Hyponatriämie in Notfall- und Intensivmedizin [Hyponatremia in emergency and critical care medicine]


  • D. Zickler
  • K.M. Schmidt-Ott


  • Nephrologe


  • Nephrologe 14 (6): 422-430


  • A diagnosis of hyponatremia is common and relevant among hospitalized patients, particularly in the intensive care unit. The etiology of hyponatremia includes an excess intake of electrolyte-free water, a reduction of the effective circulating blood volume or a situation of inadequately elevated vasopressin activity. Hyponatremia requires a timely and systematic management, which addresses the correction of hyponatremia and the identification of the etiology. Central goals of acute management include avoidance of hyponatremia-induced cerebral edema and the identification of causal factors contributing to hyponatremia development. Patients with severe symptomatic forms of chronic hyponatremia pose a particular challenge as a rapid correction of hyponatremia is important to avoid progressive cerebral edema but an excessive rise in serum sodium concentration may cause osmotic demyelination. This article provides a concise review of the pathophysiology, diagnosis, and treatment of hyponatremia and proposes an approach that is based on the recent literature and clinical guidelines.