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The electrolytes in hyponatremia.

M Graber¹, D Corish

¹Department of Medicine, Veterans Administration Medical Center, Northport, NY.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation

|November 1, 1991

Summary

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Hyponatremia significantly dilutes serum sodium and chloride, but other electrolytes remain stable due to adaptive mechanisms. Dilution is overestimated by urinary sodium losses and cellular shifts, not just free water retention.

Area of Science:

Nephrology
Internal Medicine
Endocrinology

Background:

Hyponatremia is often attributed solely to free water retention, leading to serum sodium dilution.
The impact of hyponatremia on other serum electrolytes requires further investigation.

Purpose of the Study:

To determine if other electrolytes are diluted similarly to sodium in hyponatremia.
To investigate the factors influencing electrolyte concentrations during hyponatremia.

Main Methods:

Compared electrolyte and laboratory values in 51 hyponatremic patients with their own baseline normal values.
Analyzed serum concentrations of sodium, chloride, bicarbonate, potassium, albumin, phosphate, and creatinine.
Assessed urinary sodium (UNa) and fractional sodium excretion (FENa) in relation to extracellular fluid (ECF) volume status.

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Main Results:

Serum sodium and chloride were significantly reduced (12-15%) in hyponatremia.
Mean concentrations of other electrolytes (bicarbonate, potassium, albumin, phosphate, creatinine) remained unchanged.
Urinary sodium (UNa) reliably predicted ECF volume, while fractional sodium excretion (FENa) did not.
Electrolyte derangements were common but primarily linked to diuretic use or abnormal ECF volume.

Conclusions:

Dilution in hyponatremia primarily affects sodium and chloride, not other electrolytes.
Overestimation of dilution is due to urinary sodium losses and cellular shifts.
Adaptive mechanisms, including volume-regulatory responses and hormonal influences (ADH, ANP), stabilize other electrolytes.