Hyponatremia in Emergency Medicine Medication

  • Author: Sandy Craig, MD; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Apr 13, 2010
 

Medication Summary

Appropriate treatment of hyponatremia depends on the correct classification of hyponatremia, the concomitant disease state, the severity of symptoms, and the severity of hyponatremia.

Next

Electrolyte Supplements

Class Summary

Hypertonic saline may be used to rapidly increase serum sodium level in patients with severe acute or chronic hyponatremia, as manifested by severe confusion, coma, seizures, or evidence of brainstem herniation.

Hypertonic (3%) saline

 

Contains 513 mEq/L of NaCl. Volume of hypertonic saline administered depends on current and desired serum sodium levels and patient's weight. In general, increase of 4-6 mEq/L in serum sodium level is sufficient to arrest progression of symptoms in severe hyponatremia. Further rapid increase in serum sodium level not indicated.

Previous
Next

Arginine Vasopressin Antagonists

Class Summary

These agents treat hyponatremia through V2 antagonism of AVP in the renal collecting ducts. This effect results in aquaresis (excretion of free water).

View full drug information

Conivaptan (Vaprisol)

 

Arginine vasopressin antagonist (V1A, V2) indicated for euvolemic (dilutional) and hypervolemic hyponatremia. Increases urine output of mostly free water, with little electrolyte loss.

View full drug information

Tolvaptan (Samsca)

 

Selective vasopressin V2 -receptor antagonist. Indicated for hypervolemic and euvolemic hyponatremia (ie, serum sodium level < 125 mEq/L) or less marked hyponatremia that is symptomatic and has resisted correction with fluid restriction. Used for hyponatremia associated with congestive heart failure, liver cirrhosis, and syndrome of inappropriate antidiuretic hormone secretion. Initiate or reinitiate in hospital environment only.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Sandy Craig, MD  Residency Program Director, Carolinas Medical Center; Associate Professor, Department of Emergency Medicine, University of North Carolina at Chapel Hill School of Medicine

Sandy Craig, MD is a member of the following medical societies: Alpha Omega Alpha and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Howard A Bessen, MD  Professor of Medicine, Department of Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Program Director, Harbor-UCLA Medical Center

Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

References

  1. Upadhyay A, Jaber BL, Madias NE. Incidence and prevalence of hyponatremia. Am J Med. Jul 2006;119(7 Suppl 1):S30-5. [Medline].

  2. Hawkins RC. Age and gender as risk factors for hyponatremia and hypernatremia. Clin Chim Acta. Nov 2003;337(1-2):169-72. [Medline].

  3. Hoorn E, Lindemans J, Zietse R. Hyponatremia in hospitalized patients epidemiology, etiology and symptomatology. J Am Soc Nephrol. 2004;15:561(A).

  4. Waikar SS, Mount DB, Curhan GC. Mortality after hospitalization with mild, moderate, and severe hyponatremia. Am J Med. Sep 2009;122(9):857-65. [Medline].

  5. Sajadieh A, Binici Z, Mouridsen MR, Nielsen OW, Hansen JF, Haugaard SB. Mild hyponatremia carries a poor prognosis in community subjects. Am J Med. Jul 2009;122(7):679-86. [Medline].

  6. Cole CD, Gottfried ON, Liu JK, Couldwell WT. Hyponatremia in the neurosurgical patient: diagnosis and management. Neurosurg Focus. Apr 15 2004;16(4):E9. [Medline].

  7. Neville KA, Sandeman DJ, Rubinstein A, Henry GM, McGlynn M, Walker JL. Prevention of hyponatremia during maintenance intravenous fluid administration: a prospective randomized study of fluid type versus fluid rate. J Pediatr. Feb 2010;156(2):313-9.e1-2. [Medline].

  8. Zeltser I, Pearle MS, Bagley DH. Saline is our friend. Urology. Jul 2009;74(1):28-9. [Medline].

  9. [Best Evidence] Choong K, Kho ME, Menon K, Bohn D. Hypotonic versus isotonic saline in hospitalised children: a systematic review. Arch Dis Child. Oct 2006;91(10):828-35. [Medline].

  10. Frizelle FA, Colls BM. Hyponatremia and seizures after bowel preparation: report of three cases. Dis Colon Rectum. Feb 2005;48(2):393-6. [Medline].

  11. Fenske W, Störk S, Blechschmidt A, Maier SG, Morgenthaler NG, Allolio B. Copeptin in the differential diagnosis of hyponatremia. J Clin Endocrinol Metab. Jan 2009;94(1):123-9. [Medline].

  12. Verbalis JG, Goldsmith SR, Greenberg A, Schrier RW, Sterns RH. Hyponatremia treatment guidelines 2007: expert panel recommendations. Am J Med. Nov 2007;120(11 Suppl 1):S1-21. [Medline].

  13. Arieff AI. Influence of hypoxia and sex on hyponatremic encephalopathy. Am J Med. Jul 2006;119(7 Suppl 1):S59-64. [Medline].

  14. Murase T, Sugimura Y, Takefuji S, et al. Mechanisms and therapy of osmotic demyelination. Am J Med. Jul 2006;119(7 Suppl 1):S69-73. [Medline].

  15. [Best Evidence] Schrier RW, Gross P, Gheorghiade M, Berl T, Verbalis JG, Czerwiec FS, et al. Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med. Nov 16 2006;355(20):2099-112. [Medline]. [Full Text].

  16. Olson BR. Vasopressin-receptor antagonists: a new class of agents for the treatment of hyponatremia. Endocr Metab Immune Disord Drug Targets. Sep 2006;6(3):249-58. [Medline].

  17. Arieff AI. Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. N Engl J Med. Jun 12 1986;314(24):1529-35. [Medline].

  18. Ayus JC, Wheeler JM, Arieff AI. Postoperative hyponatremic encephalopathy in menstruant women. Ann Intern Med. Dec 1 1992;117(11):891-7. [Medline].

  19. Bachu K, Godkar D, Gasparyan A, et al. Aripiprazole-induced syndrome of inappropriate antidiuretic hormone secretion (SIADH). Am J Ther. Jul-Aug 2006;13(4):370-2. [Medline].

  20. Backer HD, Shopes E, Collins SL, Barkan H. Exertional heat illness and hyponatremia in hikers. Am J Emerg Med. Oct 1999;17(6):532-9. [Medline].

  21. Berry PL, Belsha CW. Hyponatremia. Pediatr Clin North Am. Apr 1990;37(2):351-63. [Medline].

  22. Brown RG. Disorders of water and sodium balance. Postgrad Med. Mar 1993;93(4):227-8, 231-4, 239-40 passim. [Medline].

  23. Canuso CM, Goldman MB. Clozapine restores water balance in schizophrenic patients with polydipsia-hyponatremia syndrome. J Neuropsychiatry Clin Neurosci. 1999;11(1):86-90. [Medline].

  24. Cluitmans FH, Meinders AE. Management of severe hyponatremia: rapid or slow correction?. Am J Med. Feb 1990;88(2):161-6. [Medline].

  25. Dehoorne JL, Raes AM, van Laecke E, et al. Desmopressin toxicity due to prolonged half-life in 18 patients with nocturnal enuresis. J Urol. Aug 2006;176(2):754-7; discussion 757-8. [Medline].

  26. Egger C, Muehlbacher M, Nickel M, et al. A case of recurrent hyponatremia induced by venlafaxine. J Clin Psychopharmacol. Aug 2006;26(4):439. [Medline].

  27. Goldszmidt MA, Iliescu EA. DDAVP to prevent rapid correction in hyponatremia. Clin Nephrol. Mar 2000;53(3):226-9. [Medline].

  28. Hettema ME, Halma C. Beer drinker's hyponatraemia: a case report. Neth J Med. Mar 1999;54(3):105-7. [Medline].

  29. Holmes SB, Banerjee AK, Alexander WD. Hyponatraemia and seizures after ecstasy use. Postgrad Med J. Jan 1999;75(879):32-3. [Medline].

  30. Jacob S, Spinler SA. Hyponatremia associated with selective serotonin-reuptake inhibitors in older adults. Ann Pharmacother. Sep 2006;40(9):1618-22. [Medline].

  31. Norman NE, Sneed AM, Brown C, et al. Heparin-induced hyponatremia. Ann Pharmacother. Mar 2004;38(3):404-7. [Medline].

  32. O'Connor RE. Exercise-induced hyponatremia: causes, risks, prevention, and management. Cleve Clin J Med. Sep 2006;73 Suppl 3:S13-8. [Medline].

  33. Odeh M, Schiff E, Oliven A. Hyponatremia during therapy with amiodarone. Arch Intern Med. Nov 22 1999;159(21):2599-600. [Medline].

  34. Oh MS, Carroll HJ. Disorders of sodium metabolism: hypernatremia and hyponatremia. Crit Care Med. Jan 1992;20(1):94-103. [Medline].

  35. Oster JR, Singer I. Hyponatremia, hyposmolality, and hypotonicity: tables and fables. Arch Intern Med. Feb 22 1999;159(4):333-6. [Medline].

  36. Sirken G, Raja R, Garces J, et al. Contrast-induced translocational hyponatremia and hyperkalemia in advanced kidney disease. Am J Kidney Dis. Feb 2004;43(2):e31-5. [Medline].

  37. Soupart A, Ngassa M, Decaux G. Therapeutic relowering of the serum sodium in a patient after excessive correction of hyponatremia. Clin Nephrol. Jun 1999;51(6):383-6. [Medline].

  38. Sterns RH. The treatment of hyponatremia: first, do no harm. Am J Med. Jun 1990;88(6):557-60. [Medline].

  39. Trimarchi H, Gonzalez J, Olivero J. Hyponatremia-associated rhabdomyolysis. Nephron. 1999;82(3):274-7. [Medline].

  40. van den Heuvel OA, Bet PM, van Dam EW. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) during treatment with the antipsychotic agents haloperidol and quetiapine [in Dutch]. Ned Tijdschr Geneeskd. Sep 2 2006;150(35):1944-8. [Medline].

  41. Watanabe N, Tani M, Tanaka Y, et al. Severe hyponatremia with consciousness disturbance caused by hydroxyurea in a patient with chronic myeloid leukemia [in Japanese]. Rinsho Ketsueki. Mar 2004;45(3):243-6. [Medline].

  42. Weisberg LS. Pseudohyponatremia: a reappraisal. Am J Med. Mar 1989;86(3):315-8. [Medline].

  43. Wong LL, Verbalis JG. Systemic diseases associated with disorders of water homeostasis. Endocrinol Metab Clin North Am. Mar 2002;31(1):121-40. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.