Hyponatremia is defined as a decrease in the serum sodium concentrationto a level below 136 mmol per liter. Whereas hypernatremia alwaysdenotes hypertonicity, hyponatremia can be associated with low,normal, or high tonicity.1,2 Effective osmolality or tonicityrefers to the contribution to osmolality of solutes, such assodium and glucose, that cannot move freely across cell membranes,thereby inducing transcellular shifts in water.3 Dilutionalhyponatremia, by far the most common form of the disorder, iscaused by water retention. If water intake exceeds the capacityof the kidneys to excrete water, dilution of body solutes results,causing hypo-osmolality and . . . [Full Text of this Article]
Causes
Clinical Manifestations
Management
Symptomatic Hypotonic Hyponatremia
Hyponatremia in the Postoperative State
Hyponatremia in an Essentially Euvolemic State
Hyponatremia in a Hypovolemic State
Asymptomatic Hypotonic Hyponatremia
Nonhypotonic Hyponatremia
Common Errors in Management
Source Information
From the Department of Medicine, Baylor College of Medicine and Methodist Hospital, and the Renal Section, Department of Veterans Affairs Medical Center, Houston (H.J.A.); and the Department of Medicine, Tufts University School of Medicine, and the Division of Nephrology and Tupper Research Institute, New England Medical Center, Boston (N.E.M.).
Address reprint requests to Dr. Madias at the Division of Nephrology, New England Medical Center, Box 172, 750 Washington St., Boston, MA 02111, or at nmadias@infonet.tufts.edu.
References
Related Letters:
Hyponatremia
Arieff A. I., Ayus J. C., Martin A. J., Bruns D. E., Ladenson J. H., Scott M. G., Kashyap A. S., Kashyap S., van Heyningen C., Gill G. V., Watson I. D., Berl T., Adrogue H. J., Madias N. E.
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N Engl J Med 2000;
343:886-888, Sep 21, 2000.
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