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{{Hyponatremia}}
{{Hyponatremia}}
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{{CMG}}; {{AE}} {{Saeedeh}}
==Overview==
Symptoms associated with hyponatremia are caused mostly by impairment of brain function. There is a spectrum of signs from no detectable presentation to death. To evaluate the causes of hyponatremia, careful history has to be taken. Drug history and past medical history can lead to the most common causes of hyponatremia.


==History and Symptoms==
==History and Symptoms==


Common symptoms include:
* Drug  history
* Diet history
* History of [[volume loss]]: [[Diarrhea]], [[vomiting]]
* History of decreased urine output
* Chronic illnesses: [[CHF]], [[Renal failure|RF]]
* History of endocrine disorders
* History of [[malignancy]]
* History of [[infectious]] diseases
* History of [[psychiatric]] illnesses
* History of diagnostic procedures or operations
* History of blood disorders
* History of CNS disorders
*History of pulmonary diseases
*History of genetic diseases: [[Hyperlipidemia]], nephrogenic [[SIADH|SIAD]], [[RTA]]
*History of [[diabetes]]
*History of GI disorders
 
 
To see the different causes of hyponatremia, click [[Hyponatremia causes#Causes|here]].
 
===Common Symptoms  ===
The clinical signs and symptoms of hyponatremia are related to the degree of brain compensation to hypoosmolarity. Development of [[cerebral edema]], increased [[intracerebral pressure]] and [[cerebral hypoxia]] are responsible for hyponatremia presentation. Also see the [[Hyponatremia natural history, complications and prognosis#Natural History, Complications, and Prognosis|complications]] of hyponatremia.
* '''Asymptomatic'''
* '''Acute neurologic changes:''' [[seizures]], altered [[mental status]], [[coma]] , [[focal neurologic signs]] like one-sided facial droop, opposite-sided [[hemiparesis]], [[dysarthria]] and [[aphasia]] in hyperacute hyponatremia. <ref name="BalbiSadowski2021">{{cite journal|last1=Balbi|first1=Alanna|last2=Sadowski|first2=Jennifer A.|last3=Torrens|first3=Daniel|last4=Jacoby|first4=Jeanne L.|last5=Yacoub|first5=Hussam A.|last6=Eygnor|first6=Jessica K.|title=Hyperacute hyponatremia mimicking acute ischemic stroke: A case report|journal=The American Journal of Emergency Medicine|year=2021|issn=07356757|doi=10.1016/j.ajem.2021.07.017}}</ref>
 
* '''Moderate symptoms'''
** [[Nausea]]
** [[Malaise]]
** [[Headache]]
** [[Confusion]]
** Loss of energy and [[fatigue]]
** [[Restlessness]] and [[irritability]]
** [[Muscle weakness]], [[spasms]] or [[cramps]]
** [[Fatigue]]
** [[Lethargy]]
** [[Dizziness]]
** [[Gait disturbances]]
** [[Forgetfulness]]
 
* '''Severe'''
** [[Vomiting]]
** Cardio-respiratory distress
** Abnormal and deep [[somnolence]]
** [[Seizures]] <ref name="HabibHamad2021">{{cite journal|last1=Habib|first1=Mhd Baraa|last2=Hamad|first2=Mohammad Khair|last3=Kalash|first3=Tarif|last4=Ahmed|first4=Ashraf|last5=Mohamed|first5=Mouhand F|title=COVID-19 Pneumonia Complicated by Seizure Due to Severe Hyponatremia|journal=Cureus|year=2021|issn=2168-8184|doi=10.7759/cureus.15603}}</ref>
** [[Coma]] (Glasgow Coma Scale 8)
** [[Delirium]]
** [[Decreased consciousness|Impaired consciousness]]
<br>
* Mild chronic hyponatremia (plasma sodium 125–135 mEq/L) may cause subtle neurocognitive deficits that can be detected by careful testing ,these deficits improve when the plasma sodium is normalized.<ref>{{Cite journal
 
| author = [[F. C. Bartter]] & [[W. B. Schwartz]]
 
| title = The syndrome of inappropriate secretion of antidiuretic hormone
 
| journal = [[The American journal of medicine]]
 
| volume = 42
 
| issue = 5
 
| pages = 790–806
 
| year = 1967
 
| month = May
 
| pmid = 5337379


*[[Abnormal mental status]]
}}</ref>
**[[Confusion]]
*COVID-19 pneumonia patients have been found to develop SIADH and severe hyponatremia in some cases causing [[seizures]]. <ref name="HabibHamad2021">{{cite journal|last1=Habib|first1=Mhd Baraa|last2=Hamad|first2=Mohammad Khair|last3=Kalash|first3=Tarif|last4=Ahmed|first4=Ashraf|last5=Mohamed|first5=Mouhand F|title=COVID-19 Pneumonia Complicated by Seizure Due to Severe Hyponatremia|journal=Cureus|year=2021|issn=2168-8184|doi=10.7759/cureus.15603}}</ref>
**[[Decreased consciousness]]
**[[Hallucinations]]
**Possible [[coma]]
*[[Convulsions]]
*[[Fatigue]]
*[[Headache]]
*[[Irritability]]
*[[Loss of appetite]]
*[[Muscle spasms]] or [[cramps]]
*[[Muscle weakness]]
*[[Nausea]]
*[[Restlessness]]
*[[Vomiting]]


Most patients with chronic water intoxication are asymptomatic, but may have [[symptom]]s related to the underlying cause.
===Less Common Symptoms===
* [[Cardiorespiratory arrest]]


Severe hyponatremia may cause [[osmosis|osmotic]] shift of water from the plasma into the [[brain]] [[cell (biology)|cells]]. Typical symptoms include [[nausea]], [[vomit]]ing, [[headache]] and [[malaise]]. As the hyponatremia worsens, confusion, diminished [[reflex]]es, [[convulsion]]s, [[stupor]] or [[coma]] may occur. Since [[nausea]] is, itself, a stimulus for the release of [[Vasopressin|ADH]], which promotes the retention of water, a [[positive feedback loop]] may be created and the potential for a vicious circle of hyponatremia and its symptoms exists.
*Death
*[[Coma]]  
*[[Brain damage]]/ [[brain edema]]
*[[Epileptic seizures]]  
*[[Central pontine myelinolysis|Osmotic demyelinating syndrome]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Needs overview]]
[[Category:Electrolyte disturbance]]
[[Category:Nephrology]]
[[Category:Blood tests]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]


{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category: (name of the system)]]

Latest revision as of 18:15, 27 July 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Saeedeh Kowsarnia M.D.[2]

Overview

Symptoms associated with hyponatremia are caused mostly by impairment of brain function. There is a spectrum of signs from no detectable presentation to death. To evaluate the causes of hyponatremia, careful history has to be taken. Drug history and past medical history can lead to the most common causes of hyponatremia.

History and Symptoms

  • Drug history
  • Diet history
  • History of volume loss: Diarrhea, vomiting
  • History of decreased urine output
  • Chronic illnesses: CHF, RF
  • History of endocrine disorders
  • History of malignancy
  • History of infectious diseases
  • History of psychiatric illnesses
  • History of diagnostic procedures or operations
  • History of blood disorders
  • History of CNS disorders
  • History of pulmonary diseases
  • History of genetic diseases: Hyperlipidemia, nephrogenic SIAD, RTA
  • History of diabetes
  • History of GI disorders


To see the different causes of hyponatremia, click here.

Common Symptoms

The clinical signs and symptoms of hyponatremia are related to the degree of brain compensation to hypoosmolarity. Development of cerebral edema, increased intracerebral pressure and cerebral hypoxia are responsible for hyponatremia presentation. Also see the complications of hyponatremia.


  • Mild chronic hyponatremia (plasma sodium 125–135 mEq/L) may cause subtle neurocognitive deficits that can be detected by careful testing ,these deficits improve when the plasma sodium is normalized.[3]
  • COVID-19 pneumonia patients have been found to develop SIADH and severe hyponatremia in some cases causing seizures. [2]

Less Common Symptoms

References

  1. ↑ Balbi, Alanna; Sadowski, Jennifer A.; Torrens, Daniel; Jacoby, Jeanne L.; Yacoub, Hussam A.; Eygnor, Jessica K. (2021). "Hyperacute hyponatremia mimicking acute ischemic stroke: A case report". The American Journal of Emergency Medicine. doi:10.1016/j.ajem.2021.07.017. ISSN 0735-6757.
  2. ↑ 2.0 2.1 Habib, Mhd Baraa; Hamad, Mohammad Khair; Kalash, Tarif; Ahmed, Ashraf; Mohamed, Mouhand F (2021). "COVID-19 Pneumonia Complicated by Seizure Due to Severe Hyponatremia". Cureus. doi:10.7759/cureus.15603. ISSN 2168-8184.
  3. ↑ F. C. Bartter & W. B. Schwartz (1967). "The syndrome of inappropriate secretion of antidiuretic hormone". The American journal of medicine. 42 (5): 790–806. PMID 5337379. Unknown parameter |month= ignored (help)

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