Electrolyte Blood Press.  2006 Nov;4(2):72-76. 10.5049/EBP.2006.4.2.72.

Hyponatremia:Management Errors

• Seo JW
• Park TJ

• KMID: 2052274
• DOI: http://doi.org/10.5049/EBP.2006.4.2.72

Abstract

Rapid correction of hyponatremia is frequently associated with increased morbidity and mortality. Therefore, it is important to estimate the proper volume and type of infusate required to increase the serum sodium concentration predictably. The major common management errors during the treatment of hyponatremia are inadequate investigation, treatment with fluid restriction for diuretic-induced hyponatremia and treatment with fluid restriction plus intravenous isotonic saline simultaneously. We present two cases of management errors. One is about the problem of rapid correction of hyponatremia in a patient with sepsis and acute renal failure during continuous renal replacement therapy in the intensive care unit. The other is the case of hypothyroidism in which hyponatremia was aggravated by intravenous infusion of dextrose water and isotonic saline infusion was erroneously used to increase serum sodium concentration.

MeSH Terms

Acute Kidney Injury
Glucose
Humans
Hyponatremia
Hypothyroidism
Infusions, Intravenous
Intensive Care Units
Mortality
Renal Replacement Therapy
Sepsis
Sodium
Water
Glucose
Sodium
Water

Reference

1. Baran D, Hutchinson TA. The outcome of hyponatremia in a general hospital population. Clin Nephrol. 1984; 22:72–76. PMID: 6478674.

2. Vachharajani TJ, Zaman F, Abreo KD. Hyponatremia in critically ill patients. J Intensive Care Med. 2003; 18:3–8. PMID: 15189662.

3. Huda MS, Boyd A, Skagen K, Wile D, van Heyningen C, Watson I, Wong S, Gill G. Investigation and management of severe hyponatremia in a hospital setting. Postgrad Med. 2006; 82:216–219.

4. Ji DX, Gong DH, Xu B, Tao J, Ren B, Zhang YD, Liu Y, Hu WX, Li LS. Continuous veno-venous hemofiltration in treatment of acute severe hyponatremia: a report of 6 cases. Zhonghua Nei Ke Za Zhi. 2003; 42:781–784. PMID: 14636466.

5. Singer GG, Brenner BM, Robertson GL. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Hyponatremia. Harrison's Principles of Internal Medicine. 2005. 16th ed. McGraw-Hill;p. 254–256. p. 2102–2104.

6. Park GT, M HS, Cho KS, Kim HJ. Clinical analysis of severe hyponatremic patients with neurologic symptoms. Korean J Nephrol. 1998; 17:236–242.

7. Liamis G, Kalogirou M, Saugos V, Elisaf M. Therapeutic approach in patients with dysnatremias. Nephrol Dial Transplant. 2006; 21:1564–1569. PMID: 16449285.

8. Kokko JP. Goldman L, Ausiello D, editors. Hypotonic disorders. Cecil Textbook of Medicine. 2004. 22nd ed. Philadelphia: WB Saunders;p. 677–681.

9. Mun HS, Lee MH, Min KH, Han SW, Rho WK, Park GT, Park DW, Lee YJ, Kim HJ. Initial transient neurologic recovery followed by delayed deterioration of osmotic demyelination syndrome; A Case Report. Korean J Nephrol. 1998; 17:614–618.

10. Fall PJ. Hyponatremia and hypernatremia. A systematic approach to causes and their correction. Postgrad Med. 2000; 107:75–82. PMID: 10844943.

11. Hoorn EJ, Lindemans J, Zietse R. Development of severe hyponatremia in hospitalized patients: treatment-related risk factors and inadequate management. Nephrol Dial Transplant. 2006; 21:70–76. PMID: 16141458.