Hyponatremia classification: Difference between revisions

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{{CMG}}; {{AE}} {{Saeedeh}}
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==Overview==
==Overview==
hyponatremia, serum sodium less than 135  mEq/L (mmol/L),is classified based on  ADH level, duration of hyponatremia, serum osmolality and volume status.
Hyponatremia ([[serum]] [[sodium]] less than 135  mEq/L) may be classified based upon [[serum]] [[ADH]] level, duration of hyponatremia, [[serum]] [[osmolality]] and [[volume status]]. The various classification systems enable accurate identification of the cause of hyponatremia and hence translate into optimal management based on the condition of the patient.


==Classification ==
==Classification ==
Hyponatremia is defined as serum [[sodium]] less than 135 mEq/L (mmol/L) <ref name="UpadhyayJaber2006">{{cite journal|last1=Upadhyay|first1=Ashish|last2=Jaber|first2=Bertrand L.|last3=Madias|first3=Nicolaos E.|title=Incidence and Prevalence of Hyponatremia|journal=The American Journal of Medicine|volume=119|issue=7|year=2006|pages=S30–S35|issn=00029343|doi=10.1016/j.amjmed.2006.05.005}}</ref> .There are different classifications for hyponatremia based on duration, severity, volume status, [[Antidiuretic hormone|ADH]] level and serum [[osmolality]].
Hyponatremia is defined as serum [[sodium]] less than 135 mEq/L (mmol/L) <ref name="UpadhyayJaber2006">{{cite journal|last1=Upadhyay|first1=Ashish|last2=Jaber|first2=Bertrand L.|last3=Madias|first3=Nicolaos E.|title=Incidence and Prevalence of Hyponatremia|journal=The American Journal of Medicine|volume=119|issue=7|year=2006|pages=S30–S35|issn=00029343|doi=10.1016/j.amjmed.2006.05.005}}</ref> .There are different classifications for hyponatremia based on duration, severity, volume status, [[Antidiuretic hormone|ADH]] level and serum [[osmolality]].


Hyponatremia is classified based on '''serum sodium level''' to <ref name="Laczi2008">{{cite journal|last1=Laczi|first1=Ferenc|title=Etiology, diagnostics and therapy of hyponatremias|journal=Orvosi Hetilap|volume=149|issue=29|year=2008|pages=1347–1354|issn=0030-6002|doi=10.1556/OH.2008.28409}}</ref> ''':'''
=== Classification based on serum sodium level ===
Hyponatremia is classified based on '''serum sodium level''' into the following types <ref name="Laczi2008">{{cite journal|last1=Laczi|first1=Ferenc|title=Etiology, diagnostics and therapy of hyponatremias|journal=Orvosi Hetilap|volume=149|issue=29|year=2008|pages=1347–1354|issn=0030-6002|doi=10.1556/OH.2008.28409}}</ref> ''':'''
* '''Mild :''' Serum sodium 130– 135 mmol/L
* '''Mild :''' Serum sodium 130– 135 mmol/L
* '''Moderate:'''  Serum sodium ≤125–129 mmol/L
* '''Moderate:'''  Serum sodium ≤125–129 mmol/L
* '''Severe:''' Serum sodium <124 mmol/L
* '''Severe:''' Serum sodium <124 mmol/L


Classification based on '''duration<ref name="SternsIngelfinger2015">{{cite journal|last1=Sterns|first1=Richard H.|last2=Ingelfinger|first2=Julie R.|title=Disorders of Plasma Sodium — Causes, Consequences, and Correction|journal=New England Journal of Medicine|volume=372|issue=1|year=2015|pages=55–65|issn=0028-4793|doi=10.1056/NEJMra1404489}}</ref> :'''  
=== Classification based on '''duration ''' ===
* '''Hyper acute <ref name="Thomas2017">{{cite journal|last1=Thomas|first1=Sarah Beth|title=Acute hypervolemic hyponatremia|journal=Nursing|volume=47|issue=10|year=2017|pages=53–57|issn=0360-4039|doi=10.1097/01.NURSE.0000522006.83149.20}}</ref>:''' Develops in a few hours, excess water intake, impaired water excretion, runners, users of the recreational drug (Ecstasy)
Hyponatremia may be classified based on duration into the following types:'''<ref name="SternsIngelfinger2015">{{cite journal|last1=Sterns|first1=Richard H.|last2=Ingelfinger|first2=Julie R.|title=Disorders of Plasma Sodium — Causes, Consequences, and Correction|journal=New England Journal of Medicine|volume=372|issue=1|year=2015|pages=55–65|issn=0028-4793|doi=10.1056/NEJMra1404489}}</ref>'''  
* '''Hyper acute <ref name="Thomas2017">{{cite journal|last1=Thomas|first1=Sarah Beth|title=Acute hypervolemic hyponatremia|journal=Nursing|volume=47|issue=10|year=2017|pages=53–57|issn=0360-4039|doi=10.1097/01.NURSE.0000522006.83149.20}}</ref>:''' Develops in a few hours, excess water intake, impaired water excretion, runners, users of the recreational drug ([[Ecstasy (drug)|Ecstasy]])


* '''Acute:''' Rapid onset <48 hours, surgeries, [[colonoscopy]] preparation, [[polydipsia]], [[Diuretic|diuretics]]
* '''Acute:''' Rapid onset <48 hours, surgeries, [[colonoscopy]] preparation, [[polydipsia]], [[Diuretic|diuretics]]
* '''Chronic:''' Gradual onset >48 hours, caused by chronic disease ( including cardiac, renal, hepatic and other conditions)
* '''Chronic:''' Gradual onset >48 hours, caused by [[chronic disease]] ( including cardiac, renal, hepatic and other conditions)
<small>( Etiologies cause hyperacute and acute hyponatremia are applicable to each category interchangeably depending on the onset of symptoms)</small>
<small>( Etiologies cause hyperacute and acute hyponatremia are applicable to each category interchangeably depending on the onset of symptoms)</small>


Classification based on '''ADH''' level :
=== Classification based on '''ADH''' level ===
* '''↑ ADH:''' Volume depletion (GI loss, Renal loss) , decreased perfusion ( CHF, Cirrhosis), increased ADH secretion, reset osmostat
Hyponatremia may be classified into the following types based on [[ADH]] levels:
* '''↑ ADH:''' Volume depletion (GI loss, Renal loss) , decreased [[perfusion]] ( [[CHF]], [[Cirrhosis]]), increased [[ADH]] secretion, reset [[osmostat]]


* '''↓ ADH:''' Primary polydipsia,  ↓ dietary solute intake, advanced renal failure
* '''↓ ADH:''' Primary polydipsia,  ↓ dietary solute intake, advanced [[renal failure]]
Classification based upon '''osmolality''' <ref>{{Cite journal
 
=== Classification based upon '''[[osmolality]]''' ===
Hyponatremia may be classified into the following types based on serum osmolality:<ref>{{Cite journal


  | author = [[A. I. Arieff]] & [[H. J. Carroll]]
  | author = [[A. I. Arieff]] & [[H. J. Carroll]]
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  | pmid = 5013637
  | pmid = 5013637


}}</ref>''':'''
}}</ref>
* '''Hypertonic hyponatremia:''' Serum osmolality >295 mOsm/kg  
* '''Hypertonic hyponatremia:''' Serum osmolality >295 mOsm/kg  
* '''Hypotonic hyponatremia:''' Serum osmolality < 275 mOsm/kg
* '''Hypotonic hyponatremia:''' Serum osmolality < 275 mOsm/kg
* '''Norotonic hyponatremia:''' Serum osmolality 275–295 mOsm/kg   
* '''Normotonic hyponatremia:''' Serum osmolality 275–295 mOsm/kg   


According to '''volume status :'''
=== Classification based on volume status ===
Hyponatremia may be classified into the following types according to '''[[volume status]] :'''


{| class="wikitable"
{| class="wikitable"
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!Causes
!Causes
|-
|-
|'''<big>Hypovolemic</big>'''
!'''<big>Hypovolemic</big>'''
'''<big>Hyponatremia</big>'''   
'''<big>Hyponatremia</big>'''   
|
|
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* total body sodium ↓↓
* total body sodium ↓↓
|
|
* '''True volume depletion:GI loss,Renal loss,Insensible loss'''
* '''True [[volume depletion]]: GI loss, renal loss, [[insensible loss]]'''
|-
|-
|'''<big>Euvolemic</big>'''
!'''<big>Euvolemic</big>'''
'''<big>Hyponatremia</big>'''
'''<big>Hyponatremia</big>'''
|
|
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* total body sodium ↔
* total body sodium ↔
|
|
* '''Drugs, Increased ADH level,Reset osmostat,Low dietary salt intake'''
* '''Drugs, increased [[ADH]] level, reset [[osmostat]], low dietary salt intake'''
|-
|-
|'''<big>Hypervolemic Hyponatremia</big>'''
!'''<big>Hypervolemic Hyponatremia</big>'''
|
|
* total body water '''↑↑'''
* total body water '''↑↑'''
* total body sodium ↑
* total body sodium ↑
|
|
* '''Decrease effective arterial volume: Cirrhosis, Renal disease, CHF'''
* '''Decrease effective arterial volume: [[Cirrhosis]], [[Renal disease]], [[CHF]]'''
|}
|}


Latest revision as of 13:23, 7 June 2018

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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

Hyponatremia (serum sodium less than 135 mEq/L) may be classified based upon serum ADH level, duration of hyponatremia, serum osmolality and volume status. The various classification systems enable accurate identification of the cause of hyponatremia and hence translate into optimal management based on the condition of the patient.

Classification

Hyponatremia is defined as serum sodium less than 135 mEq/L (mmol/L) [1] .There are different classifications for hyponatremia based on duration, severity, volume status, ADH level and serum osmolality.

Classification based on serum sodium level

Hyponatremia is classified based on serum sodium level into the following types [2] :

  • Mild : Serum sodium 130– 135 mmol/L
  • Moderate:  Serum sodium ≤125–129 mmol/L
  • Severe: Serum sodium <124 mmol/L

Classification based on duration

Hyponatremia may be classified based on duration into the following types:[3]

  • Hyper acute [4]: Develops in a few hours, excess water intake, impaired water excretion, runners, users of the recreational drug (Ecstasy)

( Etiologies cause hyperacute and acute hyponatremia are applicable to each category interchangeably depending on the onset of symptoms)

Classification based on ADH level

Hyponatremia may be classified into the following types based on ADH levels:

  • ↓ ADH: Primary polydipsia, ↓ dietary solute intake, advanced renal failure

Classification based upon osmolality

Hyponatremia may be classified into the following types based on serum osmolality:[5]

  • Hypertonic hyponatremia: Serum osmolality >295 mOsm/kg
  • Hypotonic hyponatremia: Serum osmolality < 275 mOsm/kg
  • Normotonic hyponatremia: Serum osmolality 275–295 mOsm/kg

Classification based on volume status

Hyponatremia may be classified into the following types according to volume status :

Volume status Sodium status Causes
Hypovolemic

Hyponatremia

  • total body water ↓
  • total body sodium ↓↓
Euvolemic

Hyponatremia

  • total body water ↑
  • total body sodium ↔
  • Drugs, increased ADH level, reset osmostat, low dietary salt intake
Hypervolemic Hyponatremia
  • total body water ↑↑
  • total body sodium ↑

References

  1. ↑ Upadhyay, Ashish; Jaber, Bertrand L.; Madias, Nicolaos E. (2006). "Incidence and Prevalence of Hyponatremia". The American Journal of Medicine. 119 (7): S30–S35. doi:10.1016/j.amjmed.2006.05.005. ISSN 0002-9343.
  2. ↑ Laczi, Ferenc (2008). "Etiology, diagnostics and therapy of hyponatremias". Orvosi Hetilap. 149 (29): 1347–1354. doi:10.1556/OH.2008.28409. ISSN 0030-6002.
  3. ↑ Sterns, Richard H.; Ingelfinger, Julie R. (2015). "Disorders of Plasma Sodium — Causes, Consequences, and Correction". New England Journal of Medicine. 372 (1): 55–65. doi:10.1056/NEJMra1404489. ISSN 0028-4793.
  4. ↑ Thomas, Sarah Beth (2017). "Acute hypervolemic hyponatremia". Nursing. 47 (10): 53–57. doi:10.1097/01.NURSE.0000522006.83149.20. ISSN 0360-4039.
  5. ↑ A. I. Arieff & H. J. Carroll (1972). "Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acid-base balance, plasma-cerebrospinal fluid equilibria and the effects of therapy in 37 cases". Medicine. 51 (2): 73–94. PMID 5013637. Unknown parameter |month= ignored (help)

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