Hyponatremia
The content of the article:
- Causes
- Kinds
- Signs
- Diagnostics
- Treatment
- Prevention
- Consequences and complications
Hyponatremia is a pathological condition based on a decrease in the concentration of sodium ions in the blood to a level below 135 mEq / L.
Hyponatremia is indicated when the sodium level in the blood is below 135 mEq / L.
Causes
Various conditions and diseases can lead to the development of hyponatremia:
- Addison's disease;
- taking diuretics (diuretics);
- insufficiency of the adrenal cortex;
- inflammatory diseases of the kidneys, in which there is an increase in salt excretion;
- metabolic alkalosis;
- diabetes mellitus, accompanied by ketonuria, glucosuria;
- pronounced total hyperhidrosis;
- indomitable vomiting;
- severe diarrhea;
- intestinal obstruction;
- acute pancreatitis;
- peritonitis;
- hypothyroidism;
- psychogenic polydipsia;
- syndromes associated with impaired secretion of antidiuretic hormone (ADH);
- taking certain medications;
- nephrotic syndrome;
- acute and chronic renal failure;
- cachexia;
- cirrhosis of the liver;
- congestive heart failure;
- hypoproteinemia.
Kinds
Hyponatremia can be caused by both a lack of sodium in the body and an excess of water in the body. Depending on the sodium-water ratio, the following types of hyponatremia are distinguished:
- Hypovolemic. It leads to a large loss of extracellular fluid and sodium ions along with it.
- Hypervolemic. Caused by an increase in the volume of extracellular fluid.
- Normovolemic, or isovolemic. The total concentration of sodium ions in the body is normal, but under the influence of certain factors, a significant increase in fluid in the body occurs. This form of hyponatremia usually results from water poisoning (water intoxication).
The severity of hyponatremia is determined by the concentration of sodium ions in the blood serum:
- easy - 130-135 mmol / l;
- average - 125–129 mmol / l;
- severe - less than 125 mmol / l.
There are acute and chronic forms of hyponatremia. An acute form is spoken of in cases where violations of the water and electrolyte balance last no more than 48 hours.
Signs
The main sign of hyponatremia is the appearance of neurological symptoms of varying severity (from a minor headache to a deep coma), which is determined by the patient's age, initial state of health, as well as the degree of hyponatremia and the rate of sodium ion loss.
Headache is one of the symptoms of hyponatremia
When the concentration of sodium in the blood decreases to less than 115 mEq / L, the patient develops acute cerebral edema and coma.
Diagnostics
Diagnosis of hyponatremia presents certain difficulties, since the clinical manifestations of this pathology are nonspecific. Acute hyponatremia is alert when:
- polydipsia (pathological thirst);
- early postoperative period;
- thiazide diuretic therapy;
- excessive physical activity;
- initiation of vasopressin therapy;
- taking amphetamine;
- intravenous administration of cyclophosphamide;
- preparation for colonoscopy;
- the presence of signs of dehydration (decreased urine output, tachycardia, persistent or orthostatic hypotension, decreased skin turgor, dry mucous membranes).
Blood and urine is donated to diagnose hyponatremia
A number of laboratory tests are performed to confirm hyponatremia:
- Determination of sodium concentration in the blood. Normally, in an adult, 1 L of blood contains 136-145 mEq / L of sodium ions. Hyponatremia is indicated by a decrease in sodium concentration to a level below the physiological limit of the norm.
- Determination of plasma osmolarity. The results allow us to establish what type of observed hyponatremia belongs to. Normal blood plasma osmolarity is 280-300 mosm / kg.
- Determination of urine osmolarity (norm - 600-1200 mosm / kg).
- Determination of the level of total protein, triglycerides and blood cholesterol. The results of these studies allow to exclude pseudohyponatremia.
Treatment
The algorithm for the treatment of hyponatremia depends on the severity of electrolyte disturbance, its duration, and the characteristics of clinical manifestations (hypovolemia, hypervolemia, cerebral edema).
In hypovolemic variant, intravenous administration of isotonic sodium chloride solution is prescribed. The volume and rate of administration required for correction are calculated by the doctor in each case according to special formulas.
If the cause of hyponatremia is too much infusion of hypoosmolar solutions, then it is necessary to limit further fluid intake and correct the sodium ion content.
To correct hyponatremia, administration of isotonic sodium chloride solution is indicated
Elimination of hyponatremia, especially with severe clinical manifestations, should be carried out with great care and gradually. This approach reduces the risk of developing neurological disorders, including life-threatening ones.
Simultaneously with the correction of the water-electrolyte balance, the therapy of diseases and conditions that caused its occurrence is carried out.
Prevention
Prevention of hyponatremia consists in the timely detection and active treatment of conditions and diseases that can lead to its development.
Consequences and complications
Complications of hyponatremia are associated with damage to the central nervous system. These include:
- swelling of the brain;
- encephalitis;
- meningitis;
- cerebral artery thrombosis;
- subarachnoid or subdural hematomas;
- infarction of the hypothalamus and (or) the back of the pituitary gland;
- the formation of a hernial protrusion of the brain stem.
Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
