[Hyponatremia: differential diagnosis and therapy].

Area of Science:

• Internal Medicine
• Nephrology
• Endocrinology

Background:

• Hyponatremia is the most frequent electrolyte disorder, linked to increased morbidity and mortality.
• It is frequently underestimated and inadequately managed in clinical practice.
• Neurological symptoms vary widely with severity, from gait disturbances to coma.

Purpose of the Study:

• To emphasize the importance of identifying the underlying causes of hyponatremia.
• To highlight the Syndrome of Inappropriate Antidiuretic Hormone secretion (SiADH) as a common cause.
• To discuss diagnostic and therapeutic strategies for hyponatremia.

Main Methods:

• Utilizing a differential diagnostic approach with a simple algorithm.
• Incorporating clinical and laboratory parameters for diagnosis.
• Reviewing therapeutic options, including vaptans.

Main Results:

• The Syndrome of Inappropriate Antidiuretic Hormone secretion (SiADH) causes hyponatremia in one-third of cases.
• SiADH is often associated with medications, neurological, respiratory, or malignant diseases.
• Goal-directed therapy is essential for managing hyponatremia.

Conclusions:

• Accurate diagnosis of hyponatremia's cause is critical for effective management.
• Vaptans offer new treatment possibilities for SiADH-associated hyponatremia.
• Systematic diagnostic and therapeutic approaches improve patient outcomes.