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Erschienen in:
27.02.2024 | Review
Evaluation and Management of Hyponatremia in Heart Failure
Erschienen in: Current Heart Failure Reports | Ausgabe 3/2024
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Purpose of Review
To provide a contemporary overview of the pathophysiology, evaluation, and treatment of hyponatremia in heart failure (HF).
Recent Findings
Potassium and magnesium losses due to poor nutritional intake and treatment with diuretics cause an intracellular sodium shift in HF that may contribute to hyponatremia. Impaired renal blood flow leading to a lower glomerular filtration rate and increased proximal tubular reabsorption lead to an impaired tubular flux through diluting distal segments of the nephron, compromising electrolyte-free water excretion.
Summary
Hyponatremia in HF is typically a condition of impaired water excretion by the kidneys on a background of potassium and magnesium depletion. While those cations can and should be easily repleted, further treatment should mainly focus on improving the underlying HF and hemodynamics, while addressing congestion. For decongestive treatment, proximally acting diuretics such as sodium-glucose co-transporter-2 inhibitors, acetazolamide, and loop diuretics are the preferred options.
