Management of hyponatremia: causes, clinical aspects, differential diagnosis and treatment

ABSTRACT

Introduction: Hyponatremia is the most frequent electrolyte disorder in hospitalised patients. Acute and severe hyponatremia may be a life-threatening situation. However, also mild and chronic hyponatremia may negatively affect the health status (i.e. gait disturbances, attention deficits, falls and fractures, and bone loss) and may increase the risk of death. Therefore, it is of paramount importance for clinicians to have an in-depth knowledge on this topic, in order to appropriately manage patients affected by hyponatremia.

Areas covered: This review will cover different areas related to this electrolyte disorder. Because many pathologic conditions may be associated with hyponatremia, thorough investigations have to be performed in order to establish the underlying etiology. To establish the cause of hyponatremia is of great importance, because an appropriate therapeutic strategy is strictly dependent on a correct diagnosis. A description of the different available therapeutic approaches for the correction of hyponatremia, including vaptans, will follow.

Expert commentary: Undoubtedly, the studies that have been published in recent years and the introduction of vaptans in clinical practice have contributed to increase the awareness on hyponatremia among clinicians. Nevertheless, additional studies are needed in order to clarify some partially uncovered areas.

KEYWORDS:

• Hyponatremia
• sodium
• saline solution
• SIAD
• vaptans

Acknowledgments

The author wishes to thank all the collaborators, who contributed to basic research as well as to clinical research studies, and in particular Susanna Benvenuti, Paola Luciani, Cristiana Deledda, Benedetta Fibbi, Corinna Giuliani, Giada Marroncini, Gabriele Parenti, Giovanni Corona, Dario Norello, Mario Maggi from the University of Florence, Italy, and Joseph G Verbalis from Georgetown University (Washington DC, U.S.A.).

Declaration of interest

A Peri is on the Otsuka Pharmaceutical advisory board for tolvaptan and has received honoraria from Otsuka Pharmaceutical for speaking at symposia.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.