraemia managed in the community is impossible, as it is rarely reported.[patient.info]
  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
Sex distribution
Age distribution

Pathophysiology

  • 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.[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]
  • The pathophysiology underlying this phenomenon has been widely regarded as a mere sequela of excessive arginine vasopressin (AVP) release.[ncbi.nlm.nih.gov]
  • This case demonstrates the typical pathophysiology, which includes overconsumption of fluids, and demonstrates the challenges of diagnosis and the importance of appropriate acute management.[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]

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]
  • 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]
  • This outcome suggests that, similar to the findings in rat models, relowering the serum sodium concentration as early as possible to counter a disturbance of consciousness during the overcorrection of hyponatremia prevents ODS.[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