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Updated: Jun 21, 2025

Full-Endoscopic Surgery for Hypothalamic Hamartoma Resection

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Hyponatraemia-treatment standard 2024.

Goce Spasovski¹

¹Department of Nephrology, University of Skopje, Sts. Cyril and Methodius, Skopje, N. Macedonia.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association

|July 15, 2024

Summary

Hyponatraemia, a common hospital disorder, requires careful correction. Symptomatic cases benefit from rapid hypertonic saline, while mild cases need fluid restriction and solute intake, with urea as a safe second-line SIADH therapy.

Keywords:

diuretics fluid restriction hyponatremia urea vaptans

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Area of Science:

Nephrology
Internal Medicine
Endocrinology

Background:

Hyponatraemia is the most frequent electrolyte disturbance in hospitalized patients.
It is linked to significant increases in morbidity, mortality, hospital stay duration, and healthcare costs.
The management of hyponatraemia necessitates careful consideration of symptom severity, duration, and biochemical parameters.

Purpose of the Study:

To review current therapeutic strategies for hyponatraemia, focusing on correction speed and specific patient populations.
To evaluate the efficacy and safety of different treatment modalities, including fluid restriction, hypertonic saline, urea, and vaptans.
To provide guidance on selecting appropriate second-line therapies for hypotonic hyponatraemia, particularly in Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) patients.

Main Methods:

Review of existing literature and clinical guidelines on hyponatraemia management.
Analysis of treatment approaches based on symptom presentation (symptomatic vs. asymptomatic) and severity.
Evaluation of the role of fluid restriction, solute intake, hypertonic saline, urea, and vaptans in different hyponatraemic states.

Main Results:

Rapid intermittent administration of hypertonic saline is recommended for symptomatic hyponatraemia.
For asymptomatic mild hyponatraemia, fluid restriction (FR) and adequate solute intake are preferred initial strategies.
Urea and tolvaptan are effective second-line therapies for SIADH, with oral urea noted for its safety and efficacy.

Conclusions:

Gradual correction and clinical evaluation are emphasized over rapid normalization of serum sodium levels.
Close monitoring and preparedness for interventions like hypotonic fluids or desmopressin are crucial for optimal outcomes.
Further evidence is needed to guide the choice of second-line therapies for hypotonic hyponatraemia, especially in non-responders to initial FR for SIADH.