Hyponatremia - Symptoms, Types, Causes & Diagnosis

Hyponatremia - Symptoms, Types, Causes & Diagnosis

Hyponatremia occurs when your blood sodium levels are abnormally low. An electrolyte called sodium aids in controlling the volume of water in and around your cells. Once you have hyponatremia, your body's sodium levels are...

Hyponatremia: When Your Body's Sodium Levels are Out of Adjustment

What is Hyponatremia?

Hyponatremia occurs when your blood sodium levels are abnormally low. An electrolyte called sodium aids in controlling the volume of water in and around your cells. Once you have hyponatremia, your body's sodium levels are weakened for one or more reasons, such as a fundamental restorative condition or drinking as well as much water. When this happens, your body's water substance increments and your cells begin to swell. From minor to possibly lethal well-being issues, this swelling can be the source of various.   

How Common is Hyponatremia?

Hyponatremia is very common. It is the most typical chemical anomaly observed in hospitalized and outpatient patients. Those who are admitted to hospital care units or who have the aforementioned medical disorders have a greater incidence of hyponatremia.

Are there Types of Hyponatremia?

You might learn about various forms of hyponatremia.

Types of Hyponatremia:

  • Euvolemic hyponatremia: This condition develops when your body's sodium levels stay consistent but the amount of water in your body as a whole increase.
  • Hypervolemic hyponatremia: This condition develops when a person's body water content rises more than their sodium intake does.
  • Hypovolemic hyponatremia: This condition is characterized by a fall in total body water that is higher than the decline in total body sodium.
  • Dilutional hyponatremia: It is a type of low blood sodium level that is also referred to as "water intoxication." When electrolytes, which supply vital minerals like calcium, potassium, and salt, are not present, it refers to drinking excessive amounts of water.

Most individuals would drink a part of water rapidly to lower their blood salt levels unless they had well-being issues that make them vulnerable to hyponatremia.

Known also as hypotonic hyponatremia, hyperosmolar hyponatremia Low quantities of proteins, nutrients, and electrolytes (particularly sodium) are known as hyposmolality. Hyposmolality may result from hyponatremia.

What Causes Hyponatremia?

"Hyponatremia: the hidden danger of electrolyte imbalances."

Specific causes of hyponatremia are generally divided into hypotension (lower than normal solute concentrations), non-hypotension, and false hyponatremia. The low-pitched individuals are then grouped according to whether they have high volume, normal volume, or low volume. A low-sodium diet alone rarely causes hyponatremia.

High volume: Both sodium content and water content increase.  Elevated sodium levels lead to hypervolemia and water levels lead to hyponatremia.

  • Liver cirrhosis
  • Heart failure
  • Renal nephrotic syndrome
  • Excessive drinking of liquids 

Normal Volume: Body volume swelling, no edema, but hyponatremia occurs

  • SIADH (and its many causes)
  • Hypothyroidism
  • Not enough ACTH
  • Beer potomania
  • Normal physiological changes of pregnancy
  • Osmostat reset

Low Volume:

Hypovolemia (decrease in extracellular volume) is due to systemic sodium loss. Hyponatremia is caused by relatively low systemic water loss.

Causes of hypovolemia, such as prolonged vomiting, reduced oral intake, and severe diarrhea.

Use of Diuretics:

There are two conditions where the adrenal glands do not produce enough steroid hormones: Addison's disease and congenital adrenal hyperplasia (combined glucocorticoid and mineralocorticoid insufficiency).

  • Isolated hyperhidrosis (carbonic anhydrase XII deficiency)- It is a rare genetic disorder that results in a lifelong tendency to lose excessive amounts of sodium through sweating.
  • Pancreatitis: Sweating due to prolonged exercise in combination with electrolyte-deficient drinking water is the cause of exercise-related hyponatremia (EAH). It is commonly seen in marathon runners and participants in other endurance events.
  • The use of MDMA (Ecstasy) can cause hyponatremia.
  • Medicine: A review of medical literature from 1946 to 2016 reported that antipsychotic drugs cause hyponatremia. Available evidence indicates that all classes of psychotropic drugs, namely antipsychotics, H. Antidepressants, disposition stabilizers, and sedatives/hypnotics, can cause hyponatremia.  Age is a major factor in drug-induced hyponatremia.

Other Causes

Other causes that do not fit the above classification scheme include:

  • Pseudohyponatremia is caused by erroneous laboratory measurements of sodium due to greatly elevated blood triglyceride levels or extreme elevations in immunoglobulins, as can occur in multiple myeloma.
  • Hypertonic hyponatremia can occur with high blood sugar levels, causing excess free water to migrate into the serum. 

Who is Most at Risk for Hyponatremia?

The risk of hyponatremia may be increased by the following variables:

  1. Year: Older people may have more factors that contribute to hyponatremia, including age-related changes, and use of certain medications, and more likely to develop chronic conditions that alter the body's sodium balance.
  2. Certain Drugs: Drugs that increase the risk of hyponatremia include thiazide diuretics, antidepressants, and pain relievers. In addition, recreational drug ecstasy is associated with fatal cases of hyponatremia.
  3. A condition in which the body's water excretion is reduced. Conditions that can increase the risk of hyponatremia incorporate kidney malady, unseemly antidiuretic hormone disorder (SIADH), and heart disappointment.  
  4. Strenuous physical activity- Individuals who drink as well much water while taking part in marathons, ultramarathons, triathlons, and other long-distance, high-intensity activities are at increased risk of hyponatremia.

How is Hyponatremia Diagnosed?

A medical history, physical examination, and laboratory tests are required to identify the underlying cause of hyponatremia. A blood test showing serum sodium <135 mmol/L is diagnostic of hyponatremia. [34] A history and physical examination are necessary to determine whether the person is hypovolemic, euvolemic, or hypervolemic and are important in identifying the underlying cause. Evaluation is also done to determine if a person is experiencing symptoms of hyponatremia. These include assessments of attention, concentration, and orientation. 

Your healthcare practitioner might enquire of you:

  • What types of sports do you play and how do you prepare.
  • Which prescription drugs do you now take.
  • What types of illnesses and operations do you now have or have had in the past?
  • How much alcohol, particularly beer, do you consume.
  • Whether or not you consume illicit drugs like 3,4-methylenedioxymethamphetamine (MDMA, but also called Molly, E, or Ecstasy).

What are the Symptoms Symptoms of Hyponatremia?

Hyponatremia can manifest as nausea, vomiting, headache, disorientation, lethargy, weariness, loss of appetite, irritability, muscle weakness, tremors or convulsions, seizures, unconsciousness or coma, and short-term memory loss. The severity of the symptoms increases with a decrease in plasma sodium concentration. Nevertheless, difficulties and subtle symptoms may be linked to mild hyponatremia (plasma sodium content 131–135 mmol/L) (e.g., death).

Neurological symptoms usually develop when plasma sodium concentrations are very low (usually <115 mmol/L). When blood sodium levels become very low, water enters the brain cells and causes cerebral edema. This increases intracranial pressure and causes hyponatremic encephalopathy. Increased pressure within the skull can cause brain herniation, where the brain is squeezed onto the internal structures of the skull. This can lead to headache, nausea, vomiting, confusion, seizures, compression of the brainstem, respiratory failure, and accumulation of non-cardiogenic fluid in the lungs. Usually fatal. Chronic hyponatremia can lead to complications such as neuropathy. These neurological deficits most commonly affect gait (gait) and attention and can lead to increased reaction times and falls. Hyponatremia is associated with a dual risk of osteoporosis and an increased risk of fracture due to impaired bone metabolism.

"Hyponatremia: know the signs and symptoms, and seek medical attention when necessary."

How is Hyponatremia Treated?

Treatment of hyponatremia depends on the underlying cause. How quickly treatment is needed depends on the person's symptoms. Fluids are often the cornerstone of initial management. In people with severe disease, sodium should be increased by about 5 mmol/L over one to four hours. Rapid elevation of serum sodium is predicted in some groups when the cause of hyponatremia is treated, thus warranting closer monitoring to avoid excessive correction of serum sodium levels.

These individuals fall into one of several categories, including those who have hypovolemic hyponatremia and are treated with intravenous fluids (thereby reversing their hypovolemia),

Those with adrenal insufficiency who are given hydrocortisone, those whose medication increased their release of ADH has been stopped, and

Those who have hyponatremia because their diet is low in salt and/or other solutes and are treated with a higher solute diet. Large amounts of urine that are highly diluted may be an indication that these people are about to overcorrect.

(140 - serum sodium) x total body water[5] = sodium deficiency.

Your healthcare professional makes minor adjustments to address the issue if you just have minor symptoms. The length of the course of treatment can vary.

A brief course of treatment entails:

  • Consuming less water.
  • Modifying or discontinuing medicine.
  • Addressing the root causes.

A comprehensive therapy program might include:

  • Consuming less water.
  • Modifying, terminating or introducing newer drugs.
  • Increasing your salt intake.

You'll probably need to visit the hospital for a comprehensive medical evaluation and treatment if you have moderate to severe hyponatremia. Individuals with the most severe hyponatremia will likely have intravenous sodium replacement (straight into a vein). They'll also need to limit how much water they consume.

Body weight in kilos times 0.6 equals total body water.

  • Fluids: Treatment for mild and asymptomatic hyponatremia involves consuming enough solutes (including salt and protein) and restricting fluid intake, starting at 500 milliliters per day (mL/d).

Consider hypertonic saline (3%) 1–2 mL/kg IV in 3–4 h. Hypertonic saline can cause rapid dilution and hyponatremia. It should not be used in individuals with an enlarged extracellular fluid volume.

  •  Abnormal electrolytes: In people with hypovolemic hyponatremia (hypovolemia) caused by concomitant diuretics and hypokalemia, correction of low potassium may help correct hyponatremia.
  •  Medicine: US and European guidelines reach different conclusions about drug use. In Europe, they are generally discouraged.

There is preliminary evidence that vasopressin receptor antagonists (vaptans), such as conivaptan, may be slightly more effective than fluid restriction in people with high-volume or normal-volume hyponatremia. They should not be used in people with low mass. They may also be used in people with chronic hyponatremia because SIADH has not responded adequately to fluid restriction and/or sodium tablets.

Although it is occasionally used to treat SIADH, demeclocycline has serious adverse effects, such as a risk of kidney damage and photosensitivity. Some people can have no benefits from it, while others may experience overregulation and excessive blood salt levels.

Daily use of oral urea, although not commonly used due to taste, has tentative evidence in SIADH.

What Happens After Receiving Therapy for Hyponatremia?

Many persons who receive treatment for hyponatremia fully recover. Even if you suffer from chronic hyponatremia, your doctor can still assist you.

Poorer outcomes may occur in older folks and those who stay in the hospital for an extended period.

"Hyponatremia: a condition that affects many, but can be managed with proper care."

Are there any Complications Associated with Hyponatremia?

In chronic hyponatremia, sodium levels gradually decrease over 48 hours or so - and symptoms and complications are usually milder. During acute hyponatremia, sodium levels drop rapidly, leading to potentially dangerous effects, such as rapid brain swelling, which can lead to coma and death. 

Premenopausal women appear to have the highest risk of hyponatremia-related brain damage. This is due to the impact on female sex hormones.

Can I Prevent Hyponatremia?

"Hyponatremia: stay hydrated, but don't overdo it!"

The following measures can help you prevent hyponatremia:

  • Treatment of comorbidities.
  • Treating conditions that contribute to hyponatremia, such as adrenal insufficiency, can help prevent hypoglycemia.
  • Find out: If you have a condition that increases your risk of hyponatremia or if you take diuretics, be aware of the signs and symptoms of hyponatremia. Always discuss the risks of any new medication with your doctor. Take precautions during intense activities. Athletes should only drink as much fluid as they lose through sweating during a race. Thirst is often a good indication of how much water or other fluids you need.
  • Consider drinking sports drinks during strenuous activities. Ask your doctor about replacing water with electrolyte-containing sports drinks when participating in endurance events such as marathons, triathlons, and other strenuous activities. Drink water in moderation. Drinking water is very important for your health, so make sure to drink enough water. But don't overdo it. Thirst and the color of your urine are often the best indications of how much water you need. If you're not thirsty and your urine is light yellow, you're probably drinking enough.

Remember, hyponatremia is a serious condition that can have significant health consequences. If you suspect that you or someone you know may be experiencing hyponatremia, it's important to seek medical attention right away.

With proper diagnosis and treatment, however, many cases of hyponatremia can be successfully managed, and patients can go on to live healthy, happy lives.