Clinical Practice Guideline on Diagnosis and Treatment of Hyponatraemia

Abstract

Hyponatraemia, defined as a serum sodium concentration <135 mmol/l, is the most common disorder of body fuid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution-and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.

The role of hyponatremia in preeclampsia

“…Separately, hyponatremia can be defined as hyperacute, acute, subacute and chronic hyponatremia that the hyponatremia developed over just a few hours, within the previous 24 hours, within the previous 24-48 hours and has been present for more than 48 hours, respectively [16][17][18][19]. Hyperacute hyponatremia with a sodium level of 120 mEq/L can lead to a brain herniation but the same sodium level with chronic hyponatremia may not cause any manifestations [17,18].…”

“…Hyponatremia can be classified into two groups: hyponatremia due to non-osmotic hypersecretion of ADH (hypovolemic, hypervolemic, euvolemic) and hyponatremia of non-hypervasopressinemic origin [18,19]. Hypovolemic hyponatremia can arise in a variety of settings for example in diarrhea, vomiting or other gastrointestinal fluid losses.…”

“…The three most common causes of hyponatremia with a high or normal serum osmolality are marked hyperglycemia, severe azotemia, and alcohol intoxication. Less common causes of hyponatremia with a high or normal serum osmolality contain infusion or absorption of solutions including sugars that act as effective osmoles, systemic absorption of irrigant solutions including glycine, sorbitol, or mannitol, and pseudohyponatremia due to hyperlipidemia or hyperproteinemia [17][18][19].…”

“…Elevations of blood urea nitrogen, creatinine, and uric acid level are helpful laboratory clues to the presence of volume depletion. Measuring the urine sodium excretion is considered (it should be <20 to 30 mmol/L) [19,20]. Euvolemic (normovolemic) hyponatremia which is most often associated with the SIADH also known as SchwartzBartter syndrome but can also be seen with primary polydipsia, a low dietary solute intake, renal failure and endocrine disorders such as hypothyroidism and secondary adrenal insufficiency [17,20].…”

Recent Developments in Hyponatremia and Its Management

“…Acil servise başvuran hastaların %15-20'sinde (15), hastanede yatan hastaların ise %30'a varan kısmında gözlenmektedir (14). Hastanede yatanlarda tesbit edilen hiponatreminin %40-75 kadarının ise iyatrojenik olması düşündürücüdür (16).…”