Hyponatremia Management

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 T reatment of over correction using desmopressin or electrolyte-free water

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