Journal Reading

of
Diagnosis and Treatment of
Hyponatremia: Compilation
of the Guidelines
Keisha Deandra Christie
Overall
• Comparing the diagnostic and therapeutic guideline of United States
(2013) and Europe (2014)
• Diagnosis and Treatment of Hyponatremia: Compilation
of the Guidelines
• Ewout J. Hoorn and Robert Zietse
Introduction
• Research problem: What is the term and management used for
hyponatremia to achieve optimal result of care, being a pathophysiologic
process which could complicate the underlying disease?
• Previous studies: United States (2013) and Europe (2014) has developed
guidelines for diagnostic and therapeutic of hyponatremia
• This study was performed to assess the discrepancies between the scoring
systems for hyponatremia which were used in the two guidelines
• Aim: to compare the two guidelines and highlight recent developments
• Hypothesis: Both guidelines have chosen the optimal way for treating
hyponatremia by their perspective and both guidelines doesn’t contradict
each other
Materials and Methods
• Literature review of both guidelines
• Inclusion criteria: diagnostic term, therapeutic for each diagnostic
used
 RESULTS & DISCUSSION
Hyponatremia definition?
• Serum plasma sodium <136 mmol/L
• Pathophysiological process  disturbed water homeostasis
• Not the main diagnosis, it always has the UNDERLYING DISEASE
 RESULTS & DISCUSSION
Osmolality? Tonicity?
• Osmolality = solute mOsm / 1 kg solvent
• Tonicity = ability of a solute to attract water to cross the semi-
permeable membrane

solvent

solute
Extra Cellular Fluid | Intra Cellular Fluid

water

Semi-permeable membrane
Extra Cellular Fluid | Intra Cellular Fluid

water

Semi-permeable membrane
Classifications of Hyponatremia
Classifications of Hyponatremia RESULTS & DISCUSSION
in the United States’ Guidelines
Hyponatremia

Non-hypotonic
Hypotonic Hyponatremia
Hyponatremia
Classifications of Hyponatremia RESULTS & DISCUSSION
in the United States’ Guidelines
Hyponatremia

Non-hypotonic
Hypotonic Hyponatremia
Hyponatremia

Hypertonic
Pseudohyponatremia Hyponatremia

Caused by other active osmole;

Such as: glucose
 Classifications of Hyponatremia RESULTS & DISCUSSION
in the United States’ Guidelines
Hyponatremia

Non-hypotonic
Hypotonic Hyponatremia
Hyponatremia

Hypertonic
Pseudohyponatremia Hyponatremia
Hypervolemic
Hypovolemic
Hypernatremia
Hyponatremia

Euvolemic
Hyponatremia
 RESULTS & DISCUSSION
Diagnostic Algorithm
European Guidelines
 RESULTS & DISCUSSION
Vasopressin
• Anti-diuretic hormone
• Induced by hypovolemia or low effective arterial blood volume
• Function: to prevent water from being excreted in kidney, causing
water retention
• In SIADH, uncontrolled vasopressin is excreted
 RESULTS & DISCUSSION
Copeptin
• C-terminal pro arginine vasopressin
• Same prohormone with vasopressin
• Can be a surrogate marker for unstable vasopressin

Types of SIADH
General Approach RESULTS & DISCUSSION
Treatment
The core of treatment is:
• Reducing free water intake
• Giving hypertonic saline solution to acute/ severe hyponatremia in
order to prevent cerebral edema/ people at risk
Acute and Chronic Hyponatremia
• United States  durations
• Europe  symptoms severity

• Acute  hypertonic saline + loop diuretics

• Chronic  brain cells have adapted to the condition
• Correction rate  10 mmol/L per day to prevent ODS (osmotic
demyelination syndrome)
Conclusion
• Both guidelines has developed the algorithms to manage
hyponatremia optimally, there are more agreement than
disagreement
• Not all patients with hyponatremia can be treated with the guidelines
+ Algorithm of Hyponatremia

• Based on chloride
+ Kidney and Sodium
Thank you 