Hyponatremia, Hyposmolality, and Hypotonicity

Oster, James R.; Singer, Irwin

doi:10.1001/archinte.159.4.333

Cited by 88 publications

(53 citation statements)

References 22 publications

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“…There are broadly three categories of non-hypotonic hyponatraemia: hyponatraemia in the presence of a surplus of 'effective' osmoles, hyponatraemia in the presence of a surplus of 'ineffective' osmoles and pseudohyponatraemia (Table 10) (30,34,36,88,91).…”

Section: Classification Based On Volume Statusmentioning

confidence: 99%

“…Exogenous or endogenous solutes to which cell membranes are impermeable are restricted to the extracellular fluid compartment and are effective osmoles because they create osmotic pressure gradients across cell membranes leading to osmotic movement of water from the intracellular to the extracellular compartment (34,36). Because dilutional hyponatraemia results from the water shift from the intracellular to the extracellular compartment, there is no risk of brain oedema.…”

Section: Effective Osmolesmentioning

confidence: 99%

“…Solutes to which cell membranes are permeable are ineffective solutes because they do not create osmotic pressure gradients across cell membranes and therefore are not associated with water shifts (36,91). Consequently, they do not cause hyponatraemia.…”

Section: Ineffective Osmolesmentioning

confidence: 99%

See 2 more Smart Citations

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Spasovski

Vanholder

Allolio

et al. 2014

European Journal of Endocrinology

604

671

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Hyponatraemia, defined as a serum sodium concentration !135 mmol/l, is the most common disorder of body fluid 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.

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Section: Classification Based On Volume Statusmentioning

confidence: 99%

Section: Effective Osmolesmentioning

confidence: 99%

See 1 more Smart Citation

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Spasovski

Vanholder

Allolio

et al. 2014

European Journal of Endocrinology

604

671

View full text Add to dashboard Cite

show abstract

“…68 A different set of changes is seen when mannitol is given to patients with underlying renal failure or when it is administered in very high doses. 10,54 Not only does the rise in plasma osmolality cause hyponatremia, but the fluid shift may also lead to volume expansion and possibly pulmonary edema, metabolic acidosis, and hyperkalemia.…”

Section: Hyperosmotic Hyponatremiamentioning

confidence: 99%

Hyponatremia in the neurosurgical patient: diagnosis and management

Cole¹,

Gottfried²,

Liu³

et al. 2004

FOC

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Hyponatremia is frequently encountered in patients who have undergone neurosurgery for intracranial processes. Making an accurate diagnosis between the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and cerebral salt wasting (CSW) in patients in whom hyponatremia develops is important because treatment differs greatly between the conditions. The SIADH is a volume-expanded condition, whereas CSW is a volume-contracted state that involves renal loss of sodium. Treatment for patients with SIADH is fluid restriction and treatment for patients with CSW is generally salt and water replacement. In this review, the authors discuss the differential diagnosis of hyponatremia, distinguish SIADH from CSW, and highlight the diagnosis and management of hyponatremia, which is commonly encountered in patients who have undergone neurosurgery, specifically those with traumatic brain injury, aneurysmal subarachnoid hemorrhage, recent transsphenoidal surgery for pituitary tumors, and postoperative cranial vault reconstruction for craniosynostosis.

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“…In patients with renal failure though, mannitol may be retained and substantially increase the plasma osmolality when water will leave cells, drawn by the osmotic gradient created and cause a dilutional hyponatraemia; the physician needs to be aware of this and treat the hyperosmolality and not the hyponatraemia. 38 One of the most common uses of mannitol is its shortterm use to decrease brain bulk and cerebrospinal fluid production as a means of lowering intracranial pressure. 39 Following crush injuries, or after cardiac and major vascular surgery, it can be used in an effort to minimize the acute decrease in glomerular filtration rate (GFR) that accompanies acute tubular necrosis predisposing to acute renal failure.…”

Section: Osmotic Diureticsmentioning

confidence: 99%

Diuretics: a review

Wile

2012

Ann Clin Biochem

114

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Diuretics, in one form or another, have been around for centuries and this review sets out to chart their development and clinical use. Starting with the physiology of the kidney, it progresses to explain how diuretics actually work, via symports on the inside of the renal tubules. The different classes of diuretics are characterized, along with their mode of action. The clinical use of diuretics in conditions like congestive cardiac failure and hypertension, as well as some rarer, but clinically important, conditions is then examined. An account is given of the adverse effects of diuretics and how they come about. Common adverse effects like hypokalaemia and hyponatraemia are examined in some detail, and other electrolyte disturbances like hypomagnesaemia also gain a mention. Diuretic use in chronic kidney disease is examined and new guidelines that have been introduced are presented. A section on diuretic abuse is included as this is becoming an all too common clinical scenario, and the sometimes tragic consequences of this abuse are emphasized. Diuretics also find a role in the diagnosis of forms of renal tubular acidosis and this role is explored. Finally, a selection of some of the newer approaches to diuretic therapy are presented, often the consequence of the increasing development of molecular biology, and some of the novel compounds -which may be in drug formularies of the future -are revealed.

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Hyponatremia, Hyposmolality, and Hypotonicity

Cited by 88 publications

References 22 publications

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Hyponatremia in the neurosurgical patient: diagnosis and management

Diuretics: a review

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