Hyponatremia: Classification, Signs & Symptoms

It is defined as Serum Sodium levels when falls below 135 mEq/L which is mostly seen in medical illness like heart, kidney failures, Normal Sodium levels are 134-145 mEq/L

Classification of Hyponatremia

• Mild : 130-134 mmol/L
• Moderate 125-129 mmol/L
• Severe : <125 mmol/L

Signs & Symptoms of Hyponatremia

Headache, nausea, decreased level of consciousness, cold body temperature, nausea, dizziness, muscle cramps, lethargy.

Sub Classification : Based on Volume Status of Body

• Euvolemic hyponatremia: Sodium level will be normal but total body water will increase
• Hypovolemic hyponatremia : Decrease of body water and sodium
• Hypervolemic hyponatremia : increase sodium and total body water

Hyponatremia in Pediatrics Age Group

Clinical Features

Anorexia, Headache nausea and vomiting, weakness and muscle ache

Some critical cases present with behavioral changes, hallucinations and seizures 

Diagnostics  Studies

• Urine electrolytes and osmolality are also critical tests in the initial evaluation of hyponatremia
• Patient history and PE to check the volume status & identification of possible etiology
• Serum Osmolality
• CT & CXR is the most used to access with underlying etiology of hyponatremia

Treatment of Hyponatremia

Acute symptomatic hyponatremia: Use hypertonic saline to increase Serum sodium Na+ 1-2 mM/H  to increase 4-6 m/M increase is typically sufficient to alleviate acute symptoms from cerebral edema

Chronic hyponatremia : Na deficit = 0.6 x body weight x target of sodium – starting sodium

Oxygen is administered if patient suffer with pulmonary edema

IV Loop diuretics used to treat pulmonary edema will increase free H2O excretion by interfering with renal countercurrent multiplier system.

Management strategies depend on the severity of hyponatremia, symptoms, and underlying causes :

• Mild Hyponatremia: fluid restriction may be sufficient, Who are asymptomatic patients.
• Moderate to Severe Hyponatremia: Patients with serum sodium levels less than 120 mEq/L & Symptoms showed In this level.
  • Hypertonic Saline To raise serum sodium levels, intravenous administration of hypertonic saline (3% NaCl) may be necessary.
• Close monitoring of serum sodium is essential to prevent rapid correction, which can lead to osmotic demyelination syndrome.
• It is critical to identify and treat the underlying cause of hyponatremia, whether it involves adjusting medications, managing heart failure, or treating adrenal insufficiency.

Hyponatremia in Emergency Care

Patients with other systemic illnesses such as CNS, Pulmonary diseases; pneumonia, TB, and other carcinomas have a high risk of hyponatremia.

Clinical Features : 

• Level of alertness
• Generalized seizures
• Fixed polyps
• Sudden hypertension
• Respiratory arrest

Treatment 

• Reliable of IV Access and Oxygen support, Monitoring blood sugar 
• Anticonvulsants can be used to treat seizures
• Incubation and Hyperventilating patients may help to reduce intracranial pressure in patients who have medical conditions involving the brain stem.

Frequently Asked Questions

1. Which fluid is used to treat hyponatremia ?

Ans. Hypertonic saline 3% NaCl.

2. Which food is helpful to treat Low sodium levels  in the body ?

Ans. Seafood, Cheese, Curried meat, salty chips can be used.

3. A patient with CKD presents with hyponatremia. Which of the treatments is contraindicated?

Ans. Hypertonic saline.

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