Hyponatremia management in the light of current guidelines

Yıl 2018, Cilt: 10 Sayı: 1, 68 - 72, 01.03.2018

İrfan Karahan Çağlar Alp Aydın Çifci

https://doi.org/10.21601/ortadogutipdergisi.328101

Öz

Hyponatraemia
is the most common electrolyte disorder in hospitalized patients, defined as
serum sodium level below 135 mmol / L. This electrolyte disorder is associated
with increased mortality,  morbidity and prolonged
hospital admission. Especially in the elderly, patients with severe symptoms
may require rapid evaluation and intervention. Different disciplines can have
different approaches and this prevents the standard approach. Clinical
evaluation is usually overlooked and patients are trying to treat more
laboratory tests. For this purpose, guides have been established with the aim
of collecting approaches in a certain standard with the participation of many
institutions. In this article we aimed at presenting practical approaches to
hyponatremia by reviewing the guidelines.

Anahtar Kelimeler

Hyponatremia management, current guidelines, diagnosis, treatment

Güncel kılavuzlar ışığında hiponatremi yönetimi

Öz

Hiponatremi
serum sodyum düzeyinin 135 mmol/L altında olması olarak tanımlanan ve hastanede
yatan hastalarda en sık görülen elektrolit bozukluğudur. Bu elektrolit
bozukluğu artmış mortalite, morbidite ve uzamış hastane yatışı ile ilgilidir.
Özellikle yaşlılarda, şiddetli semptomu olan hastalarda hızlı değerlendirme ve
müdahale gerekebilmektedir. Farklı disiplinlerin farklı yaklaşımları
olabilmekte ve bu durum standart yaklaşım olmasını engellemektedir. Genellikle
klinik değerlendirme gözardı edilmekte hastadan çok laboratuvar tetkikleri
tedavi edilmeye çalışılmaktadır. Bu amaçla birçok derneğin katılımıyla
yaklaşımları belli bir standartta toplamak amacıyla kılavuzlar oluşturulmuştur.
Biz bu yazıda kılavuzları gözden geçirerek hiponatremiye uygun yaklaşımları
pratik bir şekilde sunmayı amaçladık. 

Anahtar Kelimeler

Hiponatremi yönetimi, güncel kılavuzlar, tanı, tedavi

Kaynakça

• 1. Hoorn EJ, Lindemans J, Zietse R. Development of severe hyponatraemia in hospitalized patients: treatment-related risk factors and inadequate management. Nephrol Dial Transplant 2005;21:70-6.
• 2. Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant 2014;29:i1-i39.
• 3. Verbalis JG, Goldsmith SR, Greenberg A, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med 2013;126:1-42.
• 4. Funk G-C, Lindner G, Druml W, et al. Incidence and prognosis of dysnatremias present on ICU admission. Intensive Care Med 2010;36:304-11.
• 5. Beukhof CM, Hoorn EJ, Lindemans J, Zietse R. Novel risk factors for hospital‐acquired hyponatraemia: a matched case–control study. Clin Endocrinol 2007; 66:367-72.
• 6. Sterns RH, Thomas DJ, Herndon RM. Brain dehydration and neurologic deterioration after rapid correction of hyponatremia. Kidney Int 1989;35:69-75.
• 7. Videen JS, Michaelis T, Pinto P, Ross BD. Human cerebral osmolytes during chronic hyponatremia. A proton magnetic resonance spectroscopy study. J Clin Invest 1995; 95:788.
• 8. Fazekas AS, Funk G-C, Klobassa DS, et al. Evaluation of 36 formulas for calculating plasma osmolality. Intensive Care Med 2013;39:302-8.
• 9. Adrogué HJ, Madias NE. Hyponatremia. New England J Med 2000;342:1581-9.
• 10. Hillier TA, Abbott RD, Barrett EJ. Hyponatremia: evaluating the correction factor for hyperglycemia. AmJ Med 1999;106:399-403.
• 11. Aviram A, Pfau A, Czaczkes J, Ullmann T. Hyperosmolality with hyponatremia, caused by inappropriate administration of mannitol. AmJ Med 1967; 42:648-50.
• 12. Lindner G, Zapletal B, Schwarz C, Wisser W, Hiesmayr M, Lassnigg A. Acute hyponatremia after cardioplegia by histidine-tryptophane-ketoglutarate–a retrospective study. J Ccardiothoracic Surg 2012;7:52.
• 13. Lai M-Y, Lin C-C, Chung S-L, Wu C-H, Yang W-C, Tseng YT. Milky plasma, diabetes, and severe hyponatremia. Kidney Int 2009;5:996.
• 14. Lawn N, Wijdicks EF, Burritt MF. Intravenous immune globulin and pseudohyponatremia. New England J Med 1998;339:632-4.
• 15. Oster JR, Singer I. Hyponatremia, hyposmolality, and hypotonicity: tables and fables. Archives Int Med 1999;159:333-6.
• 16. Feldman BJ, Rosenthal SM, Vargas GA, et al. Nephrogenic syndrome of inappropriate antidiuresis. New England J Med 2005;352:1884-90.
• 17. Christ-Crain M, Fenske W: Copeptin in the diagnosis of vasopressin-dependent disorders of fluid homeostasis. Nature Reviews Endocrinology 2016, 12(3):168-176.
• 18. Schwartz WB, Bennett W, Curelop S, Bartter FC. A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 1957;23:529-42.
• 19. Janicic N, Verbalis JG. Evaluation and management of hypo-osmolality in hospitalized patients. Endocrinol Metabol Clin 2003;32:459-81.
• 20. Hannon MJ, Finucane FM, Sherlock M, Agha A, Thompson CJ. Disorders of water homeostasis in neurosurgical patients. J Clin Endocrinol & Metabol 2012;97:1423-33.
• 21. Brimioulle S, Orellana-Jimenez C, Aminian A, Vincent J-L. Hyponatremia in neurological patients: cerebral salt wasting versus inappropriate antidiuretic hormone secretion. Intensive Care Med 2008;34:125-31.
• 22. Sterns RH: Treating hyponatremia: why haste makes waste. Southern Med J 1994; 87:1283-7.
• 23. Worthley L, Thomas P. Treatment of hyponatraemic seizures with intravenous 29.2% saline. Br Med J (Clin Res Ed) 1986;292:168-70.
• 24. Hoorn E, Halperin M, Zietse R. Diagnostic approach to a patient with hyponatraemia: traditional versus physiology-based options. QJM 2005;98:529-40.
• 25. Snell D, Bartley C. Osmotic demyelination syndrome following rapid correction of hyponatraemia. Anaesthesia 2008;63:92-5.
• 26. Gankam Kengne F, Andres C, Sattar L, Melot C, Decaux G. Mild hyponatremia and risk of fracture in the ambulatory elderly. QJM. An International Journal of Medicine 2008; 101:583-8.
• 27. Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med 2006;119:71-8.
• 28. Forssell G, Nordlander R, Orinius E. Treatment of dilutional hyponatremia in congestive heart failure. J Int Med 1980;207:279-81.
• 29. Musch W, Decaux G. Treating the syndrome of inappropriate ADH secretion with isotonic saline. QJM: Monthly J Assoc Phys 1998;91:749-53.
• 30. Demirel D, Atalan K, Çakar N. Yoğun bakım ünitesinde sıvı-elektrolit ve asit baz dengesi. Turkiye Klinikleri J Int Med Sci 2006;2:45-61.
• 31. Berl T, Rastegar A. A patient with severe hyponatremia and hypokalemia: osmotic demyelination following potassium repletion. AmJ Kidney Dis 2010;55:742-8.