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Approach to Hyponatremia According to the Clinical Setting

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Hydro Saline Metabolism

Part of the book series: Endocrinology ((ENDOCR))

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Abstract

Hyponatremia is the most common electrolyte disorder among hospitalized patients. There are many etiologies behind hyponatremia, which is in any case the consequence of a relative excess of water compared to total body sodium, which can be reduced, normal or even increased. Because of its frequency and different causes, hyponatremia can be observed in virtually all possible clinical scenarios, encompassing medical as well as surgery specialties. Acute, severe hyponatremia may represent a life-threatening condition; however, it is now well known that also mild, chronic hyponatremia mat affect the health status. Indeed, this situation has been associated with falls, gait instability, bone fractures, bone loss and attention deficits. In fact, it has been shown that hyponatremia is an independent risk of death in a number of pathologies, including cancer. A thorough diagnostic work-up is essential to define the etiology of hyponatremia in different clinical settings and to start the most appropriate treatment.

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References

  • Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;342(21):1581–9.

    Article  CAS  Google Scholar 

  • Angeli P, Wong F, Watson H, Gines P, CAPPS Investigators. Hyponatremia in cirrhosis: results of a patient population survey. Hepatology. 2006;44(6):1535–42.

    Article  CAS  Google Scholar 

  • Avcil M, Kapci M, Dagli B, Omurlu IK, Ozluer E, Karaman K, Yilmaz A, Zencir C. Comparision of ultrasound-based methods of jugular vein and inferior vena cava for estimating central venous pressure. Int J Clin Exp Med. 2015;8(7):10586–94.

    Google Scholar 

  • Aylwin S, Burst V, Peri A, Runkle I, Thatcher N. ‘Dos and don’ts’ in the management of hyponatremia. Curr Med Res Opin. 2015;31(9):1755–61.

    Article  CAS  Google Scholar 

  • Balachandran K, Okines A, Gunapala R, Morganstein D, Popat S. Resolution of severe hyponatraemia is associated with improved survival in patients with cancer. BMC Cancer. 2015;15:163.

    Article  Google Scholar 

  • Barsony J, Sugimura Y, Verbalis JG. Osteoclast response to low extracellular sodium and the mechanism of hyponatremia-induced bone loss. J Biol Chem. 2011;286(12):10864–75.

    Article  CAS  Google Scholar 

  • Barsony J, Manigrasso MB, Xu Q, Tam H, Verbalis JG. Chronic hyponatremia exacerbates multiple manifestations of senescence in male rats. Age. 2013;35(2):271–88.

    Article  Google Scholar 

  • Beck LH. Changes in renal function with aging. Clin Geriatr Med. 1998;14(2):199–209.

    Article  CAS  Google Scholar 

  • Benvenuti S, Deledda C, Luciani P, Modi G, Bossio A, Giuliani C, Fibbi B, Peri A. Low extracellular sodium causes neuronal distress independently of reduced osmolality in an experimental model of chronic hyponatremia. NeuroMolecular Med. 2013;15(3):493–503.

    Article  CAS  Google Scholar 

  • Benvenuti S, Deledda C, Luciani P, Giuliani C, Fibbi B, Muratori M, Peri A. Neuronal distress induced by low extracellular sodium in vitro is partially reverted by the return to normal sodium. J Endocrinol Investig. 2016;39(2):177–84.

    Article  CAS  Google Scholar 

  • Berardi R, Caramanti M, Fiordoliva I, Morgese F, Savini A, Rinaldi S, Torniai M, Tiberi M, Ferrini C, Castagnani M, Rovinelli F, Onofri A, Cascinu S. Hyponatraemia is a predictor of clinical outcome for malignant pleural mesothelioma. Support Care Cancer. 2015;23(3):621–6.

    Article  CAS  Google Scholar 

  • Berardi R, Santoni M, Rinaldi S, Nunzi E, Smerilli A, Caramanti M, Morgese F, Torniai M, Savini A, Fiordoliva I, Onofri A, Pistelli M, Taccaliti A, Cascinu S. Risk of hyponatraemia in cancer patients treated with targeted therapies: a systematic review and meta-analysis of clinical trials. PLoS One. 2016;11(5):e0152079.

    Article  Google Scholar 

  • Berardi R, Santoni M, Newsom-Davis T, Caramanti M, Rinaldi S, Tiberi M, Morgese F, Torniai M, Pistelli M, Onofri A, Bower M, Cascinu S. Hyponatremia normalization as an independent prognostic factor in patients with advanced non-small cell lung cancer treated with first-line therapy. Oncotarget. 2017;8(14):23871–9.

    Article  Google Scholar 

  • Berardi R, Antonuzzo A, Blasi L, Buosi R, Lorusso V, Migliorino MR, Montesarchio V, Zilembo N, Sabbatini R, Peri A. Practical issues for the management of hyponatremia in oncology. Endocrine. 2018;61(1):158–64.

    Article  CAS  Google Scholar 

  • Berardi R, Mastroianni C, Lo Russo G, Buosi R, Santini D, Montanino A, Carnaghi C, Tiseo M, Chiari R, Camerini A, Barni S, De Marino V, Ferrari D, Cristofano A, Doni L, Freddari F, Fumagalli D, Portalone L, Sarmiento R, Schinzari G, Sperandi F, Tucci M, Inno A, Ciuffreda L, Mariotti M, Mariani C, Caramanti M, Torniai M, Gallucci R, Bennati C, Bordi P, Buffoni L, Galeassi A, Ghidini M, Grossi E, Morabito A, Vincenzi B, Arvat E. Syndrome of inappropriate anti-diuretic hormone secretion in cancer patients: results of the first multicenter Italian study. Ther Adv Med Oncol. 2019;11:1758835919877725.

    Article  Google Scholar 

  • Berardi R, Mocchegiani F, Rinaldi S, Fiordoliva I, Rovinelli F, Caramanti M, Federici A, Burattini M, Morgese F, Torniai M, Marcantognini G, Vivarelli M. Hyponatremia is a predictor of clinical outcome for resected biliary tract cancers: a retrospective single-center study. Oncol Ther. 2020a;8(1):115–24.

    Article  Google Scholar 

  • Berardi R, Rinaldi S, Belfiori G, Partelli S, Crippa S, Torniai M, Falconi M. The role of hyponatraemia before surgery in patients with radical resected pancreatic cancer. Clin Med Insights Oncol. 2020b;14:1179554920936605.

    Article  Google Scholar 

  • Berghmans T, Paesmans M, Body JJ. A prospective study on hyponatraemia in medical cancer patients: epidemiology, aetiology and differential diagnosis. Support Care Cancer. 2000;8(3):192–7.

    Article  CAS  Google Scholar 

  • Berl T, Quittnat-Pelletier F, Verbalis JG, Schrier RW, Bichet DG, Ouyang J, Czerwiec FS, SALTWATER Investigators. Oral tolvaptan is safe and effective in chronic hyponatremia. J Am Soc Nephrol. 2010;21(4):705–12.

    Article  CAS  Google Scholar 

  • Berni A, Malandrino D, Parenti G, Maggi M, Poggesi L, Peri A. Hyponatremia, IL-6, and SARS-CoV-2 (COVID-19) infection: may all fit together? J Endocrinol Investig. 2020;43(8):1137–9.

    Article  CAS  Google Scholar 

  • Berni A, Malandrino D, Corona G, Maggi M, Parenti G, Fibbi B, Poggesi L, Bartoloni A, Lavorini F, Fanelli A, Scocchera G, Nozzoli C, Peris A, Pieralli F, Pini R, Ungar A, Peri A. Serum sodium alterations in SARS CoV-2 (COVID-19) infection: impact on patient outcome. Eur J Endocrinol. 2021;185(1):137–44.

    Article  CAS  Google Scholar 

  • Bilgetekin I, Erturk I, Basal FB, Karacin C, Karadurmus N, Oksuzoglu B, Demirci U. Tolvaptan treatment in hyponatremia due to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH): effects on survival in patients with cancer. Int Urol Nephrol. 2020; https://doi.org/10.1007/s11255-020-02623-7.

  • Castillo JJ, Glezerman IG, Boklage SH, Chiodo J 3rd, Tidwell BA, Lamerato LE, Schulman KL. The occurrence of hyponatremia and its importance as a prognostic factor in a cross-section of cancer patients. BMC Cancer. 2016;16:564.

    Article  Google Scholar 

  • Christ-Crain M, Hoorn EJ, Sherlock M, Thompson CJ, Wass JAH. ENDOCRINOLOGY IN THE TIME OF COVID-19: management of diabetes insipidus and hyponatraemia. Eur J Endocrinol. 2020;183(1):G9–G15.

    Article  CAS  Google Scholar 

  • Chung MC, Yu TM, Shu KH, Wu MJ, Chang CH, Muo CH, Chung CJ. Hyponatremia and increased risk of dementia: a population-based retrospective cohort study. PLoS One. 2017;12(6):e0178977.

    Article  Google Scholar 

  • Corona G, Giuliani C, Parenti G, Norello D, Verbalis JG, Forti G, Maggi M, Peri A. Moderate hyponatremia is associated with increased risk of mortality: evidence from a meta-analysis. PLoS One. 2013;8(12):e80451.

    Article  Google Scholar 

  • Cuesta M, Slattery D, Goulden EL, Gupta S, Tatro E, Sherlock M, Tormey W, O’Neill S, Thompson CJ. Hyponatraemia in patients with community-acquired pneumonia; prevalence and aetiology, and natural history of SIAD. Clin Endocrinol. 2019;90(5):744–52.

    Article  CAS  Google Scholar 

  • Dangoisse C, Dickie H, Tovey L, Ostermann M. Correction of hyper- and hyponatraemia during continuous renal replacement therapy. Nephron Clin Pract. 2014;128(3–4):394–8.

    CAS  Google Scholar 

  • De Vecchis R, Di Maio M, Di Biase G, Ariano C. Effects of hyponatremia normalization on the short-term mortality and rehospitalizations in patients with recent acute decompensated heart failure: a retrospective study. J Clin Med. 2016;5(10):92.

    Article  Google Scholar 

  • Decaux G, Genette F. Urea for long-term treatment of syndrome of inappropriate secretion of antidiuretic hormone. Br Med J (Clin Res Ed). 1981;283(6299):1081–3.

    Article  CAS  Google Scholar 

  • Decaux G, Unger J, Brimioulle S, Mockel J. Hyponatremia in the syndrome of inappropriate secretion of antidiuretic hormone. Rapid correction with urea, sodium chloride, and water restriction therapy. JAMA. 1982;247(4):471–4.

    Article  CAS  Google Scholar 

  • Diamanti-Kandarakis E, Dattilo M, Macut D, Duntas L, Gonos ES, Goulis DG, Gantenbein CK, Kapetanou M, Koukkou E, Lambrinoudaki I, Michalaki M, Eftekhari-Nader S, Pasquali R, Peppa M, Tzanela M, Vassilatou E, Vryonidou A, COMBO ENDO TEAM: 2016. MECHANISMS IN ENDOCRINOLOGY: aging and anti-aging: a combo-endocrinology overview. Eur J Endocrinol. 2017;176(6):R283–308.

    Article  CAS  Google Scholar 

  • Diederich S, Franzen NF, Bähr V, Oelkers W. Severe hyponatremia due to hypopituitarism with adrenal insufficiency: report on 28 cases. Eur J Endocrinol. 2003;148(6):609–17.

    Article  CAS  Google Scholar 

  • Doshi SM, Shah P, Lei X, Lahoti A, Salahudeen AK. Hyponatremia in hospitalized cancer patients and its impact on clinical outcomes. Am J Kidney Dis. 2012;59(2):222–8.

    Article  CAS  Google Scholar 

  • Duan J, Wang X, Chi J, Chen H, Bai L, Hu Q, Han X, Hu W, Zhu L, Wang X, Li Y, Zhou C, Mou H, Yan X, Guo S. Correlation between the variables collected at admission and progression to severe cases during hospitalization among patients with COVID-19 in Chongqing. J Med Virol. 2020; https://doi.org/10.1002/jmv.26082.

  • Edate S, Albanese A. Management of electrolyte and fluid disorders after brain surgery for pituitary/suprasellar tumours. Horm Res Paediatr. 2015;83(5):293–301.

    Article  CAS  Google Scholar 

  • Edwards ME, Chebib FT, Irazabal MV, Ofstie TG, Bungum LA, Metzger AJ, Senum SR, Hogan MC, El-Zoghby ZM, Kline TL, Harris PC, Czerwiec FS, Torres VE. Long-term Administration of Tolvaptan in autosomal dominant polycystic kidney disease. Clin J Am Soc Nephrol. 2018;13(8):1153–61.

    Article  CAS  Google Scholar 

  • Ellison DH, Berl T. Clinical practice. The syndrome of inappropriate antidiuresis. N Engl J Med. 2007;356(20):2064–72.

    Article  CAS  Google Scholar 

  • Farmakis D, Filippatos G, Parissis J, Kremastinos DT, Gheorghiade M. Hyponatremia in heart failure. Heart Fail Rev. 2009;14(2):59–63.

    Article  Google Scholar 

  • Fibbi B, Benvenuti S, Giuliani C, Deledda C, Luciani P, Monici M, Mazzanti B, Ballerini C, Peri A. Low extracellular sodium promotes adipogenic commitment of human mesenchymal stromal cells: a novel mechanism for chronic hyponatremia-induced bone loss. Endocrine. 2016;52(1):73–85.

    Article  CAS  Google Scholar 

  • Friedewald VE, Emmett M, Gheorghiade M, Roberts WC. The editor’s roundtable: pathophysiology and management of hyponatremia and the role of vasopressin antagonists. Am J Cardiol. 2011;107(9):1357–64.

    Article  Google Scholar 

  • Fukui H. Do vasopressin V2 receptor antagonists benefit cirrhotics with refractory ascites? World J Gastroenterol. 2015;21(41):11584–96.

    Article  CAS  Google Scholar 

  • Furst H, Hallows KR, Post J, Chen S, Kotzker W, Goldfarb S, Ziyadeh FN, Neilson EG. The urine/plasma electrolyte ratio: a predictive guide to water restriction. Am J Med Sci. 2000;319(4):240–4.

    Article  CAS  Google Scholar 

  • Garrahy A, Dineen R, Hannon AM, Cuesta M, Tormey W, Sherlock M, Thompson CJ. Continuous versus bolus infusion of hypertonic saline in the treatment of symptomatic hyponatremia caused by SIAD. J Clin Endocrinol Metab. 2019;104(9):3595–602.

    Article  Google Scholar 

  • Gattone VH 2nd, Wang X, Harris PC, Torres VE. Inhibition of renal cystic disease development and progression by a vasopressin V2 receptor antagonist. Nat Med. 2003;9(10):1323–6.

    Article  CAS  Google Scholar 

  • Gennari FJ. Hypo-hypernatraemia: disorders of water balance. In: Davison AM, Cameron JS, Grünfeld J-P, Kerr DNS, Ritz E, Winearls CG, editors. Oxford textbook of clinical nephrology, vol. 1. 2nd ed. Oxford, UK: Oxford University Press; 1998. p. 175–200.

    Google Scholar 

  • Giuliani C, Cangioli M, Beck-Peccoz P, Faustini-Fustini M, Fiaccadori E, Peri A. Awareness and management of hyponatraemia: the Italian hyponatraemia survey. J Endocrinol Investig. 2013;36(9):693–8.

    CAS  Google Scholar 

  • Greenberg A, Verbalis JG, Amin AN, Burst VR, Chiodo JA 3rd, Chiong JR, Dasta JF, Friend KE, Hauptman PJ, Peri A, Sigal SH. Current treatment practice and outcomes. Report of the hyponatremia registry. Kidney Int. 2015;88(1):167–77.

    Article  Google Scholar 

  • Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS. China medical treatment expert group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–20.

    Article  CAS  Google Scholar 

  • Hansen O, Sørensen P, Hansen KH. The occurrence of hyponatremia in SCLC and the influence on prognosis: a retrospective study of 453 patients treated in a single institution in a 10-year period. Lung Cancer. 2010;68(1):111–4.

    Article  Google Scholar 

  • Holland-Bill L, Christiansen CF, Heide-Jorgensen U, Ulrichsen SP, Ring T, Jorgensen JO, Sørensen HT. Hyponatremia and mortality risk: a Danish cohort study of 279 508 acutely hospitalized patients. Eur J Endocrinol. 2015;173(1):71–81.

    Article  CAS  Google Scholar 

  • Hoorn EJ, Liamis G, Zietse R, Zillikens MC. Hyponatremia and bone: an emerging relationship. Nat Rev Endocrinol. 2011;8(1):33–9.

    Article  Google Scholar 

  • Kao L, Al-Lawati Z, Vavao J, Steinberg GK, Katznelson L. Prevalence and clinical demographics of cerebral salt wasting in patients with aneurysmal subarachnoid multicentre. Pituitary. 2009;12(4):347–51.

    Article  Google Scholar 

  • Kawashima A, Tsujimura A, Takayama H, Arai Y, Nin M, Tanigawa G, Uemura M, Nakai Y, Nishimura K, Nonomura N, Osaka Renal Cell Carcinoma Clinical Study Collaboration. Impact of hyponatremia on survival of patients with metastatic renal cell carcinoma treated with molecular targeted therapy. Int J Urol. 2012;19(12):1050–7.

    Article  CAS  Google Scholar 

  • Khan S, Floris M, Pani A, Rosner MH. Sodium and volume disorders in advanced chronic kidney disease. Adv Chronic Kidney Dis. 2016;23(4):240–6.

    Article  Google Scholar 

  • Kinsella S, Moran S, Sullivan MO, Molloy MGM, Eustace JA. Hyponatremia independent of osteoporosis is associated with fracture occurrence. Clin J Am Soc Nephrol. 2010;5(2):275–80.

    Article  CAS  Google Scholar 

  • Koch CA, Fulop T. Clinical aspects of changes in water and sodium homeostasis in the elderly. Rev Endocr Metab Disord. 2017;18(1):49–66.

    Article  CAS  Google Scholar 

  • Konishi M, Haraguchi G, Ohigashi H, Sasaoka T, Yoshikawa S, Inagaki H, Ashikaga T, Isobe M. Progression of hyponatremia is associated with increased cardiac mortality in patients hospitalized for acute decompensated heart failure. J Card Fail. 2012;18(8):620–5.

    Article  CAS  Google Scholar 

  • Konstam MA, Gheorghiade M, Burnett JC Jr, Grinfeld L, Maggioni AP, Swedberg K, Udelson JE, Zannad F, Cook T, Ouyang J, Zimmer C, Orlandi C, Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) Investigators. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST outcome trial. JAMA. 2007;297(12):1319–31.

    Article  CAS  Google Scholar 

  • Kovesdy CP, Lott EH, Lu JL, Malakauskas SM, Ma JZ, Molnar MZ, Kalantar-Zadeh K. Hyponatremia, hypernatremia, and mortality in patients with chronic kidney disease with and without congestive heart failure. Circulation. 2012;125(5):677–84.

    Article  Google Scholar 

  • Kuo SCH, Kuo PJ, Rau CS, Wu SC, Hsu SY, Hsieh CH. Hyponatremia is associated with worse outcomes from fall injuries in the elderly. Int J Environ Res Public Health. 2017;14(5):460.

    Article  Google Scholar 

  • Larsen PR, Davies TF. Hypothyroidism. In: Larsen PR, et al., editors. Williams textbook of endocrinology. 10th ed. Philadelphia: WB Saunders; 2002. p. 423–55.

    Google Scholar 

  • Leong HN, Chan KP, Oon LL, Koay E, Ng LC, Lee MA, Barkham T, Chen MI, Heng BH, Ling AE, Leo YS. Clinical and laboratory findings of SARS in Singapore. Ann Acad Med Singap. 2006;35(5):332–9.

    Google Scholar 

  • Liamis G, Megapanou E, Elisaf M, Milionis H. Hyponatremia-inducing drugs. Front Horm Res. 2019;52:167–77.

    Article  CAS  Google Scholar 

  • Lippi G, South AM, Henry BM. Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19). Ann Clin Biochem. 2020;57(3):262–5.

    Article  CAS  Google Scholar 

  • Loh JA, Verbalis JG. Diabetes insipidus as a complication after pituitary surgery. Nat Clin Pract Endocrinol Metab. 2007;3(6):489–94.

    Article  Google Scholar 

  • Luo P, Liu Y, Qiu L, Liu X, Liu D, Li J. Tocilizumab treatment in COVID-19: a single center experience. J Med Virol. 2020;92(7):814–8.

    Article  CAS  Google Scholar 

  • Mannesse CK, Vondeling AM, van Marum RJ, van Solinge WW, Egberts TC, Jansen PA. Prevalence of hyponatremia on geriatric wards compared to other settings over four decades: a systematic review. Ageing Res Rev. 2013;12(1):165–73.

    Article  CAS  Google Scholar 

  • Mapa B, Taylor BE, Appelboom G, Bruce EM, Claassen J, Connolly ES Jr. Impact of hyponatremia on morbidity, mortality, and complications after aneurysmal subarachnoid multicentre: a systematic review. World Neurosurg. 2016;85:305–14.

    Article  Google Scholar 

  • Marriott HL. Water and salt depletion. Br Med J. 1947;1(4497):328–32.

    Article  CAS  Google Scholar 

  • Nervo A, D’Angelo V, Rosso D, Castellana E, Cattel F, Arvat E, Grossi E. Urea in cancer patients with chronic SIAD-induced hyponatremia: old drug, new evidence. Clin Endocrinol. 2019;90(6):842–8.

    Article  CAS  Google Scholar 

  • Nigwekar SU, Wenger J, Thadhani R, Bhan I. Hyponatremia, mineral metabolism, and mortality in incident maintenance hemodialysis patients: a cohort study. Am J Kidney Dis. 2013;62(4):755–62.

    Article  CAS  Google Scholar 

  • Okita K, Kawazoe S, Hasebe C, Kajimura K, Kaneko A, Okada M, Sakaida I, ASCITES Dose-Finding Trial Group. Dose-finding trial of tolvaptan in liver cirrhosis patients with hepatic edema: a randomized, double-blind, placebo-controlled trial. Hepatol Res. 2014;44(1):83–91.

    Article  CAS  Google Scholar 

  • Park M, Cook AR, Lim JT, Sun Y, Dickens BL. A systematic review of COVID-19 epidemiology based on current evidence. J Clin Med. 2020;9(4):967.

    Article  CAS  Google Scholar 

  • Percik R, Shlomai G, Tirosh A, Tirosh A, Leibowitz-Amit R, Eshet Y, Greenberg G, Merlinsky A, Barhod E, Steinberg-Silman Y, Sella T. Isolated autoimmune adrenocorticotropic hormone deficiency: from a rare disease to the dominant cause of adrenal insufficiency related to check point inhibitors. Autoimmun Rev. 2020;19(2):102454.

    Article  CAS  Google Scholar 

  • Peri A. Clinical review: the use of vaptans in clinical endocrinology. J Clin Endocrinol Metab. 2013;98(4):1321–32.

    Article  CAS  Google Scholar 

  • Petereit C, Zaba O, Teber I, Luders H, Grohe C. A rapid and efficient way to manage hyponatremia in patients with SIADH and small cell lung cancer: treatment with tolvaptan. BMC Pulm Med. 2013;13:55.

    Article  Google Scholar 

  • Pokaharel M, Block CA. Dysnatremia in the ICU. Curr Opin Crit Care. 2011;17(6):581–93.

    Article  Google Scholar 

  • Raftopoulos H. Diagnosis and management of hyponatremia in cancer patients. Support Care Cancer. 2007;15(12):1341–7.

    Article  Google Scholar 

  • Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G. Mild chronic hyponatremia is associated with falls, unsteadiness and attention deficits. Am J Med. 2006;119(1):71.e1–8.

    Article  Google Scholar 

  • Rizkallah J, Jack M, Saeed M, Shafer LA, Vo M, Tam J. Non-invasive bedside assessment of central venous pressure: scanning into the future. PLoS One. 2014;9(10):e109215.

    Article  Google Scholar 

  • Robertson GL. Vaptans for the treatment of hyponatremia. Nat Rev Endocrinol. 2011;7(3):151–61.

    Article  CAS  Google Scholar 

  • Robinson AG, Verbalis JG. The syndrome of inappropriate antidiuretic hormone secretion. In: Larsen PR, et al., editors. Williams textbook of endocrinology. 10th ed. Philadelphia: WB Saunders; 2002. p. 300–13.

    Google Scholar 

  • Rodrigues B, Staff I, Fortunato G, McCullough LD. Hyponatremia in the prognosis of acute ischemic stroke. J Stroke Cerebrovasc Dis. 2014;23(5):850–4.

    Article  Google Scholar 

  • Rossi J, Bayram M, Udelson JE, Lloyd-Jones D, Adams KF, Oconnor CM, Stough WG, Ouyang J, Shin DD, Orlandi C, Gheorghiade M. Improvement in hyponatremia during hospitalization for worsening heart failure is associated with improved outcomes: insights from the acute and chronic therapeutic impact of a vasopressin antagonist in chronic heart failure (ACTIV in CHF) trial. Acute Card Care. 2007;9(2):82–6.

    Article  Google Scholar 

  • Sakaida I, Kawazoe S, Kajimura K, Saito T, Okuse C, Takaguchi K, Okada M, Okita K, ASCITES-DOUBLEBLIND Study Group. Tolvaptan for improvement of hepatic edema: a phase 3, multicentre, randomized, double-blind, placebo-controlled trial. Hepatol Res. 2014;44(1):73–82.

    Article  CAS  Google Scholar 

  • Sbardella E, Isidori AM, Arnaldi G, Arosio M, Barone C, Benso A, Berardi R, Capasso G, Caprio M, Ceccato F, Corona G, Della Casa S, De Nicola L, Faustini-Fustini M, Fiaccadori E, Gesualdo L, Gori S, Lania A, Mantovani G, Menè P, Parenti G, Pinto C, Pivonello R, Razzore P, Regolisti G, Scaroni C, Trepiccione F, Lenzi A, Peri A, the: Fluid and Electrolyte Disorders Club of the Italian Society of Endocrinology, Italian Society of Nephrology; and Italian Association of Medical Oncology. Approach to hyponatremia according to the clinical setting: consensus statement from the Italian Society of Endocrinology (SIE), Italian Society of Nephrology (SIN), and Italian Association of Medical Oncology (AIOM). J Endocrinol Investig. 2018;41(1):3–19.

    Article  CAS  Google Scholar 

  • Schrier RW, Gross P, Gheorghiade M, Berl T, Verbalis JG, Czerwiec FS, Orlandi C, SALT Investigators. Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med. 2006;355(20):2099–112.

    Article  CAS  Google Scholar 

  • Schrier RW, Sharma S, Shchekochikhin D. Hyponatraemia: more than just a marker of disease severity? Nat Rev Nephrol. 2013;9(1):37–50.

    Article  CAS  Google Scholar 

  • Schwartz WB, Bennett W, Curelop S, Bartter FC. A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med. 1957;23(4):529–42.

    Article  CAS  Google Scholar 

  • Sherlock M, O’Sullivan E, Agha A, Behan LA, Owens D, Finucane F, Rawluk D, Tormey W, Thompson CJ. Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients. Postgrad Med J. 2009;85(1002):171–5.

    Article  CAS  Google Scholar 

  • Sorensen JB, Andersen MK, Hansen HH. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in malignant disease. J Intern Med. 1995;238(2):97–110.

    Article  CAS  Google Scholar 

  • Soupart A, Coffernils M, Couturier B, Gankam-Kengne F, Decaux G. Efficacy and tolerance of urea compared with vaptans for long-term treatment of patients with SIADH. Clin J Am Soc Nephrol. 2012;7(5):742–7.

    Article  CAS  Google Scholar 

  • Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, Decaux G, Fenske W, Hoorn EJ, Ichai C, Joannidis M, Soupart A, Zietse R, Haller M, van der Veer S, Van Biesen W, Nagler E, Hyponatraemia Guideline Development Group. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol. 2014;170(3):G1–47.

    Article  CAS  Google Scholar 

  • Suárez V, Norello D, Sen E, Todorova P, Hackl MJ, Hüser C, Grundmann F, Kubacki T, Becker I, Peri A, Burst V. Impairment of neurocognitive functioning, motor performance, and mood stability in hospitalized patients with euvolemic moderate and profound hyponatremia. Am J Med. 2020;133(8):986–93.e5.

    Article  Google Scholar 

  • Sugiyama Y, Naiki T, Tasaki Y, Kondo Y, Kataoka T, Etani T, Iida K, Nozaki S, Ando R, Osaga S, Yasui T, Kimura K. Prognostic significance of hyponatremia induced by systemic chemotherapy in a hospital-based propensity score-matched analysis. Int J Clin Oncol. 2020;25(4):541–51.

    Article  CAS  Google Scholar 

  • Svaton M, Fiala O, Pesek M, Bruha F, Mukensnabl P, Racek J, Minarik M, Bortlicek Z. Predictive and prognostic significance of sodium levels in patients with NSCLC treated by erlotinib. Anticancer Res. 2014;34(12):7461–5.

    CAS  Google Scholar 

  • Swart RM, Hoorn EJ, Betjes MG, Zietse R. Hyponatremia and inflammation: the emerging role of interleuchin-6 in osmoregulation. Nephron Physiol. 2011;118(2):45–51.

    Article  Google Scholar 

  • Tanaka A, Katsuno T, Ozaki T, Sakata F, Kato N, Suzuki Y, Kosugi T, Kato S, Tsuboi N, Sato W, Yasuda Y, Mizuno M, Ito Y, Matsuo S, Maruyama S. The efficacy of tolvaptan as a diuretic for chronic kidney disease patients. Acta Cardiol. 2015;70(2):217–23.

    Article  Google Scholar 

  • Tiseo M, Buti S, Boni L, Mattioni R, Ardizzoni A. Prognostic role of hyponatremia in 564 small cell lung cancer patients treated with topotecan. Lung Cancer. 2014;86(1):91–5.

    Article  Google Scholar 

  • Torres VE, Wang X, Qian Q, Somlo S, Harris PC, Gattone VH 2nd. Effective treatment of an orthologous model of autosomal dominant polycystic kidney disease. Nat Med. 2004;10(4):363–4.

    Article  CAS  Google Scholar 

  • Torres VE, Chapman AB, Devuyst O, Gansevoort RT, Grantham JJ, Higashihara E, Perrone RD, Krasa HB, Ouyang J, Czerwiec FS, TEMPO 3:4 Trial Investigators. Tolvaptan in patients with autosomal dominant polycystic kidney disease. N Engl J Med. 2012;367(25):2407–18.

    Article  CAS  Google Scholar 

  • Torres VE, Chapman AB, Devuyst O, Gansevoort RT, Perrone RD, Dandurand A, Ouyang J, Czerwiec FS, Blais JD, TEMPO 4:4 Trial Investigators. Multicenter, open-label, extension trial to evaluate the long-term efficacy and safety of early versus delayed treatment with tolvaptan in autosomal dominant polycystic kidney disease: the TEMPO 4:4 trial. Nephrol Dial Transplant. 2017;32(7):1262.

    Article  Google Scholar 

  • Udelson JE, Bilsker M, Hauptman PJ, Sequeira R, Thomas I, O’Brien T, Zimmer C, Orlandi C, Konstam MA. A multicentre, randomized, double-blind, placebo-controlled study of tolvaptan monotherapy compared to furosemide and the combination of tolvaptan and furosemide in patients with heart failure and systolic dysfunction. J Card Fail. 2011;17(12):973–81.

    Article  CAS  Google Scholar 

  • Upadhyay A, Jaber BL, Madias NE. Incidence and prevalence of hyponatremia. Am J Med. 2006;119(7 Suppl 1):S30–5.

    Article  CAS  Google Scholar 

  • Urso C, Brucculeri S, Caimi G. Acid-base and electrolyte abnormalities in heart failure: pathophysiology and implications. Heart Fail Rev. 2015;20(4):493–503.

    Article  CAS  Google Scholar 

  • Vaidya C, Ho W, Freda BJ. Management of hyponatremia: providing treatment and avoiding harm. Cleve Clin J Med. 2010;77(10):715–26.

    Article  Google Scholar 

  • Verbalis JG. Managing hyponatremia in patients with syndrome of inappropriate antidiuretic hormone secretion. Endocrinol Nutr. 2010;57(Suppl 2):30–40.

    Article  Google Scholar 

  • Verbalis JG, Barsony J, Sugimura Y, Tian Y, Adams DJ, Carter EA, Resnick HE. Hyponatremia-induced osteoporosis. J Bone Miner Res. 2010;25(3):554–63.

    Article  CAS  Google Scholar 

  • Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, Thompson CJ. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013;126(10 Suppl 1):S1–42.

    Article  Google Scholar 

  • Wald R, Jaber BL, Price LL, Upadhyay A, Madias NE. Impact of hospital-associated hyponatremia on selected outcomes. Arch Intern Med. 2010;170(3):294–302.

    Article  CAS  Google Scholar 

  • Wang X, Wu Y, Ward CJ, Harris PC, Torres VE. Vasopressin directly regulates cyst growth in polycystic kidney disease. J Am Soc Nephrol. 2008;19(1):102–8.

    Article  CAS  Google Scholar 

  • Wang L, Zhang Q, Liu M, Chen S, Han S, Li J, Du R. Tolvaptan in reversing worsening acute heart failure: a systematic review and meta-analysis. J Int Med Res. 2019;47(11):5414–25.

    Article  Google Scholar 

  • Wannamethee SG, Shaper AG, Lennon L, Papacosta O, Whincup P. Mild hyponatremia, hypernatremia and incident cardiovascular disease and mortality in older men: a population-based cohort study. Nutr Metab Cardiovasc Dis. 2016;26(1):12–9.

    Article  CAS  Google Scholar 

  • Warner MH, Holding S, Kilpatrick ES. The effect of newly diagnosed hypothyroidism on serum sodium concentrations: a retrospective study. Clin Endocrinol. 2006;64(5):598–9.

    Article  Google Scholar 

  • Watkins PB, Lewis JH, Kaplowitz N, Alpers DH, Blais JD, Smotzer DM, Krasa H, Ouyang J, Torres VE, Czerwiec FS, Zimmer CA. Clinical pattern of tolvaptan-associated liver injury in subjects with autosomal dominant polycystic kidney disease: analysis of clinical trials database. Drug Saf. 2015;38(11):1103–13.

    Article  CAS  Google Scholar 

  • Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. JAMA. 2020;324(8):782–93.

    Article  CAS  Google Scholar 

  • Williams C, Simon TD, Riva-Cambrin J, Bratton SL. Hyponatremia with intracranial malignant tumor resection in children. J Neurosurg Pediatr. 2012;9(5):524–9.

    Article  Google Scholar 

  • Woodward M, Gonski P, Grossmann M, Obeid J, Scholes R, Topliss DJ. Diagnosis and management of hyponatraemia in the older patient. Intern Med J. 2018;48(Suppl 1):5–12.

    Article  CAS  Google Scholar 

  • Yamazoe M, Mizuno A, Kohsaka S, Shiraishi Y, Kohno T, Goda A, Higuchi S, Yagawa M, Nagatomo Y, Yoshikawa T, West Tokyo Heart Failure Registry Investigators Tokyo, Japan. Incidence of hospital-acquired hyponatremia by the dose and type of diuretics among patients with acute heart failure and its association with long-term outcomes. J Cardiol. 2018;71(6):550–6.

    Article  Google Scholar 

  • Yeh HC, Li CC, Wen SC, Singla N, Woldu SL, Robyak H, Huang CN, Ke HL, Li WM, Lee HY, Li CY, Yeh BW, Yang SF, Tu HP, Shariat SF, Sagalowsky AI, Raman JD, Lotan Y, Hsieh JT, Margulis V, Wu WJ. Validation of hyponatremia as a prognostic predictor in multiregional upper tract urothelial carcinoma. J Clin Med. 2020;9(4):1218.

    Article  CAS  Google Scholar 

  • Yuen KCJ, Ajmal A, Correa R, Little AS. Sodium perturbations after pituitary surgery. Neurosurg Clin N Am. 2019;30(4):515–24.

    Article  Google Scholar 

  • Zhang X, Cai H, Hu J, Lian J, Gu J, Zhang S, Ye C, Lu Y, Jin C, Yu G, Jia H, Zhang Y, Sheng J, Li L, Yang Y. Epidemiological, clinical characteristics of cases of SARS-CoV-2 infection with abnormal imaging findings. Int J Infect Dis. 2020;94:81–7.

    Article  Google Scholar 

  • Zieschang T, Wolf M, Vellappallil T, Uhlmann L, Oster P, Kopf D. The association of hyponatremia, risk of confusional state, and mortality. Dtsch Arztebl Int. 2016;113(50):855–62.

    Google Scholar 

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Authors and Affiliations

  1. Endocrinology, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy

    Alessandro Peri

  2. Pituitary Diseases and Sodium Alterations Unit, Endocrinology, Department of Medicine and Geriatrics, Careggi University Hospital, Florence, Italy

    Alessandro Peri, Dario Norello & Benedetta Fibbi

Authors
  1. Alessandro Peri
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  2. Dario Norello
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  3. Benedetta Fibbi
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Correspondence to Alessandro Peri .

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Editors and Affiliations

  1. Department of Endocrinology, San Raffaele University, Rome, Italy

    Massimiliano Caprio

  2. Cardiovascular Research Center, Paris Descartes University, Paris, France

    Fabio Luiz Fernandes-Rosa

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Peri, A., Norello, D., Fibbi, B. (2022). Approach to Hyponatremia According to the Clinical Setting. In: Caprio, M., Fernandes-Rosa, F.L. (eds) Hydro Saline Metabolism. Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-030-44628-4_8-1

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