Treatment of Severe Hyponatremia

Patients with severe (serum sodium ≤120 mEq/L), symptomatic hyponatremia can develop life-threatening or fatal complications from cerebral edema if treatment is inadequate and permanent neurologic disability from osmotic demyelination if treatment is excessive. Unfortunately, as is true of all elect...

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Bibliographic Details
Published in:Clinical journal of the American Society of Nephrology 2018-04, Vol.13 (4), p.641-649
Main Author: Sterns, Richard H
Format: Article
Language:English
Subjects:
Acute Disease
Brain Edema - etiology
Chronic Disease
Demyelinating Diseases - chemically induced
Evidence-Based Nephrology
Hyponatremia - blood
Hyponatremia - complications
Hyponatremia - therapy
Practice Guidelines as Topic
Saline Solution - administration & dosage
Saline Solution - adverse effects
Severity of Illness Index
Sodium - adverse effects
Sodium - blood
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Summary:Patients with severe (serum sodium ≤120 mEq/L), symptomatic hyponatremia can develop life-threatening or fatal complications from cerebral edema if treatment is inadequate and permanent neurologic disability from osmotic demyelination if treatment is excessive. Unfortunately, as is true of all electrolyte disturbances, there are no randomized trials to guide the treatment of this challenging disorder. Rather, therapeutic decisions rest on physiologic principles, animal models, observational studies, and single-patient reports. European guidelines and recommendations of an American Expert panel have come to similar conclusions on how much correction of hyponatremia is enough and how much is too much, but there are important differences. We review the evidence supporting these recommendations, identifying areas that rest on relatively solid ground and highlighting areas in greatest need of additional data.
ISSN:1555-9041
1555-905X
DOI:10.2215/cjn.10440917