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DOI: 10.1055/a-1020-7303
Hyponatriämie – Diagnose und Therapie
Hyponatremia – Diagnosis and Therapy![](https://www.thieme-connect.de/media/dmw/202021/lookinside/thumbnails/dmw-10207303_10-1055-a-1020-7303-1.jpg)
Da die Hyponatriämie potenziell lebensbedrohlich sein kann, ist ein effizientes Management unerlässlich. Es umfasst das Identifizieren der auslösenden Ursache und die anschließende gezielte Therapie unter Vermeidung therapieassoziierter Nebenwirkungen (z. B. pontine Myelinolyse). Dieser Beitrag erklärt die Pathophysiologie und Differenzialdiagnosen der Hyponatriämie und erläutert praxisorientiert die Diagnostik und Therapie.
Abstract
Hyponatremia is a common condition affecting hospitalized and ambulatory patients as well. The clinical spectrum of hyponatremia can range from asymptomatic laboratory findings to severely symptomatic conditions such as acute epileptic seizures. Etiologies of hyponatremia include excessive intake of solute-free fluids, side-effects of medication, diseases associated with hypervolemic states such as congestive heart failure, and the syndrome of inappropriate antidiuretic hormone secretion (SIADH).
As hyponatremia can be a potentially life-threatening condition, it requires an efficient management with the goal of identifying the etiology and to subsequently provide adequate treatment, while avoiding treatment-related adverse effects such as overcorrection and pontine myelinolysis. This article summarizes the pathophysiology and differential diagnosis, as well as useful diagnostic tests and therapy of hyponatremia in a practice-oriented manner.
Publication History
Article published online:
20 October 2020
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Literatur
- 1 Beukhof CM, Hoorn EJ, Lindemans J. et al. Novel risk factors for hospital-acquired hyponatraemia: a matched case-control study. Clin Endocrinol (Oxf) 2007; 66: 367-372
- 2 Upadhyay A, Jaber BL, Madias NE. Epidemiology of hyponatremia. Semin Nephrol 2009; 29: 227-238
- 3 Wald R, Jaber BL, Pricet LL. et al. Impact of hospital-associated hyponatremia on selected outcomes. Arch Intern Med 2010; 170: 294-302
- 4 Liamis G, Rodenburg EM, Hofman A. et al. Electrolyte disorders in community subjects: prevalence and risk factors. Am J Med 2013; 126: 256-263
- 5 Sterns RH. Disorders of plasma sodium – causes, consequences, and correction. N Engl J Med 2015; 372: 55-65
- 6 Ashraf N, Locksley R, Arieff AI. Thiazide-induced hyponatremia associated with death or neurologic damage in outpatients. Am J Med 1981; 70: 1163-1168
- 7 Ayus JC, Wheeler JM, Arieff AI. Postoperative hyponatremic encephalopathy in menstruant women. Ann Intern Med 1992; 117: 891-897
- 8 Ellis SJ. Severe hyponatraemia: complications and treatment. QJ Med 1995; 88: 905-909
- 9 Ayus JC, Varon J, Arieff AI. Hyponatremia, cerebral edema, and noncardiogenic pulmonary edema in marathon runners. Ann Intern Med 2000; 132: 711-714
- 10 Moritz ML, Ayus JC. The pathophysiology and treatment of hyponatraemic encephalopathy: an update. Nephrol Dial Transplant 2003; 18: 2486-2491
- 11 Worthley LI, Thomas PD. Treatment of hyponatraemic seizures with intravenous 29.2% saline. Brit Med J (Clin Res ed.) 1986; 292: 168-170
- 12 Sterns RH. Severe symptomatic hyponatremia: treatment and outcome. A study of 64 cases. Ann Intern Med 1987; 107: 656-664
- 13 Sterns RH, Nigwekar SU, Hix JK. The treatment of hyponatremia. Semin Nephrol 2009; 29: 282-299
- 14 Spasovski G, Vanholder R, Allolio B. et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Intens Care Med 2014; 40: 320-331