Hyponatremia classification

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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

There is no established system for the classification of [disease name].

OR

[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].

OR

[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3]. [Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].

OR

Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.

OR

If the staging system involves specific and characteristic findings and features: According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].

OR

The staging of [malignancy name] is based on the [staging system].

OR

There is no established system for the staging of [malignancy name].

Classification

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

Hyponatremia is classified based on serum sodium level to :

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

Classification based on duration :

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

• Acute: Rapid onset <48 hours, surgeries, colonoscopy preparation, polydipsia, diuretics
• Chronic: Gradual onset >48 hours, caused by chronic disease ( including cardiac, renal, hepatic and other conditions)

( Etiologies cause hyper acute and acute hyponatremia are applicable interchangeably to each categories)

Classification based on ADH level :

• ↑ 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

Classification based upon osmolality :

• Hypertonic hyponatremia: Serum osmolality >295 mOsm/kg
• Hypotonic hyponatremia: Serum osmolality < 280 mOsm/kg
• Norotonic hyponatremia: Serum osmolality 280-295 mOsm/kg

According to volume status :

Volume status	Sodium status	True volume depletion : GI loss, Renal loss, Insensible loss
Hypovolemic Hyponatremia	total body water ↓ total body sodium ↓↓
Hypervolemic Hyponatremia	total body water ↑↑ total body sodium ↑	Decreased effective arterial volume : Cirrhosis, Renal disease, CHF
Euvolemic Hyponatremia	total body water ↑ total body sodium ↔	Drugs ,Increased ADH level, Reset osmostat, Low dietary salt intake