Hypotonic hyponatremia

Hypotonic hyponatremia is a medical condition characterized by low sodium concentration in the blood plasma, specifically when the plasma sodium concentration is less than 135 mmol/L, and the plasma is hypotonic, meaning it has a lower osmolarity than the body's cells. This condition leads to water moving into cells, causing them to swell. It is one of the most common electrolyte abnormalities encountered in clinical practice and can have a wide range of causes and presentations.

Causes

Hypotonic hyponatremia can be caused by a variety of factors, which are broadly classified into three categories based on the patient's extracellular fluid volume status: hypovolemic, euvolemic, and hypervolemic.

• Hypovolemic hyponatremia occurs when there is a decrease in total body water accompanied by a greater decrease in total body sodium. Causes include gastrointestinal losses (e.g., vomiting, diarrhea), renal losses (e.g., use of diuretics, adrenal insufficiency), and skin losses (e.g., burns, sweating).
• Euvolemic hyponatremia is characterized by normal body fluid volume with dilutional hyponatremia. The most common cause is the syndrome of inappropriate antidiuretic hormone secretion (SIADH), but it can also result from hypothyroidism, pain, stress, or the use of certain medications.
• Hypervolemic hyponatremia involves an increase in total body water that exceeds the increase in total body sodium. This condition is often associated with congestive heart failure, liver cirrhosis, and renal failure.

Symptoms

The symptoms of hypotonic hyponatremia vary based on the severity and rate of decrease in plasma sodium concentration. Mild cases may be asymptomatic or present with non-specific symptoms such as nausea, headache, and malaise. Severe hyponatremia can lead to neurological symptoms due to cerebral edema, including confusion, seizures, coma, and potentially death.

Diagnosis

Diagnosis of hypotonic hyponatremia involves a thorough history and physical examination, assessment of the patient's fluid status, and laboratory tests. Key laboratory tests include serum sodium, serum osmolality, urine osmolality, and urine sodium concentration. The assessment of the patient's volume status helps in distinguishing between the hypovolemic, euvolemic, and hypervolemic forms of hyponatremia.

Treatment

The treatment of hypotonic hyponatremia depends on the underlying cause, the severity of symptoms, and the patient's volume status. In cases of acute, symptomatic hyponatremia, hypertonic saline may be administered to rapidly increase serum sodium concentration. In chronic or asymptomatic cases, the correction of serum sodium should be gradual to avoid the risk of osmotic demyelination syndrome. Treatment may also involve fluid restriction, addressing the underlying cause, and in some cases, the use of vasopressin receptor antagonists.

Prevention

Prevention of hypotonic hyponatremia involves the careful management of fluid intake and the treatment of underlying conditions that may contribute to the development of hyponatremia. In hospital settings, monitoring of electrolyte levels in patients at risk for hyponatremia is crucial for early detection and management.