Hyponatremia physiopathology

INTRODUCTION: The diagnostic algorithms currently used for hypotonic hyponatremia focus primarily on impaired urinary dilution and often neglect the influence of free water intake and solute excretion. We hypothesized that, in each case of hypotonic hyponatremia different pathophysiological mechanisms play a role simultaneously. METHODS: Using clinical data of the previous observational Co-Med study, we defined each case of hypotonic hyponatremia concurrently in 3 dimensions as follows: (i) high net free water intake (HNFWI), (ii) impaired dilution of the urine (IDU), and (iii) low nonelectrolyte solute excretion (LNESE)...

Cirrhosis is characterised by a prolonged asymptomatic period in which the inflammation persists, increasing as the disease progresses. Characteristic of this is the increase in pro-inflammatory cytokines and pro-oxidant molecules which are determining factors in the development of multiple organ dysfunction. In the early development of cirrhosis, splanchnic arterial vasodilation, activation of vasoconstrictor systems (renin-angiotensin-aldosterone) and the sympathetic nervous system (noradrenaline) bring about bacterial translocation and systemic dissemination via portal circulation of bacterial products, and molecular patterns associated with damage, which exacerbate the systemic inflammation present in the patient with cirrhosis...

The osmotic demyelination syndrome (ODS) is a non-primary inflammatory disorder of the central nervous system myelin that is often associated with a precipitous rise of serum sodium concentration. To investigate the physiopathology of ODS in vivo, we generated a novel murine model based on the abrupt correction of chronic hyponatremia. Accordingly, ODS mice developed impairments in brainstem auditory evoked potentials and in grip strength. At 24 hr post-correction, oligodendrocyte markers (APC and Cx47) were downregulated, prior to any detectable demyelination...

INTRODUCTION: Hyponatremic-hypertensive syndrome (HHS) is characterized by hypertension and hyponatremia. CASE PRESENTATION: We report a case of HHS in a 73-year-old woman, revealed by a hyponatremia leading to status epilepticus, without initial hypertension due to hypovolemia. She was successfully treated by endovascular therapy without any long-term supplementation or anti-hypertensive medication. CONCLUSION: Physiopathology hypothesis of HHS implicate pressure natriuresis, in this case, hypertension is not initially found and we discuss other hyponatremia mechanisms...

Electrolyte and acid-base disturbances are frequent in patients with end-stage liver disease; the underlying physiopathological mechanisms are often complex and represent a diagnostic and therapeutic challenge to the physician. Usually, these disorders do not develop in compensated cirrhotic patients, but with the onset of the classic complications of cirrhosis such as ascites, renal failure, spontaneous bacterial peritonitis and variceal bleeding, multiple electrolyte, and acid-base disturbances emerge. Hyponatremia parallels ascites formation and is a well-known trigger of hepatic encephalopathy; its management in this particular population poses a risky challenge due to the high susceptibility of cirrhotic patients to osmotic demyelination...

Hyponatremia is the commonest electrolyte disorder encountered in clinical practice. It develops when the mechanisms regulating water and electrolyte handling are impaired, which in many instances occur in the setting of concurrent diseases such as heart failure, liver failure, renal failure etc… Hyponatremia as an electrolyte disorder has several specificities: when profound it can be quickly fatal and when moderate it carries a high risk of mortality and morbidity, but at the same time incorrect treatment of profound hyponatremia can lead to debilitating neurological disease and it remains unclear if treatment of moderate hyponatremia is associated with a decrease in mortality and morbidity...

PURPOSE: Dengue virus is the most frequent arthropod-borne viral infection worldwide. Simultaneously to the growth of its incidence, cases of bacterial coinfection in dengue have been increasingly reported. The clinical course of dual infections may worsen for reciprocal interactions and delays in the diagnosis, so that clinicians should be aware of this eventuality. Therefore, we reviewed literature to provide an overview of the epidemiological, clinical, and physiopathological issues related to bacterial coinfections and bacteremia in dengue...

Hyponatremia is a common electrolyte derangement in the setting of the intensive care unit. Life-threatening neurological complications may arise not only in case of a severe (<120 mmol/L) and acute fall of plasma sodium levels, but may also stem from overly rapid correction of hyponatremia. Additionally, even mild hyponatremia carries a poor short-term and long-term prognosis across a wide range of conditions. Its multifaceted and intricate physiopathology may seem deterring at first glance, yet a careful multi-step diagnostic approach may easily unravel the underlying mechanisms and enable physicians to adopt the adequate measures at the patient's bedside...

The present review examines the types of hypertension that women may suffer throughout life, their physiopathological characteristics and management. In early life, the currently used low-dose oral contraceptives seldom cause hypertension. Pregnancy provokes preeclampsia, its main medical complication, secondary to inadequate transformation of the spiral arteries and the subsequent multisystem endothelial damage caused by deportation of placental factors and microparticles. Hypertension in preeclampsia is an epiphenomenon which needs to be controlled at levels that reduce maternal risk without impairing placental perfusion...

BACKGROUND: Hyponatremia is the most frequent electrolyte abnormality observed in post-operative pediatric patients receiving intravenous maintenance fluid therapy. If plasma sodium concentration (p-Na+) declines to levels below 125 mmol/L in < 48 h, transient or permanent brain damage may occur. There is an intense debate as to whether the administered volume (full rate vs. restricted rate of infusion) and the composition of solutions used for parenteral maintenance fluid therapy (hypotonic vs...

Hyponatremia is the most common electrolyte disorder in hospitalized patients and may be associated with non negligible morbidity and mortality. Here we summerize its diagnostic approach based on the physiopathology. Assessment of volume status, measurement of plasma and urinary osmolality remain key steps in the management of this electrolyte disorder.

Hyponatremia is a well-known adverse prognostic factor in patients with chronic heart failure. The mechanisms linking hyponatremia with poor outcomes in these patients are not well understood and may be related to the presence of the abnormal management of water and neurohormonal activation seen in patients with chronic heart failure, which in turn are associated with a worse prognosis. Possibly, free-water retention exceeds the degree of sodium retention in chronic heart failure, which could partially explain the hyponatremia found in these patients...

Hyponatremia is the most common electrolyte disturbance. This disorder is usually produced by water retention due to the patient's inability to balance water excretion with ingestion of liquids. The present article provides basic information on the physiopathology and epidemiology of hyponatremia in certain contexts such as the ambulatory and hospitalized settings, the geriatric population, exercise-induced hyponatremia, drug-induced hyponatremia and finally hyponatremia observed in some common diseases such as heart failure, liver cirrhosis, pneumonia and HIV infection...

Ascites, dilutional hyponatremia and hepatorenal syndrome are three clinical manifestations of the same physiopathological disorder: cirrhotic portal hypertension, hyperproduction of nitric oxide, arterial vasodilation with reduction of efficient arterial volume, which have as consequences renal vasoconstriction, sympathetic stimulation, the stimulation of renin-angiotensin-aldosteron system and of vasopressin secretion. In dilutional hyponatremia, the selective receptor V2 (vasopressin 1) antagonists may be efficient according to Spanish and American specialists and also according to personal experience...

Hypotonic hyponatremia is the most common electrolyte abnormality encountered in hospitalized patients. It is often asymptomatic but associated with increased mortality and morbidity. Prompt recognition of the underlying cause using a systematic physiology based approach and careful evaluation the chronicity of the hyponatremia is mandatory for an optimal management. One should first document hypotonicity, and then assess the renal response to hypotonicity to exclude water intoxication, and the extracellular volumes...

Acute and severe hyponatremia causes a metabolic encephalothy. It is physiopathologically based on the cerebral edema, and its fatal symptoms include seizures and coma. We present a case of an extreme hyponatremia of multifactorial etiology in a schizophrenic patient with potomania. Potomania does not usually cause hyponatremia, unless it coexists with other trigger factors. This patient had a syndrome of inappropriate antidiuretic hormone (SIADH), and a deep hypokaliemia, due to vomiting and a treatment with indapamida, which perpetuates the deficit of extracellular sodium...

Cystic fibrosis (CF) is usually diagnosed during childhood by respiratory or gastro-intestinal symptoms. Hyponatremic hypochloremic dehydration with metabolic alkalosis is a rare but typical presentation of CF in infants. In contrast, only 3 cases have been described in adults. We report a case of CF in a 33-year-old Caucasian female presenting with a severe sodium and chloride depletion caused by inappropriate sweating. She experienced three episodes of severe dehydration before the diagnosis was suspected...

Cirrhosis is a chronic, progressive disease characterized by complications associated with portal hypertension and liver failure. Renal function disorders are a common complication in patients with cirrhosis and are associated with high morbidity and mortality and poor prognosis. Renal function alterations in these patients include sodium and water retention and renal vasoconstriction. Sodium retention causes the formation of ascites and edema, solute-free water leads to dilutional hyponatremia, and renal vasoconstriction gives rise to the development of hepatorenal syndrome (HRS)...

Hyponatraemia is a common clinical finding in cardiac failure, complicating the management of these patients. Vasopressin plays a fundamental role in the physiopathology of the hyponatraemia of cardiac failure and binds to two distinct specific receptors, receptor V1a and V2. The V2 receptors, situated in the renal collecting duct, control the resorbtion of free water. The V1a receptors, present everywhere, are responsible for the vasoconstrictive effect of vasopressin. Specific antagonists of vasopressin receptors are being evaluated in pathologies associated with hyponatraemia...

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