[Hyponatremia]

Hyponatremia is the most common electrolyte disorder in the hospital setting and is defined as a serum sodium concentration less than 135 mmol/l. Most patients have mild hyponatremia (plasma sodium concentration 130-134 mmol/l) and few if any symptoms. Serum sodium concentrations between 120 and 129 mmol/l can be associated with lack of concentration, nausea, forgetfulness, apathy and loss of balance. Severe hyponatremia (<120 mmol/l) can cause coma or grand mal seizure. If hyponatremia occurs acutely (duration <48 h) it will cause more severe symptoms than are observed in chronic hyponatremia (>48 h). It is important to distinguish between different types of hyponatremia: euvolemic hyponatremia causing syndrome of inappropriate antidiuretic hormone secretion(SIADH) also known as Schwartz-Bartter syndrome, hypervolemic hyponatremia (cardiac failure and liver cirrhosis) and hypovolemic hyponatremia (diarrhoea, vomiting or other gastrointestinal fluid losses). Increased levels of ADH and continued fluid intake are the pathogenetic causes of all three types of hyponatremia; nonetheless, infusion of isotonic fluid is the therapy of choice for hypovolemic hyponatremia. In contrast, fluid restriction, lithium carbonate, urea, loop diuretics or demeclocycline have been used as therapeutic options to correct hyponatremia in euvolemic or hypervolemic hyponatremia but most of these therapies have proven to be cumbersome and inefficient. Recently a new class of pharmacological agents has become available, the vaptans, orally taken vasopressin antagonists. Clinical trials showed them to provide effective, specific and safe therapy of hyponatremia. In Europe tolvaptan, the only such agent on the market is now approved for the treatment of euvolemic hyponatremia.