Top

Published in:

01-03-2014 | Guidelines

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Authors: Goce Spasovski, Raymond Vanholder, Bruno Allolio, Djillali Annane, Steve Ball, Daniel Bichet, Guy Decaux, Wiebke Fenske, Ewout Hoorn, Carole Ichai, Michael Joannidis, Alain Soupart, Robert Zietse, Maria Haller, Sabine van der Veer, Wim Van Biesen, Evi Nagler

Published in: Intensive Care Medicine | Issue 3/2014

Abstract

Hyponatraemia, defined as a serum sodium concentration <135 mmol/L, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. Hyponatraemia is present in 15–20 % of emergency admissions to hospital and occurs in up to 20 % of critically ill patients. Symptomatology may vary from subtle to severe or even life threatening. Despite this, the management of patients remains problematic. Against this background, the European Society of Intensive Care Medicine, the European Society of Endocrinology and the European Renal Association–European Dialysis and Transplant Association, represented by European Renal Best Practice have developed a Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia.

Available only for authorised users

Funk GC, Lindner G, Druml W et al (2010) Incidence and prognosis of dysnatremias present on ICU admission. Intens Care Med 36:304–311CrossRef

Beukhof CM, Hoorn EJ, Lindemans J, Zietse R (2007) Novel risk factors for hospital-acquired hyponatraemia: a matched case-control study. Clin Endocrinol 66:367–372CrossRef

Upadhyay A, Jaber BL, Madias NE (2009) Epidemiology of hyponatremia. Semin Nephrol 29:227–238PubMedCrossRef

Hoorn EJ, Lindemans J, Zietse R (2006) Development of severe hyponatraemia in hospitalized patients: treatment-related risk factors and inadequate management. Nephrol Dial Transpl 21:70–76CrossRef

Waikar SS, Mount DB, Curhan GC (2009) Mortality after hospitalization with mild, moderate, and severe hyponatremia. Am J Med 122:857–865PubMedCentralPubMedCrossRef

Doshi SM, Shah P, Lei X, Lahoti A, Salahudeen AK (2012) Hyponatremia in hospitalized cancer patients and its impact on clinical outcomes. Am J Kidney Dis 59:222–228PubMedCrossRef

Sterns RH (1987) Severe symptomatic hyponatremia: treatment and outcome. A study of 64 cases. Ann Intern Med 107:656–664PubMedCrossRef

Gill G, Huda B, Boyd A et al (2006) Characteristics and mortality of severe hyponatraemia—a hospital-based study. Clin Endocrinol 65:246–249CrossRef

Arieff AI, Llach F, Massry SG (1976) Neurological manifestations and morbidity of hyponatremia: correlation with brain water and electrolytes. Medicine 55:121–129PubMedCrossRef

10.

Halberthal M, Halperin ML, Bohn D (2001) Lesson of the week: acute hyponatraemia in children admitted to hospital: retrospective analysis of factors contributing to its development and resolution. BMJ 322:780–782PubMedCentralPubMedCrossRef

11.

Darmon M, Diconne E, Souweine B et al (2013) Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change. Crit Care 17:R12PubMedCentralPubMedCrossRef

12.

Sakr Y, Rother S, Ferreira AMP et al (2013) Fluctuations in serum sodium level are associated with an increased risk of death in surgical ICU patients. Crit Care Med 41:133–142PubMedCrossRef

13.

Stelfox HT, Ahmed SB, Khandwala F, Zygun D, Shahpori R, Laupland K (2008) The epidemiology of intensive care unit-acquired hyponatraemia and hypernatraemia in medical-surgical intensive care units. Crit Care 12:R162PubMedCentralPubMedCrossRef

14.

Pirzada NA, Ali II (2001) Central pontine myelinolysis. Mayo Clin Proc 76:559–562PubMedCrossRef

15.

Arieff AI (1986) Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. N Engl J Med 314:1529–1535PubMedCrossRef

16.

Ayus JC, Wheeler JM, Arieff AI (1992) Postoperative hyponatremic encephalopathy in menstruant women. Ann Intern Med 117:891–897PubMedCrossRef

17.

Nzerue CM, Baffoe-Bonnie H, You W, Falana B, Dai S (2003) Predictors of outcome in hospitalized patients with severe hyponatremia. J Natl Med Assoc 95:335–343PubMedCentralPubMed

18.

Arieff AI, Ayus JC, Fraser CL (1992) Hyponatraemia and death or permanent brain damage in healthy children. BMJ 304:1218–1222PubMedCentralPubMedCrossRef

19.

Verbalis JG, Drutarosky MD, Ertel RJ, Vollmer RR (1989) Adaptive responses to sustained volume expansion in hyponatraemic rats. J Endocrinol 122:421–431PubMedCrossRef

20.

Verbalis JG, Gullans SR (1991) Hyponatremia causes large sustained reductions in brain content of multiple organic osmolytes in rats. Brain Res 567:274–282PubMedCrossRef

21.

Sterns RH, Silver SM (2006) Brain volume regulation in response to hypo-osmolality and its correction. Am J Med 119:S12–S16PubMedCrossRef

22.

Melton JE, Patlak CS, Pettigrew KD, Cserr HF (1987) Volume regulatory loss of Na, Cl, and K from rat brain during acute hyponatremia. Am J Physiol 252:F661–F669PubMed

23.

Sterns RH, Thomas DJ, Herndon RM (1989) Brain dehydration and neurologic deterioration after rapid correction of hyponatremia. Kidney Int 35:69–75PubMedCrossRef

24.

Verbalis JG, Martinez AJ (1991) Neurological and neuropathological sequelae of correction of chronic hyponatremia. Kidney Int 39:1274–1282PubMedCrossRef

25.

Videen JS, Michaelis T, Pinto P, Ross BD (1995) Human cerebral osmolytes during chronic hyponatremia. A proton magnetic resonance spectroscopy study. J Clin Invest 95:788–793PubMedCentralPubMedCrossRef

26.

Hoorn EJ, Zietse R (2008) Hyponatremia revisited: translating physiology to practice. Nephron Physiol 108:46–59CrossRef

27.

Hsu Y-J, Chiu J-S, Lu K-C, Chau T, Lin S-H (2005) Biochemical and etiological characteristics of acute hyponatremia in the emergency department. J Emerg Med 29:369–374PubMedCrossRef

28.

Sterns RH (1994) Treating hyponatremia: why haste makes waste. South Med J 87:1283–1287PubMedCrossRef

29.

Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G (2006) Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med 119(71):e71–e78

30.

Fazekas AS, Funk G-C, Klobassa DS et al (2012) Evaluation of 36 formulas for calculating plasma osmolality. Intens Care Med 39:302–308CrossRef

31.

Adrogue HJ, Madias NE (2000) Hyponatremia. N Engl J Med 342:1581–1589PubMedCrossRef

32.

Hoorn EJ, Halperin ML, Zietse R (2005) Diagnostic approach to a patient with hyponatraemia: traditional versus physiology-based options. Q J Med 98:529–540CrossRef

33.

Chung HM, Kluge R, Schrier RW, Anderson RJ (1987) Clinical assessment of extracellular fluid volume in hyponatremia. Am J Med 83:905–908PubMedCrossRef

34.

McGee S, Abernethy WB 3rd, Simel DL (1999) The rational clinical examination. Is this patient hypovolemic? JAMA 281:1022–1029PubMedCrossRef

35.

Hillier TA, Abbott RD, Barrett EJ (1999) Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med 106:399–403PubMedCrossRef

36.

Schwartz WB, Bennett W, Curelop S, Bartter FC (1957) A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 23:529–542PubMedCrossRef

37.

Janicic N, Verbalis JG (2003) Evaluation and management of hypo-osmolality in hospitalized patients. Endocrinol Metab Clin N Am 32:459–481 viiCrossRef

38.

Aviram A, Pfau A, Czaczkes JW, Ullmann TD (1967) Hyperosmolality with hyponatremia, caused by inappropriate administration of mannitol. Am J Med 42:648–650PubMedCrossRef

39.

Desmond J (1970) Serum osmolality and plasma electrolytes in patients who develop dilutional hyponatremia during transurethral resection. Can J Surg 13:116–121PubMed

40.

Lindner G, Zapletal B, Schwarz C, Wisser W, Hiesmayr M, Lassnigg A (2012) Acute hyponatremia after cardioplegia by histidine–tryptophane–ketoglutarate—a retrospective study. J Cardiothorac Surg 7:52PubMedCentralPubMedCrossRef

41.

Sirken G, Raja R, Garces J, Bloom E, Fumo P (2004) Contrast-induced translocational hyponatremia and hyperkalemia in advanced kidney disease. Am J Kidney Dis 43:e31–e35PubMedCrossRef

42.

Palevsky PM, Rendulic D, Diven WF (1993) Maltose-induced hyponatremia. Ann Intern Med 118:526–528PubMedCrossRef

43.

Oster JR, Singer I (1999) Hyponatremia, hyposmolality, and hypotonicity: tables and fables. Arch Intern Med 159:333–336PubMedCrossRef

44.

Lai M-Y, Lin C-C, Chung S-L, Wu C-H, Yang W-C, Tseng Y-T (2009) Milky plasma, diabetes, and severe hyponatremia. Kidney Int 75:996PubMedCrossRef

45.

Lawn N, Wijdicks EF, Burritt MF (1998) Intravenous immune globulin and pseudohyponatremia. N Engl J Med 339:632PubMedCrossRef

46.

Vaswani SK, Sprague R (1993) Pseudohyponatremia in multiple myeloma. South Med J 86:251–252PubMedCrossRef

47.

Sherlock M, O’Sullivan E, Agha A et al (2006) The incidence and pathophysiology of hyponatraemia after subarachnoid haemorrhage. Clin Endocrinol 64:250–254CrossRef

48.

Brimioulle S, Orellana-Jimenez C, Aminian A, Vincent JL (2008) Hyponatremia in neurological patients: cerebral salt wasting versus inappropriate antidiuretic hormone secretion. Intensive Care Med 34:125–131PubMedCrossRef

Title: Clinical practice guideline on diagnosis and treatment of hyponatraemia
Authors: Goce Spasovski
Raymond Vanholder
Bruno Allolio
Djillali Annane
Steve Ball
Daniel Bichet
Guy Decaux
Wiebke Fenske
Ewout Hoorn
Carole Ichai
Michael Joannidis
Alain Soupart
Robert Zietse
Maria Haller
Sabine van der Veer
Wim Van Biesen
Evi Nagler
Publication date: 01-03-2014
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 3/2014
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-014-3210-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Abstract

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2014

Research accomplishments that are too good to be true: reply to Ting

Azygos vein enlargement and cavo-suprahepatic regurgitation in massive pulmonary embolism

What is the optimal post-arrest hemodynamic strategy? Towards personalized resuscitation strategies

Time course of central venous-to-arterial carbon dioxide tension difference in septic shock patients receiving incremental doses of dobutamine

Should mechanical ventilation care be centralized and should we thus transfer all ventilated patients to high volume units? Take a breath first

What’s new in antimicrobial use and resistance in critically ill patients?