CLINICAL PRACTICE GUIDELINE ON

DIAGNOSIS AND TREATMENT OF

HYPONATRAEMIA
European Journal of Endocrinology
 ABSTRACT

• Hyponatraemia, defined as a serum sodium concentration <135mmol/l, is the

most common disorder of body fluid and electrolyte balance encountered in
clinical practice.
• It can lead to a wide spectrum of clinical symptoms, from subtle to severe or
even life threatening, and is associated with increased mortality, morbidity and
length of hospital stay in patient presenting with a range of conditions.
 DIAGNOSIS OF HYPONATRAEMIA
CLASSIFIC ATION OF HYPONATRAEMIA

Biochemical Severity Time of Development Symptoms

Mild : 130 – 135 mmol/l Acute: <48h Moderately symptomatic
Moderate: 125 – 129 mmol/l Chronic: >48h Severely symptomatic
Profound: <125 mmol/l Unclassified

Drugs and conditions associated with acute hyponatraemia (<48h)

- Postoperative phase
- Post resection of the prostate, post-resection of endoscopic uterine surgery
- Polydipsia
- Exercise
- Recent Thiazides prescription
- 3,4 Methylenedioxymethamfetamine (MDMA, XTC)
- Colonoscopy preparation
- Cyclophosphamide (i.v)
- Oxytocine
- Recently started desmopressin therapy
- Recently started terlipressin, vasopressin
 CLINICAL FEATURES

Severity Symptom
Moderately severe Nausea without vomiting
Confusion
Headache
Severe Vomiting
Cardiorespiratory distress
Abnormal and deep somnolence
Seizures
Coma
 HYPONATRAEMIA TYPE

• Non-hypotonic hyponatraemia
• Isotonic hyponatraemia
• Hypertonic hyponatraemia
• Ineffective osmoles

• Hypotonic hyponatraemia with decreased extracellular fluid volume

• Non-renal sodium loss
• Renal sodium loss
• Third spacing
• Hypotonic hyponatraemia with normal extracellular fluid volume
• Syndrome of inappropriate antidiuresis (SIADH)
• Secondary adrenal insufficiency

• Hypotonic hyponatraemia with increased extracellular fluid volume

• Kidney Disease
• Heart Failure
• Liver Failure
• Nephrotic Syndrome
WHICH PARAMETERS TO BE USED FOR
DIFFERENTIATING
 CONFIRMING HYPOTONIC AND
EXCLUDING NON HYPOTONIC
HYPONATRAEMIA
• Excluding hyperglycaemic hyponatraemia by measuring
the serum glucose concentration and correcting the
measured serum sodium concentration for the serum
glucose consentration if the latter is increased
• Hyponatraemia with a measured osmolarity
<275mOsm/kg always reflects hypotonic hyponatraemia