4.7 Article

Approach to the Patient: Hyponatremia and the Syndrome of Inappropriate Antidiuresis (SIAD)

期刊

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
卷 107, 期 8, 页码 2362-2376

出版社

ENDOCRINE SOC
DOI: 10.1210/clinem/dgac245

关键词

hyponatremia; SIAD; tolvaptan; fluid restriction; hypertonic saline

资金

  1. Royal College of Surgeons in Ireland (RCSI)/Beacon Hospital Strategic Academic Recruitment (StAR) programme
  2. Irish Endocrine Society Clinical Science Award
  3. Health Research Board (HRB)
  4. Wellcome Trust [203930/B/16/Z]
  5. HRB Emerging Clinician Scientist Award [ECSA-2020-001]
  6. Wellcome Trust [203930/B/16/Z] Funding Source: Wellcome Trust

向作者/读者索取更多资源

Hyponatremia is a common electrolyte disturbance with significant clinical outcomes. This article reviews and compares the current recommendations, guidelines, and literature for diagnosis and treatment options for both acute and chronic hyponatremia, using case studies as examples.
Hyponatremia is the most common electrolyte disturbance seen in clinical practice, affecting up to 30% of acute hospital admissions, and is associated with significant adverse clinical outcomes. Acute or severe symptomatic hyponatremia carries a high risk of neurological morbidity and mortality. In contrast, chronic hyponatremia is associated with significant morbidity including increased risk of falls, osteoporosis, fractures, gait instability, and cognitive decline; prolonged hospital admissions; and etiology-specific increase in mortality. In this Approach to the Patient, we review and compare the current recommendations, guidelines, and literature for diagnosis and treatment options for both acute and chronic hyponatremia, illustrated by 2 case studies. Particular focus is concentrated on the diagnosis and management of the syndrome of inappropriate antidiuresis. An understanding of the pathophysiology of hyponatremia, along with a synthesis of the duration of hyponatremia, biochemical severity, symptomatology, and blood volume status, forms the structure to guide the appropriate and timely management of hyponatremia. We present 2 illustrative cases that represent common presentations with hyponatremia and discuss the approach to management of these and other causes of hyponatremia.

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