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 and ADH level.

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:

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

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

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

According to volume status:

Classification based on volume status		Causes
Hypovolemic Hyponatremia	total body water ↓ total body sodium ↓↓	GI loss: Vomiting, diarrhea, tube drainage Insensible loss: Sweating, burns Renal loss: Salt-wasting nephropathy (Inappropriate loss of Na+-Cl– in the urine), Bicarbonaturia ( Renal tubular acidosis, Metabolic alkalosis) Third spacing of fluids : Pancreatitis, hypoalbuminemia Cerebral salt-wasting syndrome : Stroke ,SAH (urinary salt wasting, brain natriuretic peptide ↑) Mineralocorticoid deficiency: Addison disease Excessive diuretic administration
Hypervolemic Hyponatremia	total body water ↑↑ total body sodium ↑	Acute/chronic kidney injury/disease:(low sodium levels in advanced kidney disease or dialysis patients due to relatively higher water versus salt intake and poor excretion due to underlying kidney disease) Congestive heart failure Cirrhosis Nephrotic syndrome Iatrogenic
Euvolemic Hyponatremia	total body water ↑ total body sodium ↔	Drugs:Vasopressin, diuretics, antidepressants, opioids SIADH: Malignancy, central nervous system (CNS) disorders, pulmonary disease, or drugs, postoperative nausea, pain,stress,Neoplasia (common),trauma,pregnancy High fluid intake: Physical activity, surgery, primary polydipsia, potomania (caused by a low intake of solutes with relatively high fluid intake) Medical testing (excess fluid intake) :Colonoscopy or cardiac catheterization Hypothyroidism Glucocorticoid deficiency Reset osmostat Iatrogenic

• 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]
  • [Group4]

OR

• [Disease name] may be classified into [large number > 6] subtypes based on:
  • [Classification method 1]
  • [Classification method 2]
  • [Classification method 3]
• [Disease name] may be classified into several subtypes based on:
  • [Classification method 1]
  • [Classification method 2]
  • [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].