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Hyponatremia

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Hyponatremia is a condition in which the amount of sodium (salt) in the blood is lower than normal.
Causes
Sodium is found mostly in the body fluids outside the cells. It is very important for maintaining blood
pressure. Sodium is also needed for nerves, muscles, and other body tissues to work properly.
When the amount of sodium in fluids outside cells drops, water moves into the cells to balance the
levels. This causes the cells to swell with too much water. Brain cells are especially sensitive to swelling,
and this causes many of the symptoms of hyponatremia.
In hyponatremia, the imbalance of water to salt is caused by one of three conditions:
Euvolemic hyponatremia -- total body water increases, but the body's sodium content stays the
same
Hypervolemic hyponatremia -- both sodium and water content in the body increase, but the
water gain is greater
Hypovolemic hyponatremia -- water and sodium are both lost from the body, but the sodium
loss is greater
Hyponatremia can be caused by:
Burns that affect a large area of the body
Diarrhea
Diuretic medicines, which increase urine output
Heart failure
Kidney diseases
Liver cirrhosis
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Sweating
Vomiting
Symptoms
Common symptoms include:
Confusion
Convulsions
Fatigue
Headache
Irritability
Loss of appetite
Muscle spasms or cramps
Muscle weakness
Nausea
Restlessness
Vomiting
Exams and Tests
The health care provider will perform a complete physical examination to help determine the cause of
your symptoms. Blood and urine tests will be done.
The following laboratory tests can confirm and help diagnose hyponatremia:
Comprehensive metabolic panel (includes blood sodium)
Osmolality blood test
Urine osmolality
Urine sodium
Treatment
The cause of hyponatremia must be diagnosed and treated. If cancer is the cause of the condition,
radiation, chemotherapy, or surgery to remove the tumor may correct the sodium imbalance.
Other treatments depend on the specific type of hyponatremia.
Treatments may include:
Fluids through a vein (IV)
Medication to relieve symptoms
Water restriction
Outlook (Prognosis)
The outcome depends on the condition that is causing the problem. Acute hyponatremia, which occurs
in less than 48 hours, is more dangerous than hyponatremia that develops slowly over time. When
sodium level falls slowly over days or weeks (chronic hyponatremia), the brain cells have time to adjust
and swelling is minimal.
Possible Complications
In severe cases, hyponatremia can lead to:
Decreased consciousness, hallucinations or coma
Brain herniation
Death
When to Contact a Medical Professional
Hyponatremia can be a life-threatening emergency. Call your health care provider right away if you have
symptoms of this condition.
Prevention
Treating the condition that is causing hyponatremia can help. If you play sports, drink fluids such as
sports drinks that contain electrolytes. Drinking only water while you are active can lead to acute
hyponatremia.
Alternative Names
Dilutional hyponatremia; Euvolemic hyponatremia; Hypervolemic hyponatremia; Hypovolemic
hyponatremia
References
Skorecki K, Ausiello D. Disorders of sodium and water homeostasis. In: Goldman L, Schafer AI,
eds.Goldmans Cecil Medicine. 24th ed. Philadelphia, Pa.: Elsevier Saunders; 2011:chap 118.
Update Date: 4/14/2013
Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department
of Medicine, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions,
Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.