Hyponatremia causes: Difference between revisions
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!<big>Other causes</big> | !<big>Other causes</big> | ||
|'''Hereditary:''' Gain-of-function mutation of | |'''Hereditary:''' Gain-of-function mutation of V2 receptors | ||
'''Idiopathic''' | '''Idiopathic''' | ||
'''[[#Drugs cause hyponatremia|Drugs]]''' | '''[[#Drugs cause hyponatremia|Drugs]]''' | ||
'''Transient:''' Exercise, general anesthesia, nausea, pain, stress | '''Transient:''' [[Exercise]], [[general anesthesia]], nausea, pain, stress | ||
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|'''<big>Hypertonic or Isotonic Hyponatremia</big>''' | |'''<big>Hypertonic or Isotonic Hyponatremia</big>''' | ||
|> 295 mOsm/kg | |> 295 mOsm/kg | ||
|Hyperglycemia<sup>‡</sup>, Mannitol, Glycine, Maltose, severe azotemia | |[[Hyperglycemia]]<sup>‡</sup>, [[Mannitol]], [[Glycine]], [[Maltose]], severe [[azotemia]] | ||
|- | |- | ||
|'''<big>Isotonic Hyponatremia</big>''' | |'''<big>Isotonic Hyponatremia</big>''' | ||
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|'''<big>Hypotonic Hyponatremia</big>''' | |'''<big>Hypotonic Hyponatremia</big>''' | ||
|< 275 mOsm/kg | |< 275 mOsm/kg | ||
|Glycerol, Sorbitol, Etiology depends upon volume status (Hypervolemic/ Euvolemic/ Hypovolemic) | |[[Glycerol]], [[Sorbitol]], Etiology depends upon volume status (Hypervolemic/ Euvolemic/ Hypovolemic) | ||
|- | |- | ||
| colspan="3" |Alcohol, Urea, Ethylen glycol are ineffective osmoles, cause hyperosmolar isotonic serum but not hyponatremia. | | colspan="3" |[[Alcohol]], [[Urea]], Ethylen glycol are ineffective osmoles, cause hyperosmolar isotonic serum but not hyponatremia. | ||
|} | |} | ||
<small>‡ Hyperglycemia causes osmotic diuresis results in a rise in serum sodium concentration, on the other hand it leads to extracellular shift of water due to osmotic gradient which causes relative hyponatremia , depends on which effect is stronger, there would be hypertonicity or hypotonicity<ref>{{Cite journal | <small>‡ Hyperglycemia causes osmotic diuresis results in a rise in serum sodium concentration, on the other hand it leads to extracellular shift of water due to osmotic gradient which causes relative hyponatremia , depends on which effect is stronger, there would be hypertonicity or hypotonicity<ref>{{Cite journal | ||
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* total body sodium ↓↓ | * total body sodium ↓↓ | ||
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* '''GI loss:''' Vomiting, diarrhea, tube drainage | * '''GI loss:''' [[Vomiting]], [[Diarrheal|diarrhea]], tube drainage | ||
* '''Insensible loss:''' Sweating, burns | * '''Insensible loss:''' [[Sweating]], [[burns]] | ||
* '''Renal loss:''' Salt-wasting nephropathy (Inappropriate loss of Na+-Cl– in the urine), | * '''Renal loss:''' Salt-wasting nephropathy (Inappropriate loss of Na+-Cl– in the urine), | ||
Bicarbonaturia ( Renal tubular acidosis, Metabolic alkalosis), osmotic diuresis, diuretic use, | Bicarbonaturia ( Renal tubular acidosis, Metabolic alkalosis), [[osmotic diuresis]], [[diuretic use]], | ||
Cerebral salt-wasting | [[Cerebral salt-wasting syndrome]] ([[Stroke]] ,[[SAH]] ,↑ [[brain natriuretic peptide]] and ↑ renal sodium loss ) | ||
* '''Third spacing of fluids :''' Pancreatitis, hypoalbuminemia, Small bowel obstruction | * '''Third spacing of fluids :''' [[Pancreatitis]], [[hypoalbuminemia]], [[Small bowel obstruction]] | ||
* '''Mineralocorticoid deficiency:''' Addison disease (primary) | * '''Mineralocorticoid deficiency:''' [[Addison disease]] (primary) | ||
* '''Excessive diuretic administration''' | * '''Excessive diuretic administration''' | ||
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* total body sodium ↔ | * total body sodium ↔ | ||
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* '''Drugs:''' Vasopressin, diuretics, antidepressants, opioids | * '''Drugs:''' [[Vasopressin]], [[diuretics]], [[antidepressants]], [[opioids]] | ||
* '''SIAD:''' SIADH (Malignancy, central nervous system (CNS) disorders, pulmonary disease, or drugs, | * '''SIAD:''' [[SIADH]] (Malignancy, central nervous system (CNS) disorders, pulmonary disease, or drugs, | ||
postoperative nausea, pain, stress, neoplasia (common), trauma, pregnancy) | postoperative nausea, pain, stress, neoplasia (common), trauma, pregnancy) | ||
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* '''High fluid intake:''' Physical activity, surgery, primary polydipsia, potomania, tea & toast diet | * '''High fluid intake:''' Physical activity, surgery, primary polydipsia, potomania, tea & toast diet | ||
(caused by a low intake of solutes with relatively high fluid intake) | (caused by a low intake of solutes with relatively high fluid intake) | ||
* '''Medical testing''' (excess fluid intake) ''':'''Colonoscopy or cardiac catheterization | * '''Medical testing''' (excess fluid intake) ''':'''[[Colonoscopy]] or [[cardiac catheterization]] | ||
* '''Hypothyroidism''' | * '''Hypothyroidism''' | ||
* '''Hormonal:''' Glucocorticoid deficiency, pituitary failure (secondary), hypothalamic failure (tertiary) | * '''Hormonal:''' [[Glucocorticoid deficiency 1|Glucocorticoid deficiency]], [[pituitary failure]] (secondary), hypothalamic failure (tertiary) | ||
* '''Reset osmostat <sup>†</sup> :''' Drugs, pregnancy | * '''Reset osmostat <sup>†</sup> :''' Drugs, pregnancy | ||
Revision as of 14:05, 24 May 2018
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Hyponatremia Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Hyponatremia causes On the Web |
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American Roentgen Ray Society Images of Hyponatremia causes |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Saeedeh Kowsarnia M.D.[2]
Overview
Disease name] may be caused by [cause1], [cause2], or [cause3].
OR
Common causes of [disease] incl ude [cause1], [cause2], and [cause3].
OR
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
OR
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click here.
Causes
- Etiologies of SIAD:
| Conditions | |
|---|---|
| Malignant disorders | Carcinoma: Lung ( small cell carcinoma, mesothelioma), oropharynx, stomach, duodenum, pancreas, ureter, bladder, prostate, endometrium, thymoma
Lymphomas sarcomas: Ewing's sarcoma Olfactory neuroblastoma |
| Pulmonary diseases | Infections: Bacterial pneumonia, viral pneumonia, pulmonary abscess, tuberculosis, aspergillosis
Others: Asthma, cystic fibrosis, respiratory failure, emphysema, COPD, positive-pressure ventilation |
| CNS disorders | Infections: Encephalitis, meningitis, brain abscess, RMSF, AIDS, malaria
vascular and SOP: Subarachnoid hemorrhage, stroke, brain tumors, head trauma Others: Hydrocephalus, cavernous sinus thrombosis, multiple sclerosis, Guillain–Barré syndrome, Shy–Drager syndrome, delirium tremens, acute intermittent porphyria, chronic psychosis, pituitary stalk section, transsphenoidal adenomectomy |
| Other causes | Hereditary: Gain-of-function mutation of V2 receptors
Idiopathic Transient: Exercise, general anesthesia, nausea, pain, stress |
- Causes of acute hyponatremia:
| Post operative phase
Polydipsia Exercise Oxytocin Cyclophosphamide Ecstasy( 3,4-Methylenedioxymethamphetamine, MDMA) Thiazide |
( Etiologies that cause hyperacute and acute hyponatremia are applicable to each category interchangeably depending on the onset of symptoms)
- Causes of Hyponatremia based upon Serum Osmolality:
| Classification | Serum Osmolality | Etiology |
|---|---|---|
| Hypertonic or Isotonic Hyponatremia | > 295 mOsm/kg | Hyperglycemia‡, Mannitol, Glycine, Maltose, severe azotemia |
| Isotonic Hyponatremia
(Pseudohyponatremia) |
275 – 295 mOsm/kg | Lab/blood draw error, Post TURP (bladder irrigation with osmotic solutions),
intravenous immunoglobulin (IVIg), Hyperlipidemia ( triglyceride, cholesterol ), hyper paraproteinemia (monoclonal gammopathy of undetermined significance (MGUS), multiple myeloma), |
| Hypotonic Hyponatremia | < 275 mOsm/kg | Glycerol, Sorbitol, Etiology depends upon volume status (Hypervolemic/ Euvolemic/ Hypovolemic) |
| Alcohol, Urea, Ethylen glycol are ineffective osmoles, cause hyperosmolar isotonic serum but not hyponatremia. | ||
‡ Hyperglycemia causes osmotic diuresis results in a rise in serum sodium concentration, on the other hand it leads to extracellular shift of water due to osmotic gradient which causes relative hyponatremia , depends on which effect is stronger, there would be hypertonicity or hypotonicity[1].
- Causes of Hyponatremia based on volume status [2] :
| Volume status | Sodium status | Causes |
|---|---|---|
| Hypovolemic
Hyponatremia[3] |
|
Bicarbonaturia ( Renal tubular acidosis, Metabolic alkalosis), osmotic diuresis, diuretic use, Cerebral salt-wasting syndrome (Stroke ,SAH ,↑ brain natriuretic peptide and ↑ renal sodium loss )
|
| Hypervolemic
Hyponatremia |
|
(due to relatively higher water versus salt intake and poor excretion), nephrotic syndrome
|
| Euvolemic
Hyponatremia |
|
postoperative nausea, pain, stress, neoplasia (common), trauma, pregnancy) , nephrogenic SIAD (Gain-of-function mutation of v2 receptors)
(caused by a low intake of solutes with relatively high fluid intake)
|
† Altered sensitivity to serum osmolality by the hypothalamic osmoreceptors
- Drugs which cause hyponatremia:
| Drug Mechanisms [4] | Drug Classification |
|---|---|
| Increase ADH secretion | Antidepressants:Tricyclic antidepressants ( Amitryptiline,
Protriptyline, Desipramine),Selective serotonin reuptake inhibitors, Antipsychotic drugs: Phenothiazines (Thioridazine, Trifluoperazine), Antiepileptic drugs: Carbamazepine, Oxcarbazepine, Sodium valproate Anticancer agents: Vinca alkaloids (Vincristine, Vinblastine), Platinum compounds (Cisplatin, Carboplatin) Alkylating agents: Intravenous Cyclophosphamide, Melphalan, Ifosfamide Miscellaneous: Methotrexate, Interferon, Levamisole, Pentostatin, Monoclonal antibodies, MDMA, Nicotine Opiates |
| Increase ADH effect | Antiepileptic drugs: Carbamazepine, Lamotrigine
Antidiabetic drugs: Chlorpropamide, Tolbutamide Anticancer agents: Alkylating agents (Intravenous cyclophosphamide) NSAIDS |
| Drugs affecting water and sodium homeostasis | Diuretics: Thiazides, Indapamide, Amiloride, Loop diuretics |
| Reset omostat ‡ | Antidepressants: Venlafaxine
Antiepileptic drugs: Carbamazepine |
| Vasopressin analogues | Desmopressin, oxytocin, terlipressin, vasopressin |
‡ Altered sensitivity to serum osmolality by the hypothalamic osmoreceptors
Causes by Organ System
Causes in Alphabetical Order
References
- ↑ 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) - ↑ Guillaumin, Julien; DiBartola, Stephen P. (2017). "A Quick Reference on Hyponatremia". Veterinary Clinics of North America: Small Animal Practice. 47 (2): 213–217. doi:10.1016/j.cvsm.2016.10.003. ISSN 0195-5616.
- ↑ Rondon-Berrios, Helbert; Agaba, Emmanuel I.; Tzamaloukas, Antonios H. (2014). "Hyponatremia: pathophysiology, classification, manifestations and management". International Urology and Nephrology. 46 (11): 2153–2165. doi:10.1007/s11255-014-0839-2. ISSN 0301-1623.
- ↑ Liamis, George; Milionis, Haralampos; Elisaf, Moses (2008). "A Review of Drug-Induced Hyponatremia". American Journal of Kidney Diseases. 52 (1): 144–153. doi:10.1053/j.ajkd.2008.03.004. ISSN 0272-6386.