Hyponatremia (patient information): Difference between revisions
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'''For the WikiDoc page for this topic, click [[Hyponatremia|here]]''' | '''For the WikiDoc page for this topic, click [[Hyponatremia|here]]''' | ||
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Common symptoms include: | Common symptoms include: | ||
*Abnormal mental status | *[[Abnormal mental status]] | ||
**Confusion | **[[Confusion]] | ||
**Decreased consciousness | **[[Decreased consciousness]] | ||
**Hallucinations | **[[Hallucinations]] | ||
**Possible coma | **Possible [[coma]] | ||
*Convulsions | *[[Convulsions]] | ||
*Fatigue | *[[Fatigue]] | ||
*Headache | *[[Headache]] | ||
*Irritability | *[[Irritability]] | ||
*Loss of appetite | *[[Loss of appetite]] | ||
*Muscle spasms or cramps | *[[Muscle spasms]] or [[cramps]] | ||
*Muscle weakness | *[[Muscle weakness]] | ||
*Nausea | *[[Nausea]] | ||
*Restlessness | *[[Restlessness]] | ||
*Vomiting | *[[Vomiting]] | ||
==What causes Hyponatremia?== | ==What causes Hyponatremia?== | ||
| Line 46: | Line 47: | ||
*[[Burns]] | *[[Burns]] | ||
*[[Congestive heart failure]] | *[[Congestive heart failure]] <ref name="pmid30843491">{{cite journal| author=Rodriguez M, Hernandez M, Cheungpasitporn W, Kashani KB, Riaz I, Rangaswami J | display-authors=etal| title=Hyponatremia in Heart Failure: Pathogenesis and Management. | journal=Curr Cardiol Rev | year= 2019 | volume= 15 | issue= 4 | pages= 252-261 | pmid=30843491 | doi=10.2174/1573403X15666190306111812 | pmc=8142352 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30843491 }} </ref> | ||
*Diarrhea | *[[Diarrhea]] | ||
*Diuretic medications, which increase urine output | *[[Diuretics|Diuretic]] medications, which increase urine output | ||
*Kidney diseases | *Kidney diseases | ||
*Liver cirrhosis | *[[Liver cirrhosis]] | ||
*Syndrome of inappropriate antidiuretic hormone secretion (SIADH) | *[[Syndrome of inappropriate antidiuretic hormone secretion]] ([[SIADH]]) | ||
*Sweating | *[[Sweating]] | ||
*Vomiting | *[[Vomiting]] | ||
*[[Anti-epileptic drugs]] -Carbamazepine and oxcarbazepine are the most common AEDs which induce hyponatremia<ref name="DongLeppik2005">{{cite journal|last1=Dong|first1=X.|last2=Leppik|first2=I. E.|last3=White|first3=J.|last4=Rarick|first4=J.|title=Hyponatremia from oxcarbazepine and carbamazepine|journal=Neurology|volume=65|issue=12|year=2005|pages=1976–1978|issn=0028-3878|doi=10.1212/01.wnl.0000188819.45330.90}}</ref> Recently, other AEDs, such as eslicarbazepine <ref name="VerrottiTambucci2016">{{cite journal|last1=Verrotti|first1=Alberto|last2=Tambucci|first2=Renato|last3=Basti|first3=Claudia|last4=Maresca|first4=Maria|last5=Coppola|first5=Giangennaro|title=Update on the role of eslicarbazepine acetate in the treatment of partial-onset epilepsy|journal=Neuropsychiatric Disease and Treatment|year=2016|pages=1251|issn=1178-2021|doi=10.2147/NDT.S86765}}</ref>,valproic acid <ref name="pmid26251688">{{cite journal| author=Gupta E, Kunjal R, Cury JD| title=Severe Hyponatremia Due to Valproic Acid Toxicity. | journal=J Clin Med Res | year= 2015 | volume= 7 | issue= 9 | pages= 717-9 | pmid=26251688 | doi=10.14740/jocmr2219w | pmc=4522991 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26251688 }} </ref> have been found to cause hyponatremia. | |||
==Who is at highest risk?== | ==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. <ref name="FronteraValdes2020">{{cite journal|last1=Frontera|first1=Jennifer A.|last2=Valdes|first2=Eduard|last3=Huang|first3=Joshua|last4=Lewis|first4=Ariane|last5=Lord|first5=Aaron S.|last6=Zhou|first6=Ting|last7=Kahn|first7=D. Ethan|last8=Melmed|first8=Kara|last9=Czeisler|first9=Barry M.|last10=Yaghi|first10=Shadi|last11=Scher|first11=Erica|last12=Wisniewski|first12=Thomas|last13=Balcer|first13=Laura|last14=Hammer|first14=Elizabeth|title=Prevalence and Impact of Hyponatremia in Patients With Coronavirus Disease 2019 in New York City|journal=Critical Care Medicine|volume=48|issue=12|year=2020|pages=e1211–e1217|issn=0090-3493|doi=10.1097/CCM.0000000000004605}}</ref> | |||
==Diagnosis== | ==Diagnosis== | ||
| Line 64: | Line 67: | ||
*Comprehensive metabolic panel (includes blood sodium) | *Comprehensive metabolic panel (includes blood sodium) | ||
*Osmolality blood test | *Osmolality blood test | ||
*Urine osmolality | *[[Urine osmolality]] | ||
*Urine sodium | *[[Urine sodium]] | ||
==When to seek urgent medical care?== | ==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== | ==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=== | |||
{{MedCondContrPI | |||
|MedCond =hyponatremia|Acebutolol|Tolvaptan}} | |||
==Where to find medical care for Hyponatremia?== | ==Where to find medical care for Hyponatremia?== | ||
==Prevention of 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)?== | ==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. <ref name="FronteraValdes2020">{{cite journal|last1=Frontera|first1=Jennifer A.|last2=Valdes|first2=Eduard|last3=Huang|first3=Joshua|last4=Lewis|first4=Ariane|last5=Lord|first5=Aaron S.|last6=Zhou|first6=Ting|last7=Kahn|first7=D. Ethan|last8=Melmed|first8=Kara|last9=Czeisler|first9=Barry M.|last10=Yaghi|first10=Shadi|last11=Scher|first11=Erica|last12=Wisniewski|first12=Thomas|last13=Balcer|first13=Laura|last14=Hammer|first14=Elizabeth|title=Prevalence and Impact of Hyponatremia in Patients With Coronavirus Disease 2019 in New York City|journal=Critical Care Medicine|volume=48|issue=12|year=2020|pages=e1211–e1217|issn=0090-3493|doi=10.1097/CCM.0000000000004605}}</ref> | |||
==Possible complications== | ==Possible complications== | ||
*[[Brain herniation]] | |||
*[[Death]] | |||
*Possible [[coma]] | |||
==Sources== | |||
*http://www.nlm.nih.gov/medlineplus/ency/article/000394.htm | |||
[[Category:Patient information]] | |||
[[Category:Electrolyte disturbance]] | |||
[[Category:Nephrology]] | |||
[[Category:Blood tests]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Intensive care medicine]] | |||
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Latest revision as of 15:51, 13 July 2021
For the WikiDoc page for this topic, click here
|
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.