Sanny Marselina 16011132

Summary

Exercise-induced Hyponatraemia
Hyponatremia is a common finding in clinical practice and is estimated to occur in 15% of all hospital inpatients. It is defined as a serum sodium <135 mEq/L; severe hyponatremia is defined as a serum sodium <120 mEq/L. Patients with hyponatremia have increased morbidity and mortality compared with patients without hyponatremia. Mild hyponatremia is an independent risk factor of adverse outcome and mortality even in the general population. Sodium is a major osmotic solute in the extracellular fluid and is therefore an important determinant of the extracellular volume status, serum osmolality, and tonicity. The serum sodium concentration is a measure of water status rather than total body salt content. A low serum sodium concentration indicates dilute body fluids or an excess of water. The clinical manifestations of hyponatremia depend on the rate of decline of serum sodium. An acute fall in sodium over 24 to 48 hours produces severe cerebral edema, which can be fatal. A gradual fall in sodium over several days or weeks can be compensated for by the brain, produces relatively modest morbidity and may be asymptomatic. Hyponatraemia is often iatrogenic and avoidable. One of the most common causes is the administration of hypotonic fluids to patients and use of thiazide diuretics. Sodium homeostasis and types of hyponatremia Sodium homeostasis is maintained by thirst (which drives fluid intake), ADH (which increases renal water reabsorption), aldosterone (which increases renal sodium resorption), and the kidneys (which can control sodium resorption in the proximal tubule independent of external hormonal input). Hyponatremia may result from an inappropriate hypotonic fluid intake, inappropriate fluid retention by excessive ADH, or inadequate renal reabsorption of sodium. Hyponatremia can be classified into 5 main types.

Hypovolemic hyponatremia: total body water decreases, but total body sodium decreases to a greater extent. The extracellular fluid volume is also decreased.

Sanny Marselina 16011132

Euvolemic hyponatremia: total body water increases, but total body sodium remains unchanged. There is a modest increase in extracellular fluid volume, but not enough to cause edema.

Hypervolemic hyponatremia: total body water and sodium both increase, but total body water increases to a greater extent. The extracellular fluid volume is markedly increased, causing edema.

Hypertonic (redistributive) hyponatremia: increased osmotic pressure in the extracellular compartment causes water to shift from the intracellular to the extracellular compartment diluting extracellular sodium. However, total body sodium and water are unchanged. This is commonly seen with hyperglycemia and mannitol administration.

Pseudohyponatremia: excessive lipids or proteins dilute the aqueous phase of the extracellular compartment and the measured sodium levels are low. However, this decrease is an artifact and should be excluded before proceeding with further investigations. Total body sodium and water are unchanged, and there has not been a shift of fluid between compartments. The use of ion-specific electrodes has helped reduce the incidence of this artifact.A simple formula to correct sodium level in the presence of hyperglycemia: serum sodium is decreased by 2.4 mEq/dL for every 100 mg/dL elevation of serum glucose over 100 mg/dL.