Download PDF
Dtsch Med Wochenschr 2017; 142(16): 1231-1247
DOI: 10.1055/s-0043-108953
CME-Fortbildung
© Georg Thieme Verlag KG Stuttgart · New York

Hyponatriämie: Differenzialdiagnose und Therapie

Hyponatremia: Differential Diagnosis and Treatment
Heiner Mönig
,
Alexander Arlt
Further Information

Publication History

Publication Date:
15 August 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Hyponatremia is the most common electrolyte abnormality seen in hospitalized patients, with up to 30 % having a plasma sodium concentration below 135 mmol/l. It is now clear that the clinical problem extends beyond the neurological symptoms, which can be explained by intracerebral osmotic fluid shifts and brain edema. Instead, chronic hyponatremia is associated with impaired gait stability and an increased risk of bone fragility fractures. Moreover, hyponatremia has been demonstrated to be an indicator of poor prognosis in a variety of conditions.

Hyponatremia can be a life-threatening disorder due to increased intracranial pressure, thus requiring prompt and efficacious treatment. However, overly rapid correction may be complicated by osmotic demyelination syndrome with catastrophic clinical sequelae, i. e., spastic quadriparesis, or even coma or death.

To avoid inappropriate treatment, the underlying pathophysiology in each case as well as the time course (acute vs. chronic) and the clinical and biochemical severity must be considered.

The purpose of this review is to provide the reader with a systematic approach to the correct diagnosis and management of hyponatremia based on available European and international guidelines.

Hyponatriämie ist die häufigste Elektrolytstörung bei stationär aufgenommenen Patienten. Grundzüge der Diagnostik und Therapie müssen auf jeder internistischen Notaufnahme- und Intensivstation bekannt sein. Auch in der ambulanten Versorgung sollte der Befund „Hyponatriämie“ aufmerksam zur Kenntnis genommen und weiterverfolgt werden. Der vorliegende CME-Beitrag soll die dafür notwendigen Grundkenntnisse vermitteln.

Schlüsselwörter

Hyponatriämie - Diagnostik - Therapie - Leitlinien

Key words

hyponatremia - diagnosis - treatment - guidelines
 

  • Literatur

  • 1 Upadhyay A, Jaber BL, Madias NE. Incidence and prevalence of hyponatremia. Am J Med 2006; 119 (07) 30-35
    CrossrefPubMedGoogle Scholar
  • 2 Ayus JC, Fuentes NA, Negri AL. et al. Mild prolonged chronic hyponatremia and risk of hip fracture in the elderly. Nephrol Dial Transplant 2016; 31: 1662-1669
    CrossrefPubMedGoogle Scholar
  • 3 Zieschang T, Wolf M, Vellappallil T. et al. Assoziation von Hyponatriämie, Delirrisiko und Mortalität. Dtsch Arztebl Int 2016; 113: 855-862
    PubMedGoogle Scholar
  • 4 Burst V, Hensen J. Hyponatriämie – häufig und komplex. Dtsch med Wochenschr 2015; 140: 608-611
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Spasovski G, Vanholder R, Allolio B. et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol 2014; 170: G1-G47
    CrossrefPubMedGoogle Scholar
  • 6 Gross P, Benzing T, Hensen J. et al. Praxisnaher Leitfaden zum Vorgehen bei Hyponatriämie. Dtsch med Wochenschr 2011; 136: 1728-1732
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Fenske W, Störk S, Blechschmidt A. et al. Copeptin in the differential diagnosis of hyponatremia. J Clin Endocrinol Metab 2009; 94: 123-129
    CrossrefPubMedGoogle Scholar
  • 8 Maesaka JK, Imbriano L, Mattana J. et al. Differentiating SIADH from cerebral/renal salt wasting: failure of the volume approach and need for a new approach to hyponatremia. J Clin Med 2014; 3: 1373-1385
    CrossrefPubMedGoogle Scholar
  • 9 Schwartz WB, Bennett W, Curelop S. et al. A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 1957; 23: 529-542
    CrossrefPubMedGoogle Scholar
  • 10 Janicic N, Verbalis JG. Evaluation and management of hypo-osmolality in hospitalized patients. Endocrinol Metab Clin North Am 2003; 32: 459-481
    CrossrefPubMedGoogle Scholar
  • 11 Nigro N, Wizeler B, Suter-Widmer I. et al. Evaluation of copeptin and commonly used laboratory parameters for the differential diagnosis of profound hyponatraemia in hospitalized patients: ‘The Co-MED Study’. Clin Endocrinol (Oxf) 2017; 86: 456-462
    CrossrefPubMedGoogle Scholar
  • 12 Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med 2000; 342: 1581-1589
    CrossrefPubMedGoogle Scholar
  • 13 Watkins PB, Lewis JH, Kaplowitz N. et al. Clinical pattern of tolvaptan-associated liver injury in subjects with autosomal dominant polycystic kidney disease: Analysis of clinical trials database. Drug Saf 2015; 38: 1103-1113
    CrossrefPubMedGoogle Scholar
  • 14 Verbalis JG, Grossman A, Höybye C. et al. Review and analysis of differing regulatory indications and expert panel guidelines for the treatment of hyponatremia. Curr Med Res Opin 2014; 30: 1201-1207
    CrossrefPubMedGoogle Scholar
  • 15 Grant P, Ayuk J, Bouloux PM. et al. The diagnosis and management of inpatient hyponatraemia and SIADH. Eur J Clin Invest 2015; 45: 888-894
    CrossrefPubMedGoogle Scholar