Hyponatremia—Adult
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Definition
Hyponatremia is a potentially serious condition in which the level of sodium in the blood is too low. An imbalance is created when there is too little sodium for the amount of water in the body. As a result, water moves into the body’s cells causing them to swell.

There are different types of hyponatremia, each resulting in low sodium in the body:

TypeWhat Happens?Euvolemic hyponatremiaWater level increases, but sodium level stays the sameHypervolemic hyponatremiaWater and sodium levels increase, but the water gain is greaterHypovolemic hyponatremiaWater and sodium levels decrease, but the sodium loss is greater
Causes
Hyponatremia may be caused by:

  • Syndrome of inappropriate antidiuretic hormone secretion (SIADH)—Antidiuretic hormone signals the kidneys to absorb more water, reducing urine output. In SIADH, the mechanism that stops antidiuretic hormone from collecting water is impaired. This impairment results in excess water in the body.
  • Sweating—In people with cystic fibrosis excess sodium is excreted through sweat. It may also occur in people with severe burns when electrolytes and fluids are not replaced.
Kidney Failure

Kidney failure is one condition that may cause hyponatremia.
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Risk Factors
Factors that may increase your risk of developing hyponatremia include:

  • Advanced age
  • Excess water intake without electrolytes—may occur in people who are participating in endurance exercise
  • Certain medications, such as some diuretics or antipsychotics
  • Certain health conditions, such as:
  • Having prostate surgery
  • Sweating in people without cystic fibrosis or severe burns
Symptoms
People with mild hyponatremia usually don't have symptoms. As hyponatremia progresses, symptoms will appear and worsen.

Moderate to severe hyponatremia may cause:

  • Nausea
  • Loss of appetite
  • Irritability
  • Headache
  • Restlessness
  • Sluggishness
  • Confusion
  • Hallucinations
  • Muscle twitching
Severe and rapid onset hyponatremia may cause seizures, coma, or death.

Diagnosis
Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor will ask you about your fluid intake and do some tests.

Tests may include:

  • Blood tests—to check the sodium level in your blood, and the functioning of your organs
  • Urine test—to check the sodium level in your urine
Other tests may be done to look for any underlying causes of your hyponatremia.

Treatment
Treatment may depend on:

  • What is causing the low sodium level
  • How long the sodium level has been low
  • How low the sodium level is
  • Your level of hydration
In most cases, your doctor will want to correct the sodium level slowly. Serious complications may occur when sodium levels rise too rapidly.

Treatment options may include:

  • Restricting fluid intake
  • Identifying the underlying cause and getting proper treatment
  • Medications to help remove extra fluid from your body
  • IV fluids to deliver sodium restore proper balance
Prevention
To help reduce your chance of getting hyponatremia, take these steps:

  • If participating in sports, drink only as much water or sports drink as you need to quench your thirst. Sport drinks that provide electrolytes, such as sodium, may be helpful during endurance events.
  • Work with your doctor to effectively manage any conditions that you may have.



RESOURCES:
American Society forNutriton

National Institute of Diabetes and Digestive and Kidney Diseases

CANADIAN RESOURCES:
The College of Family Physicians of Canada


References:
Almond CS, Shin AY, et al. Hyponatremia among runners in the Boston Marathon. N Engl J Med. 2005;352(15):1550-1556.

Ayus JC, Arieff AI. Glycine-induced hypo-osmolar hyponatremia. Arch Intern Med. 1997;157(2):223-226.

Elhassan EA, Schrier RW. Hyponatremia: diagnosis, complications, and management including V2 receptor antagonists. Curr Opin Nephrol Hypertens. 2011;20(2):161-168.

Hyponatremia. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated November 8, 2012. Accessed November 15, 2013.

Mittal R, Sheftel H, et al. Management of hyponatraemia. Br J Hosp Med (Lond). 2011;72(2):M22-5.

Peng K. Management of hyponatremia. Am Fam Physician.  2004;69(10):2387-2394.

Syndrome of inappropriate antidiuretic hormone secretion (SIADH). EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated December 15, 2012. Accessed November 15, 2013.

Last Reviewed November 2013



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