The Management of Hyponatremia

Abstract

A case of hyponatremia in a previously healthy 76-year-old woman is described with discussion revolving around key questions: 1. Is hyponatremia really hypotonic? 2. Is there an emergency present on admission necessitating acute therapeutic action to improve the electrolyte disturbances? 3. What is the best approach to obtaining a correct diagnosis? 4. What is the best approach to raise serum Na? 5. What are the risk factors, symptoms and pathophysiology of thiazide-induced hyponatremia? 6. What is the role of hypokalemia in the pathophysiology of hyponatremia? 7. What are the options for therapy to raise the plasma sodium in this patient? 8. How should the concomitant hypokalemia be treated, and is it an additional danger in the treatment of the hyponatremia? 9. What are the lessons from this case for the management of chronic “asymptomatic” or mildly symptomatic hyponatremic patients? 10. Would this patient be approached differently in Europe and the United States?