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Previous Volume 342:1581-1589 May 25, 2000 Number 21 Next

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Hyponatremia is defined as a decrease in the serum sodium concentration to a level below 136 mmol per liter. Whereas hypernatremia always denotes hypertonicity, hyponatremia can be associated with low, normal, or high tonicity.^1,2 Effective osmolality or tonicity refers to the contribution to osmolality of solutes, such as sodium and glucose, that cannot move freely across cell membranes, thereby inducing transcellular shifts in water.³ Dilutional hyponatremia, by far the most common form of the disorder, is caused by water retention. If water intake exceeds the capacity of 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.
Extract | Full Text  
N Engl J Med 2000; 343:886-888, Sep 21, 2000. Correspondence

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