Hyponatremia: an updated review

Hyponatremia is a very common fluid and electrolyte disorder, especially in hospitalized patients, typically associated with other comorbidities. Its diagnosis can be complex, and approaches to its management may differ. Optimal treatment translates into better clinical outcomes; therefore, it is essential to distinguish between forms that require urgent treatment. In severe symptomatic hyponatremia, a paradigm shift has occurred: the administration of hypertonic saline boluses is currently recommended to achieve a rapid yet controlled increase in plasma sodium concentration. Conversely, in mildly symptomatic hyponatremia, the correction of the underlying cause constitutes the cornerstone of treatment. In the presence of the syndrome of inappropriate antidiuresis (SIAD), fluid restriction is recommended, and additional treatments, such as urea or vaptans, may be considered. SGLT2 inhibitors are emerging as an alternative option in selected circumstances.