Hyponatremia (patient information)
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Hyponatremia |
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Hyponatremia On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Hyponatremia is a metabolic condition in which there is not enough sodium (salt) in the body fluids outside the cells.
What are the symptoms of Hyponatremia?
Common symptoms include:
- Abnormal mental status
- Convulsions
- Fatigue
- Headache
- Irritability
- Loss of appetite
- Muscle spasms or cramps
- Muscle weakness
- Nausea
- Restlessness
- Vomiting
What causes Hyponatremia?
Sodium is found mostly in the body fluids outside the cells. It is very important for maintaining blood pressure. Sodium is also needed for nerves and muscles to work properly.
When the amount of sodium in fluids outside cells drops, water moves into the cells to balance the levels. This causes the cells to swell with too much water. Although most cells can handle this swelling, brain cells cannot, because the skull bones confine them. Brain swelling causes most of the symptoms of hyponatremia.
In hyponatremia, the imbalance of water to salt is caused by one of three conditions:
- Euvolemic hyponatremia -- total body water increases, but the body's sodium content stays the same
- Hypervolemic hyponatremia -- both sodium and water content in the body increase, but the water gain is greater
- Hypovolemic hyponatremia -- water and sodium are both lost from the body, but the sodium loss is greater
Hyponatremia is the most common electrolyte disorder in the United States.
Causes of hyponatremia include:
- Burns
- Congestive heart failure [1]
- Diarrhea
- Diuretic medications, which increase urine output
- Kidney diseases
- Liver cirrhosis
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- Sweating
- Vomiting
- Anti-epileptic drugs -Carbamazepine and oxcarbazepine are the most common AEDs which induce hyponatremia[2] Recently, other AEDs, such as eslicarbazepine [3],valproic acid [4] have been found to cause hyponatremia.
Who is at highest risk?
Although hyponatremia can develop in a variety of disease conditions or due to iatrogenic causes, certain patient cohorts like those with acute or chronic renal failure (inability to excrete water), congestive heart failure, cirrhosis (ADH release due to low effective circulatory volume) are very prone to develop hyponatremia. More recently, hyponatremia has seen to be occuring in nearly a third of coronavirus disease patients. [5]
Diagnosis
The health care provider will perform a complete physical examination to help determine the cause of your symptoms. Blood and urine tests will be done.
The following laboratory tests can confirm hyponatremia:
- Comprehensive metabolic panel (includes blood sodium)
- Osmolality blood test
- Urine osmolality
- Urine sodium
When to seek urgent medical care?
Hyponatremia can be a life-threatening emergency. Call your health care provider if you have symptoms of this condition.
Treatment options
The cause of hyponatremia must be diagnosed and treated. In some cases, cancer may cause the condition, and radiation, chemotherapy, or surgery to remove the tumor may correct the sodium imbalance.
Other treatments depend on the specific type of hyponatremia.
Treatments may include:
- Fluids through a vein (IV)
- Medication to relieve symptoms
- Water restriction
Medications to avoid
Patients diagnosed with hyponatremia should avoid using the following medications:
- Acebutolol
- Tolvaptan
If you have been diagnosed with hyponatremia, consult your physician before starting or stopping any of these medications.
Where to find medical care for Hyponatremia?
Prevention of Hyponatremia
Treating the condition that is causing hyponatremia can help. If you play any sports, drink fluids that contain electrolytes (sports drinks). Drinking only water while you take part in high-energy athletic events can lead to acute hyponatremia.
What to expect (Outlook/Prognosis)?
The outcome depends on the condition that is causing the problem. In general, acute hyponatremia, which occurs in less than 48 hours, is more dangerous than hyponatremia that develops slowly over time. When sodium levels fall slowly over a period of days or weeks (chronic hyponatremia), the brain cells have time to adjust and swelling is minimal. In COVID 19 patients, hyponatremia was associated with increased risk of encephalopathy and mechanical ventilation. [5]
Possible complications
- Brain herniation
- Death
- Possible coma
Sources
- ↑ Rodriguez M, Hernandez M, Cheungpasitporn W, Kashani KB, Riaz I, Rangaswami J; et al. (2019). "Hyponatremia in Heart Failure: Pathogenesis and Management". Curr Cardiol Rev. 15 (4): 252–261. doi:10.2174/1573403X15666190306111812. PMC 8142352 Check
|pmc=value (help). PMID 30843491. - ↑ Dong, X.; Leppik, I. E.; White, J.; Rarick, J. (2005). "Hyponatremia from oxcarbazepine and carbamazepine". Neurology. 65 (12): 1976–1978. doi:10.1212/01.wnl.0000188819.45330.90. ISSN 0028-3878.
- ↑ Verrotti, Alberto; Tambucci, Renato; Basti, Claudia; Maresca, Maria; Coppola, Giangennaro (2016). "Update on the role of eslicarbazepine acetate in the treatment of partial-onset epilepsy". Neuropsychiatric Disease and Treatment: 1251. doi:10.2147/NDT.S86765. ISSN 1178-2021.
- ↑ Gupta E, Kunjal R, Cury JD (2015). "Severe Hyponatremia Due to Valproic Acid Toxicity". J Clin Med Res. 7 (9): 717–9. doi:10.14740/jocmr2219w. PMC 4522991. PMID 26251688.
- ↑ 5.0 5.1 Frontera, Jennifer A.; Valdes, Eduard; Huang, Joshua; Lewis, Ariane; Lord, Aaron S.; Zhou, Ting; Kahn, D. Ethan; Melmed, Kara; Czeisler, Barry M.; Yaghi, Shadi; Scher, Erica; Wisniewski, Thomas; Balcer, Laura; Hammer, Elizabeth (2020). "Prevalence and Impact of Hyponatremia in Patients With Coronavirus Disease 2019 in New York City". Critical Care Medicine. 48 (12): e1211–e1217. doi:10.1097/CCM.0000000000004605. ISSN 0090-3493.