Skip to main content
Erschienen in: Intensive Care Medicine 3/2014

01.03.2014 | Guidelines

Clinical practice guideline on diagnosis and treatment of hyponatraemia

verfasst von: Goce Spasovski, Raymond Vanholder, Bruno Allolio, Djillali Annane, Steve Ball, Daniel Bichet, Guy Decaux, Wiebke Fenske, Ewout Hoorn, Carole Ichai, Michael Joannidis, Alain Soupart, Robert Zietse, Maria Haller, Sabine van der Veer, Wim Van Biesen, Evi Nagler

Erschienen in: Intensive Care Medicine | Ausgabe 3/2014

Einloggen, um Zugang zu erhalten

Abstract

Hyponatraemia, defined as a serum sodium concentration <135 mmol/L, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. Hyponatraemia is present in 15–20 % of emergency admissions to hospital and occurs in up to 20 % of critically ill patients. Symptomatology may vary from subtle to severe or even life threatening. Despite this, the management of patients remains problematic. Against this background, the European Society of Intensive Care Medicine, the European Society of Endocrinology and the European Renal Association–European Dialysis and Transplant Association, represented by European Renal Best Practice have developed a Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Funk GC, Lindner G, Druml W et al (2010) Incidence and prognosis of dysnatremias present on ICU admission. Intens Care Med 36:304–311CrossRef Funk GC, Lindner G, Druml W et al (2010) Incidence and prognosis of dysnatremias present on ICU admission. Intens Care Med 36:304–311CrossRef
2.
Zurück zum Zitat Beukhof CM, Hoorn EJ, Lindemans J, Zietse R (2007) Novel risk factors for hospital-acquired hyponatraemia: a matched case-control study. Clin Endocrinol 66:367–372CrossRef Beukhof CM, Hoorn EJ, Lindemans J, Zietse R (2007) Novel risk factors for hospital-acquired hyponatraemia: a matched case-control study. Clin Endocrinol 66:367–372CrossRef
3.
Zurück zum Zitat Upadhyay A, Jaber BL, Madias NE (2009) Epidemiology of hyponatremia. Semin Nephrol 29:227–238PubMedCrossRef Upadhyay A, Jaber BL, Madias NE (2009) Epidemiology of hyponatremia. Semin Nephrol 29:227–238PubMedCrossRef
4.
Zurück zum Zitat Hoorn EJ, Lindemans J, Zietse R (2006) Development of severe hyponatraemia in hospitalized patients: treatment-related risk factors and inadequate management. Nephrol Dial Transpl 21:70–76CrossRef Hoorn EJ, Lindemans J, Zietse R (2006) Development of severe hyponatraemia in hospitalized patients: treatment-related risk factors and inadequate management. Nephrol Dial Transpl 21:70–76CrossRef
5.
6.
Zurück zum Zitat Doshi SM, Shah P, Lei X, Lahoti A, Salahudeen AK (2012) Hyponatremia in hospitalized cancer patients and its impact on clinical outcomes. Am J Kidney Dis 59:222–228PubMedCrossRef Doshi SM, Shah P, Lei X, Lahoti A, Salahudeen AK (2012) Hyponatremia in hospitalized cancer patients and its impact on clinical outcomes. Am J Kidney Dis 59:222–228PubMedCrossRef
7.
Zurück zum Zitat Sterns RH (1987) Severe symptomatic hyponatremia: treatment and outcome. A study of 64 cases. Ann Intern Med 107:656–664PubMedCrossRef Sterns RH (1987) Severe symptomatic hyponatremia: treatment and outcome. A study of 64 cases. Ann Intern Med 107:656–664PubMedCrossRef
8.
Zurück zum Zitat Gill G, Huda B, Boyd A et al (2006) Characteristics and mortality of severe hyponatraemia—a hospital-based study. Clin Endocrinol 65:246–249CrossRef Gill G, Huda B, Boyd A et al (2006) Characteristics and mortality of severe hyponatraemia—a hospital-based study. Clin Endocrinol 65:246–249CrossRef
9.
Zurück zum Zitat Arieff AI, Llach F, Massry SG (1976) Neurological manifestations and morbidity of hyponatremia: correlation with brain water and electrolytes. Medicine 55:121–129PubMedCrossRef Arieff AI, Llach F, Massry SG (1976) Neurological manifestations and morbidity of hyponatremia: correlation with brain water and electrolytes. Medicine 55:121–129PubMedCrossRef
10.
Zurück zum Zitat Halberthal M, Halperin ML, Bohn D (2001) Lesson of the week: acute hyponatraemia in children admitted to hospital: retrospective analysis of factors contributing to its development and resolution. BMJ 322:780–782PubMedCentralPubMedCrossRef Halberthal M, Halperin ML, Bohn D (2001) Lesson of the week: acute hyponatraemia in children admitted to hospital: retrospective analysis of factors contributing to its development and resolution. BMJ 322:780–782PubMedCentralPubMedCrossRef
11.
Zurück zum Zitat Darmon M, Diconne E, Souweine B et al (2013) Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change. Crit Care 17:R12PubMedCentralPubMedCrossRef Darmon M, Diconne E, Souweine B et al (2013) Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change. Crit Care 17:R12PubMedCentralPubMedCrossRef
12.
Zurück zum Zitat Sakr Y, Rother S, Ferreira AMP et al (2013) Fluctuations in serum sodium level are associated with an increased risk of death in surgical ICU patients. Crit Care Med 41:133–142PubMedCrossRef Sakr Y, Rother S, Ferreira AMP et al (2013) Fluctuations in serum sodium level are associated with an increased risk of death in surgical ICU patients. Crit Care Med 41:133–142PubMedCrossRef
13.
Zurück zum Zitat Stelfox HT, Ahmed SB, Khandwala F, Zygun D, Shahpori R, Laupland K (2008) The epidemiology of intensive care unit-acquired hyponatraemia and hypernatraemia in medical-surgical intensive care units. Crit Care 12:R162PubMedCentralPubMedCrossRef Stelfox HT, Ahmed SB, Khandwala F, Zygun D, Shahpori R, Laupland K (2008) The epidemiology of intensive care unit-acquired hyponatraemia and hypernatraemia in medical-surgical intensive care units. Crit Care 12:R162PubMedCentralPubMedCrossRef
14.
15.
Zurück zum Zitat Arieff AI (1986) Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. N Engl J Med 314:1529–1535PubMedCrossRef Arieff AI (1986) Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. N Engl J Med 314:1529–1535PubMedCrossRef
16.
Zurück zum Zitat Ayus JC, Wheeler JM, Arieff AI (1992) Postoperative hyponatremic encephalopathy in menstruant women. Ann Intern Med 117:891–897PubMedCrossRef Ayus JC, Wheeler JM, Arieff AI (1992) Postoperative hyponatremic encephalopathy in menstruant women. Ann Intern Med 117:891–897PubMedCrossRef
17.
Zurück zum Zitat Nzerue CM, Baffoe-Bonnie H, You W, Falana B, Dai S (2003) Predictors of outcome in hospitalized patients with severe hyponatremia. J Natl Med Assoc 95:335–343PubMedCentralPubMed Nzerue CM, Baffoe-Bonnie H, You W, Falana B, Dai S (2003) Predictors of outcome in hospitalized patients with severe hyponatremia. J Natl Med Assoc 95:335–343PubMedCentralPubMed
19.
Zurück zum Zitat Verbalis JG, Drutarosky MD, Ertel RJ, Vollmer RR (1989) Adaptive responses to sustained volume expansion in hyponatraemic rats. J Endocrinol 122:421–431PubMedCrossRef Verbalis JG, Drutarosky MD, Ertel RJ, Vollmer RR (1989) Adaptive responses to sustained volume expansion in hyponatraemic rats. J Endocrinol 122:421–431PubMedCrossRef
20.
Zurück zum Zitat Verbalis JG, Gullans SR (1991) Hyponatremia causes large sustained reductions in brain content of multiple organic osmolytes in rats. Brain Res 567:274–282PubMedCrossRef Verbalis JG, Gullans SR (1991) Hyponatremia causes large sustained reductions in brain content of multiple organic osmolytes in rats. Brain Res 567:274–282PubMedCrossRef
21.
Zurück zum Zitat Sterns RH, Silver SM (2006) Brain volume regulation in response to hypo-osmolality and its correction. Am J Med 119:S12–S16PubMedCrossRef Sterns RH, Silver SM (2006) Brain volume regulation in response to hypo-osmolality and its correction. Am J Med 119:S12–S16PubMedCrossRef
22.
Zurück zum Zitat Melton JE, Patlak CS, Pettigrew KD, Cserr HF (1987) Volume regulatory loss of Na, Cl, and K from rat brain during acute hyponatremia. Am J Physiol 252:F661–F669PubMed Melton JE, Patlak CS, Pettigrew KD, Cserr HF (1987) Volume regulatory loss of Na, Cl, and K from rat brain during acute hyponatremia. Am J Physiol 252:F661–F669PubMed
23.
Zurück zum Zitat Sterns RH, Thomas DJ, Herndon RM (1989) Brain dehydration and neurologic deterioration after rapid correction of hyponatremia. Kidney Int 35:69–75PubMedCrossRef Sterns RH, Thomas DJ, Herndon RM (1989) Brain dehydration and neurologic deterioration after rapid correction of hyponatremia. Kidney Int 35:69–75PubMedCrossRef
24.
Zurück zum Zitat Verbalis JG, Martinez AJ (1991) Neurological and neuropathological sequelae of correction of chronic hyponatremia. Kidney Int 39:1274–1282PubMedCrossRef Verbalis JG, Martinez AJ (1991) Neurological and neuropathological sequelae of correction of chronic hyponatremia. Kidney Int 39:1274–1282PubMedCrossRef
25.
Zurück zum Zitat Videen JS, Michaelis T, Pinto P, Ross BD (1995) Human cerebral osmolytes during chronic hyponatremia. A proton magnetic resonance spectroscopy study. J Clin Invest 95:788–793PubMedCentralPubMedCrossRef Videen JS, Michaelis T, Pinto P, Ross BD (1995) Human cerebral osmolytes during chronic hyponatremia. A proton magnetic resonance spectroscopy study. J Clin Invest 95:788–793PubMedCentralPubMedCrossRef
26.
Zurück zum Zitat Hoorn EJ, Zietse R (2008) Hyponatremia revisited: translating physiology to practice. Nephron Physiol 108:46–59CrossRef Hoorn EJ, Zietse R (2008) Hyponatremia revisited: translating physiology to practice. Nephron Physiol 108:46–59CrossRef
27.
Zurück zum Zitat Hsu Y-J, Chiu J-S, Lu K-C, Chau T, Lin S-H (2005) Biochemical and etiological characteristics of acute hyponatremia in the emergency department. J Emerg Med 29:369–374PubMedCrossRef Hsu Y-J, Chiu J-S, Lu K-C, Chau T, Lin S-H (2005) Biochemical and etiological characteristics of acute hyponatremia in the emergency department. J Emerg Med 29:369–374PubMedCrossRef
28.
29.
Zurück zum Zitat Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G (2006) Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med 119(71):e71–e78 Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G (2006) Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med 119(71):e71–e78
30.
Zurück zum Zitat Fazekas AS, Funk G-C, Klobassa DS et al (2012) Evaluation of 36 formulas for calculating plasma osmolality. Intens Care Med 39:302–308CrossRef Fazekas AS, Funk G-C, Klobassa DS et al (2012) Evaluation of 36 formulas for calculating plasma osmolality. Intens Care Med 39:302–308CrossRef
32.
Zurück zum Zitat Hoorn EJ, Halperin ML, Zietse R (2005) Diagnostic approach to a patient with hyponatraemia: traditional versus physiology-based options. Q J Med 98:529–540CrossRef Hoorn EJ, Halperin ML, Zietse R (2005) Diagnostic approach to a patient with hyponatraemia: traditional versus physiology-based options. Q J Med 98:529–540CrossRef
33.
Zurück zum Zitat Chung HM, Kluge R, Schrier RW, Anderson RJ (1987) Clinical assessment of extracellular fluid volume in hyponatremia. Am J Med 83:905–908PubMedCrossRef Chung HM, Kluge R, Schrier RW, Anderson RJ (1987) Clinical assessment of extracellular fluid volume in hyponatremia. Am J Med 83:905–908PubMedCrossRef
34.
Zurück zum Zitat McGee S, Abernethy WB 3rd, Simel DL (1999) The rational clinical examination. Is this patient hypovolemic? JAMA 281:1022–1029PubMedCrossRef McGee S, Abernethy WB 3rd, Simel DL (1999) The rational clinical examination. Is this patient hypovolemic? JAMA 281:1022–1029PubMedCrossRef
35.
Zurück zum Zitat Hillier TA, Abbott RD, Barrett EJ (1999) Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med 106:399–403PubMedCrossRef Hillier TA, Abbott RD, Barrett EJ (1999) Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med 106:399–403PubMedCrossRef
36.
Zurück zum Zitat Schwartz WB, Bennett W, Curelop S, Bartter FC (1957) A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 23:529–542PubMedCrossRef Schwartz WB, Bennett W, Curelop S, Bartter FC (1957) A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 23:529–542PubMedCrossRef
37.
Zurück zum Zitat Janicic N, Verbalis JG (2003) Evaluation and management of hypo-osmolality in hospitalized patients. Endocrinol Metab Clin N Am 32:459–481 viiCrossRef Janicic N, Verbalis JG (2003) Evaluation and management of hypo-osmolality in hospitalized patients. Endocrinol Metab Clin N Am 32:459–481 viiCrossRef
38.
Zurück zum Zitat Aviram A, Pfau A, Czaczkes JW, Ullmann TD (1967) Hyperosmolality with hyponatremia, caused by inappropriate administration of mannitol. Am J Med 42:648–650PubMedCrossRef Aviram A, Pfau A, Czaczkes JW, Ullmann TD (1967) Hyperosmolality with hyponatremia, caused by inappropriate administration of mannitol. Am J Med 42:648–650PubMedCrossRef
39.
Zurück zum Zitat Desmond J (1970) Serum osmolality and plasma electrolytes in patients who develop dilutional hyponatremia during transurethral resection. Can J Surg 13:116–121PubMed Desmond J (1970) Serum osmolality and plasma electrolytes in patients who develop dilutional hyponatremia during transurethral resection. Can J Surg 13:116–121PubMed
40.
Zurück zum Zitat Lindner G, Zapletal B, Schwarz C, Wisser W, Hiesmayr M, Lassnigg A (2012) Acute hyponatremia after cardioplegia by histidine–tryptophane–ketoglutarate—a retrospective study. J Cardiothorac Surg 7:52PubMedCentralPubMedCrossRef Lindner G, Zapletal B, Schwarz C, Wisser W, Hiesmayr M, Lassnigg A (2012) Acute hyponatremia after cardioplegia by histidine–tryptophane–ketoglutarate—a retrospective study. J Cardiothorac Surg 7:52PubMedCentralPubMedCrossRef
41.
Zurück zum Zitat Sirken G, Raja R, Garces J, Bloom E, Fumo P (2004) Contrast-induced translocational hyponatremia and hyperkalemia in advanced kidney disease. Am J Kidney Dis 43:e31–e35PubMedCrossRef Sirken G, Raja R, Garces J, Bloom E, Fumo P (2004) Contrast-induced translocational hyponatremia and hyperkalemia in advanced kidney disease. Am J Kidney Dis 43:e31–e35PubMedCrossRef
42.
Zurück zum Zitat Palevsky PM, Rendulic D, Diven WF (1993) Maltose-induced hyponatremia. Ann Intern Med 118:526–528PubMedCrossRef Palevsky PM, Rendulic D, Diven WF (1993) Maltose-induced hyponatremia. Ann Intern Med 118:526–528PubMedCrossRef
43.
Zurück zum Zitat Oster JR, Singer I (1999) Hyponatremia, hyposmolality, and hypotonicity: tables and fables. Arch Intern Med 159:333–336PubMedCrossRef Oster JR, Singer I (1999) Hyponatremia, hyposmolality, and hypotonicity: tables and fables. Arch Intern Med 159:333–336PubMedCrossRef
44.
Zurück zum Zitat Lai M-Y, Lin C-C, Chung S-L, Wu C-H, Yang W-C, Tseng Y-T (2009) Milky plasma, diabetes, and severe hyponatremia. Kidney Int 75:996PubMedCrossRef Lai M-Y, Lin C-C, Chung S-L, Wu C-H, Yang W-C, Tseng Y-T (2009) Milky plasma, diabetes, and severe hyponatremia. Kidney Int 75:996PubMedCrossRef
45.
Zurück zum Zitat Lawn N, Wijdicks EF, Burritt MF (1998) Intravenous immune globulin and pseudohyponatremia. N Engl J Med 339:632PubMedCrossRef Lawn N, Wijdicks EF, Burritt MF (1998) Intravenous immune globulin and pseudohyponatremia. N Engl J Med 339:632PubMedCrossRef
46.
Zurück zum Zitat Vaswani SK, Sprague R (1993) Pseudohyponatremia in multiple myeloma. South Med J 86:251–252PubMedCrossRef Vaswani SK, Sprague R (1993) Pseudohyponatremia in multiple myeloma. South Med J 86:251–252PubMedCrossRef
47.
Zurück zum Zitat Sherlock M, O’Sullivan E, Agha A et al (2006) The incidence and pathophysiology of hyponatraemia after subarachnoid haemorrhage. Clin Endocrinol 64:250–254CrossRef Sherlock M, O’Sullivan E, Agha A et al (2006) The incidence and pathophysiology of hyponatraemia after subarachnoid haemorrhage. Clin Endocrinol 64:250–254CrossRef
48.
Zurück zum Zitat Brimioulle S, Orellana-Jimenez C, Aminian A, Vincent JL (2008) Hyponatremia in neurological patients: cerebral salt wasting versus inappropriate antidiuretic hormone secretion. Intensive Care Med 34:125–131PubMedCrossRef Brimioulle S, Orellana-Jimenez C, Aminian A, Vincent JL (2008) Hyponatremia in neurological patients: cerebral salt wasting versus inappropriate antidiuretic hormone secretion. Intensive Care Med 34:125–131PubMedCrossRef
Metadaten
Titel
Clinical practice guideline on diagnosis and treatment of hyponatraemia
verfasst von
Goce Spasovski
Raymond Vanholder
Bruno Allolio
Djillali Annane
Steve Ball
Daniel Bichet
Guy Decaux
Wiebke Fenske
Ewout Hoorn
Carole Ichai
Michael Joannidis
Alain Soupart
Robert Zietse
Maria Haller
Sabine van der Veer
Wim Van Biesen
Evi Nagler
Publikationsdatum
01.03.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 3/2014
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-014-3210-2

Weitere Artikel der Ausgabe 3/2014

Intensive Care Medicine 3/2014 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.