References

Adrogué HJ, Madias NE The challenge of hyponatremia. J Am Soc Nephrol. 2012; 23:(7)1140-1148 https://doi.org/10.1681/ASN.2012020128

Al Mawed S, Pankratz VS, Chong K, Sandoval M, Roumelioti ME, Unruh M Low serum sodium levels at hospital admission: outcomes among 2.3 million hospitalized patients. PLoS One. 2018; 13:(3) https://doi.org/10.1371/journal.pone.0194379

Ball S, Barth J, Levy M Society for Endocrinology endocrine emergency guidance: emergency management of severe symptomatic hyponatraemia in adult patients. Endocr Connect. 2016; 5:(5)G4-G6 https://doi.org/10.1530/EC-16-0058

Besen BAMP, Gobatto ALN, Melro LMG, Maciel AT, Park M Fluid and electrolyte overload in critically ill patients: an overview. World J Crit Care Med. 2015; 4:(2)116-129 https://doi.org/10.5492/wjccm.v4.i2.116

Biswas M, Davies JS Hyponatraemia in clinical practice. Postgrad Med J. 2007; 83:(980)373-378 https://doi.org/10.1136/pgmj.2006.056515

Chawla A, Sterns RH, Nigwekar SU, Cappuccio JD Mortality and serum sodium: do patients die from or with hyponatremia?. Clin J Am Soc Nephrol. 2011; 6:(5)960-965 https://doi.org/10.2215/CJN.10101110

Corona G, Giuliani C, Verbalis JG, Forti G, Maggi M, Peri A Hyponatremia improvement is associated with a reduced risk of mortality: evidence from a meta-analysis. PLoS One. 2015; 10:(4) https://doi.org/10.1371/journal.pone.0124105

Dineen R, Thompson CJ, Sherlock M Hyponatraemia – presentations and management. Clin Med (Northfield Ill). 2017; 17:(3)263-269 https://doi.org/10.7861/clinmedicine.17-3-263

Antimicrobials induced hyponatremia in elderly patients. 2019. https://medcraveonline.com/UNOAJ/UNOAJ-07-00254.pdf (accessed 3 October 2022)

Finnerty CC, Mabvuure NT, Ali A, Kozar RA, Herndon DN The surgically induced stress response. JPEN J Parenter Enteral Nutr. 2013; 37:21S-29S https://doi.org/10.1177/0148607113496117

Fogarty J, Loughrey C Hyponatraemia in hospitalised adults: a guide for the junior doctor. Ulster Med J. 2017; 86:(2)84-89

Friedman B, Cirulli J Hyponatremia in critical care patients: Frequency, outcome, characteristics, and treatment with the vasopressin V2-receptor antagonist tolvaptan. J Crit Care. 2013; 28:(2)219.e1-219.e12 https://doi.org/10.1016/j.jcrc.2012.06.001

Garrahy A, Dineen R, Hannon AM Continuous versus bolus infusion of hypertonic saline in the treatment of symptomatic hyponatremia caused by SIAD. J Clin Endocrinol Metab. 2019; 104:(9)3595-3602 https://doi.org/10.1210/jc.2019-00044

Gankam-Kengne F, Ayers C, Khera A, de Lemos J, Maalouf NM Mild hyponatremia is associated with an increased risk of death in an ambulatory setting. Kidney Int. 2013; 83:(4)700-6 https://doi.org/10.1038/ki.2012.459

Gankam-Kengne F, Decaux G Hyponatremia and the brain. Kidney Int Rep. 2018; 3:(1)24-35 https://doi.org/10.1016/j.ekir.2017.08.015

Health Education England. Multi-professional framework for advanced clinical practice in England. 2017. https://tinyurl.com/35xhx9fv (accessed 26 September 2022)

Hoorn EJ, Zietse R Diagnosis and treatment of hyponatremia: compilation of the guidelines. J Am Soc Nephrol. 2017; 28:(5)1340-1349 https://doi.org/10.1681/ASN.2016101139

Kim H, Kim JK, Cho SC Comparison of sodium ion levels between an arterial blood gas analyzer and an autoanalyzer in preterm infants admitted to the neonatal intensive care unit: a retrospective study. BMC Pediatr. 2016; 16:(1) https://doi.org/10.1186/s12887-016-0636-4

Hyponatraemia. 2022. https://patient.info/doctor/hyponatraemia-pro) (accessed 26 September 2022)

Królicka AL, Kruczkowska A, Krajewska M, Kusztal MA Hyponatremia in infectious diseases—a literature review. Int J Environ Res Public Health. 2020; 17:(15) https://doi.org/10.3390/ijerph17155320

Lee JW Fluid and electrolyte disturbances in critically ill patients. Electrolyte Blood Press. 2010; 8:(2)72-81 https://doi.org/10.5049/EBP.2010.8.2.72

Lee G, Gilroy JA, Ritchie A, Grover V, Gull K, Gruber P Advanced critical care practitioners – practical experience of implementing the advanced critical care practitioner faculty of intensive care medicine curriculum in a London critical care unit. J Intensive Care Soc. 2018; 19:(2)147-154 https://doi.org/10.1177/1751143717740019

Liamis G, Megapanou E, Elisaf M, Milionis H Hyponatremia-inducing drugs. Disorders of fluid and electrolyte metabolism. Focus on hyponatremia. Frontiers of Human Research. 2019; 52:67-177 https://doi.org/10.1159/isbn.978-3-318-06383-7

Lopez-Ruiz A, Niven AS Hyponatremia in the critically Ill. Critical Care Alert. 2017; 25:(8)

Lu H, Vollenweider P, Kissling S, Marques-Vidal P Prevalence and description of hyponatremia in a swiss tertiary care hospital: an observational retrospective study. Frontiers in Medicine. 2020; 7 https://doi.org/10.3389/fmed.2020.00512

Malbrain MLNG, Langer T, Annane D Intravenous fluid therapy in the perioperative and critical care setting: executive summary of the International Fluid Academy (IFA). Ann Intensive Care. 2020; 10:(1) https://doi.org/10.1186/s13613-020-00679-3

Nagler EV, Vanmassenhove J, van der Veer SN Diagnosis and treatment of hyponatremia: a systematic review of clinical practice guidelines and consensus statements. BMC Med. 2014; 12:(1)1-16 https://doi.org/10.1186/s12916-014-0231-1

National Institute for Health and Care Excellence. Intravenous fluid therapy in adults in hospital. 2017. https://www.nice.org.uk/guidance/cg174 (accessed 26 September 2022)

National Institute for Health and Care Excellence. Hyponatraemia. 2020. https://cks.nice.org.uk/topics/hyponatraemia (accessed 26 September 2022)

Padhi R, Panda BN, Jagati S, Patra SC Hyponatremia in critically ill patients. Indian J Crit Care Med. 2014; 18:(2)83-87 https://doi.org/10.4103/0972-5229.126077

Patil S, Mukherji A, Shetty A Incidence of hyponatremia in critically ill patients in intensive care unit: observational study. International Journal of Dental and Medical Specialty. 2016; 3:1:(12-16) https://doi.org/10.5958/2394-4196.2016.00004.2

Peters A, Brailovsky Y, Lakhter V, Forfia P Case Report of vasopressin induced hyponatremia in a patient with pulmonary hypertension, hypotension and sepsis. Circulation. 2014; 130:(2)A9594-A9594

Rafat C, Flamant M, Gaudry S, Vidal-Petiot E, Ricard JD, Dreyfuss D Hyponatremia in the intensive care unit: how to avoid a Zugzwang situation?. Ann Intensive Care. 2015; 5:(1) https://doi.org/10.1186/s13613-015-0066-8

Salazar M, Hu BB, Vazquez J, Wintz RL, Varon J Exogenous vasopressin-induced hyponatremia in patients with vasodilatory shock. J Intensive Care Med. 2015; 30:(5)253-258 https://doi.org/10.1177/0885066613507410

Seay NW, Lehrich RW, Greenberg A Diagnosis and management of disorders of body tonicity—hyponatremia and hypernatremia: core curriculum 2020. Am J Kidney Dis. 2020; 75:(2)272-286 https://doi.org/10.1053/j.ajkd.2019.07.014

Sim JK, Ko RE, Na SJ, Suh GY, Jeon K Intensive care unit-acquired hyponatremia in critically ill medical patients. J Transl Med. 2020; 18:(1) https://doi.org/10.1186/s12967-020-02443-4

Spasovski G, Vanholder R, Allolio B Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrology Dialysis Transplantation. 2014; 29:i1-i39

Sterns RH, Hix JK, Silver SM Management of hyponatremia in the ICU. Chest. 2013; 144:(2)672-679 https://doi.org/10.1378/chest.12-2600

Verbalis JG, Goldsmith SR, Greenberg A Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013; 126:(10)S1-S42 https://doi.org/10.1016/j.amjmed.2013.07.006

Winata AS, Jen WY, Teng ML Intravenous maintenance fluid tonicity and hyponatremia after major surgery- a cohort study. Int J Surg. 2019; 67:1-7 https://doi.org/10.1016/j.ijsu.2019.04.019

Winzeler B, Jeanloz N, Nigro N Long-term outcome of profound hyponatremia: a prospective 12 months follow-up study. Eur J Endocrinol. 2016; 175:(6)499-507 https://doi.org/10.1530/EJE-16-0500

Zhang X, Li XY Prevalence of hyponatremia among older inpatients in a general hospital. Eur Geriatr Med. 2020; 11:(4)685-692 https://doi.org/10.1007/s41999-020-00320-3

Critical Care

The diagnosis and management of acute hyponatraemia in critical care

13 October 2022

Clinical

02 October 2022

Volume 31 · Issue 18

ISSN (print): 0966-0461

ISSN (online): 2052-2819

Abstract

Nurses working in critical care, consisting of the intensive care and high dependency units, will encounter a broad range of diseases and conditions. Therefore, a comprehensive knowledge and understanding of common presentations is required, especially for advanced clinical practitioners (ACPs). One of the most common electrolyte disturbances seen within these areas is hyponatraemia, affecting around 40% of patients in critical care and 30% of inpatients. It is important that ACPs working in this area are aware of the symptoms and recommended diagnosis and management.

As health care has become increasingly technology driven and demanding, there has been a growing need to develop health professionals who can work at an advanced level. The introduction of advanced clinical practitioners (ACPs) has led to a blended workforce within the medical team. This is particularly important in areas such as critical care. Continuous professional development for practitioners is essential to consolidate learning, maintain competency and further develop clinical examination and decision-making skills. Although hyponatraemia is commonplace, affecting around 40% of patients in critical care and 30% of inpatients (Friedman and Cirulli, 2013), there is a paucity of literature on this subject within nursing journals. Therefore, this clinical review will focus on hyponatraemia, its diagnosis, and treatment, and is particularly aimed at ACPs working in critical care.

The recognised normal range for serum sodium concentration (SNa) in adults is accepted as 135-145 millimoles per litre (mmol/litre). Hyponatraemia is more commonly an excess of total body water rather than sodium deficiency, being defined as an SNa of less than 135 mmol/litre. It is classified into mild (130-134 mmol/litre), moderate (125-129 mmol/litre) or severe hyponatraemia (an SNa below 125 mmol/litre). Severe hyponatraemia is prevalent in 2-3% of patients (Winzeler et al, 2016; National Institute for Health and Care Excellence (NICE), 2020).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

Limited access to clinical or professional articles
Unlimited access to the latest news, blogs and video content

Or continue by

Signing in with your registered email address

Hyponatraemia

Electrolyte imbalance

Critical care

Advanced clinical practice