Hyponatremia Management

1. Hyponatremia
Management
ADE WIJAYA, MD
NOVEMBER 2017

2. Outline
 Introduction
 Etiology
 Classification
 Diagnostic Algorhytm
 Management
 Summary

3. Introduction
 Is a common water balance disorder that often poses a diagnostic or therapeutic challenge
 Is not a disease but rather a pathophysiologic process indicating disturbed water homeostasis
 A very heterogeneous disorder
Adrogué HJ, Madias NE: The challenge of hyponatremia. J Am Soc Nephrol 23: 1140–1148, 2012
Sterns RH: Disorders of plasma sodium– causes, consequences, and correction. N Engl J Med 372: 55–65, 2015
Winzeler B, Jeanloz N, Nigro N, SuterWidmer I, Schuetz P, Arici B, Bally M, Blum C, Bock A, Huber A, Mueller B, Christ-Crain M: Long-term outcome of profound hyponatremia: A prospective 12 months followup study. Eur J Endocrinol 175: 499–507, 2016
Chawla A, Sterns RH, Nigwekar SU, Cappuccio JD: Mortality and serum sodium: Do patients die from or with hyponatremia? Clin J Am Soc Nephrol 6: 960–965, 2011

4. Etiology
The syndrome of inappropriate antidiuresis (SIAD),
Diuretic use,
Polydipsia,
Adrenal insufficiency,
Hypovolemia,
Heart failure,
Liver cirrhosis
(the latter two are often collectively referred to as “hypervolemic hyponatremia”).
Hoorn, E. J., & Zietse, R. (2017). Diagnosis and treatment of hyponatremia: Compilation of the guidelines. J Am Soc Nephrol.

5. Classification
Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, Decaux G, Fenske W, Hoorn EJ, Ichai C, Joannidis M, Soupart A, Zietse R, Haller M, van der Veer S, Van Biesen W, Nagler E; Hyponatraemia Guideline Development Group: Clinical practice guideline
on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant 29[Suppl 2]: i1–i39, 2014
Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, Thompson CJ: Diagnosis, evaluation, and treatment of hyponatremia: Expert panel recommendations. Am J Med 126[Suppl 1]: S1–S42, 2013

6. Diagnostic
Algorhytm
Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, Decaux G, Fenske
W, Hoorn EJ, Ichai C, Joannidis M, Soupart A, Zietse R, Haller M, van der Veer S,
Van Biesen W, Nagler E; Hyponatraemia Guideline Development Group: Clinical
practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial
Transplant 29[Suppl 2]: i1–i39, 2014

7. Management
Hoorn, E. J., & Zietse, R. (2017). Diagnosis and treatment of hyponatremia: Compilation of the guidelines. J Am Soc Nephrol.

8. Central Pontine Myelinolysis
Risk factors:
- Too rapid correction
- Chronicity
- Severity of hyponatremia
- Alcoholic, malnourished, chronically ill
Symptoms: deterioration of the consciousness,
quadriplegia, dysphasia, mutism
No treatment  supportive
Prognostic  mostly poor  locked-in syndrome /
death
Ubaidur Rahaman,
,

9. Summary
 Is a serious condition that needed to be detected and treated well
 Not a disease but a pathophysiologic process of various conditions
 Acute vs chronic
 Asymptomatic vs symptomatic
 Management depend on etiology and classification of hyponatremia
 overcorrection!  central pontine myelinolysis
 Treatment of over correction using desmopressin or electrolyte-free water