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Diagnóstico y tratamiento de la hiponatremia: una revisión
Horacio J Adrogué1,2, Bryan M Tucker1,2, Nicolaos E Madias3,4
1Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
JAMA
|July 19, 2022
Resumen
La hiponatremia, un trastorno común de los electrolitos, afecta al 5% de los adultos y aumenta la hospitalización y la mortalidad. El tratamiento implica abordar la causa subyacente, con terapias específicas para casos graves para prevenir complicaciones peligrosas como la desmielinización osmótica.
Área de la Ciencia:
- Nefrología
- Médico interno
- Endocrinología
Sus antecedentes:
- La hiponatremia es el trastorno electrolítico más común, que afecta al 5% de los adultos y al 35% de los pacientes hospitalizados.
- Definida por sodio sérico < 135 mEq/ L, a menudo resulta de la retención de agua y está relacionada con el aumento de la hospitalización y la mortalidad.
- Los síntomas varían desde leves (debilidad) hasta severos (convulsiones, coma), influenciados por la velocidad de aparición, la duración y la gravedad.
Objetivo del estudio:
- Revisar la importancia clínica, los síntomas y las estrategias de tratamiento de la hiponatremia.
- Para resaltar la asociación de la hiponatremia con el deterioro cognitivo, caídas, fracturas y osteoporosis.
- Trazar directrices para el tratamiento de la hiponatremia, incluidas las terapias para afecciones específicas y la gestión de emergencias.
Principales métodos:
- Revisión de la literatura sobre la prevalencia, los síntomas y los resultados clínicos de la hiponatremia.
- Análisis de estudios sobre la asociación de la hiponatremia con caídas, fracturas y densidad ósea.
- Examen de las directrices actuales de tratamiento y opciones terapéuticas, incluidas la urea, los vaptans y la solución salina hipertónica.
Principales resultados:
- La hiponatremia crónica leve está asociada con deterioro cognitivo, trastornos de la marcha, caídas y fracturas.
- La hiponatremia se identifica como una causa secundaria de la osteoporosis.
- Las estrategias de tratamiento varían según el estado del volumen de líquido (hipovolemia, euvolemia, hipervolemia) y la gravedad de los síntomas.
Conclusiones:
- La mayoría de los casos de hiponatremia requieren el tratamiento de la enfermedad subyacente.
- La urea y los vaptans son opciones para el síndrome de antidiuresis inadecuada y la hiponatremia relacionada con la insuficiencia cardíaca, con posibles efectos secundarios.
- La hiponatremia severamente sintomática requiere tratamiento de emergencia con solución salina hipertónica, monitoreada cuidadosamente para evitar la desmielinización osmótica.
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