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Related to hyponatremia: hypernatremia




The normal concentration of sodium in the blood plasma is 136-145 mM. Hyponatremia occurs when sodium falls below 130 mM. Plasma sodium levels of 125 mM or less are dangerous and can result in seizures and coma.


Sodium is an atom, or ion, that carries a single positive charge. The sodium ion may be abbreviated as Na+ or as simply Na. Sodium can occur as a salt in a crystalline solid. Sodium chloride (NaCl), sodium phosphate (Na2HPO4) and sodium bicarbonate (NaHCO3) are commonly occurring salts. These salts can be dissolved in water or in juices of various foods. Dissolving involves the complete separation of ions, such as sodium and chloride in common table salt (NaCl).
About 40% of the body's sodium is contained in bone. Approximately 2-5% occurs within organs and cells and the remaining 55% is in blood plasma and other extracellular fluids. The amount of sodium in blood plasma is typically 140 mM, a much higher amount than is found in intracellular sodium (about 5 mM). This asymmetric distribution of sodium ions is essential for human life. It makes possible proper nerve conduction, the passage of various nutrients into cells, and the maintenance of blood pressure.
The body continually regulates its handling of sodium. When dietary sodium is too high or low, the intestines and kidneys respond to adjust concentrations to normal. During the course of a day, the intestines absorb dietary sodium while the kidneys excrete a nearly equal amount of sodium into the urine. If a low sodium diet is consumed, the intestines increase their efficiency of sodium absorption, and the kidneys reduce its release into urine.
The concentration of sodium in the blood plasma depends on two things: the total amount of sodium and water in arteries, veins, and capillaries (the circulatory system). The body uses separate mechanisms to regulate sodium and water, but they work together to correct blood pressure when it is too high or too low. Too low a concentration of sodium, or hyponatremia, can be corrected either by increasing sodium or by decreasing body water. The existence of separate mechanisms that regulate sodium concentration account for the fact that there are numerous diseases that can cause hyponatremia, including diseases of the kidney, pituitary gland, and hypothalamus.

Causes and symptoms

Hyponatremia can be caused by abnormal consumption or excretion of dietary sodium or water and by diseases that impair the body's ability to regulate them. Maintenance of a low salt diet for many months or excessive sweat loss during a race on a hot day can present a challenge to the body to conserve adequate sodium levels. While these conditions alone are not likely to cause hyponatremia, it can occur under special circumstances. For example, hyponatremia often occurs in patients taking diuretic drugs who maintain a low sodium diet. This is especially of concern in elderly patients, who have a reduced ability to regulate the concentrations of various nutrients in the bloodstream. Diuretic drugs that frequently cause hyponatremia include furosemide (Lasix), bumetanide (Bumex), and most commonly, the thiazides. Diuretics enhance the excretion of sodium into the urine, with the goal of correcting high blood pressure. However, too much sodium excretion can result in hyponatremia. Usually only mild hyponatremia occurs in patients taking diuretics, but when combined with a low sodium diet or with the excessive drinking of water, severe hyponatremia can develop.
Severe and prolonged diarrhea can also cause hyponatremia. Severe diarrhea, causing the daily output of 8-10 liters of fluid from the large intestines, results in the loss of large amounts of water, sodium, and various nutrients. Some diarrheal diseases release particularly large quantities of sodium and are therefore most likely to cause hyponatremia.
Drinking excess water sometimes causes hyponatremia, because the absorption of water into the bloodstream can dilute the sodium in the blood. This cause of hyponatremia is rare, but has been found in psychotic patients who compulsively drink more than 20 liters of water per day. Excessive drinking of beer, which is mainly water and low in sodium, can also produce hyponatremia when combined with a poor diet.
Marathon running, under certain conditions, leads to hyponatremia. Races of 25-50 miles can result in the loss of great quantities (8 to 10 liters) of sweat, which contains both sodium and water. Studies show that about 30% of marathon runners experience mild hyponatremia during a race. But runners who consume only pure water during a race can develop severe hyponatremia because the drinking water dilutes the sodium in the bloodstream. Such runners may experience neurological disorders as a result of the severe hyponatremia and require emergency treatment.
Hyponatremia also develops from disorders in organs that control the body's regulation of sodium or water. The adrenal gland secretes a hormone called aldosterone that travels to the kidney, where it causes the kidney to retain sodium by not excreting it into the urine. Addison's disease causes hyponatremia as a result of low levels of aldosterone due to damage to the adrenal gland. The hypothalamus and pituitary gland are also involved in sodium regulation by making and releasing vasopressin, known as anti-diuretic hormone, into the bloodstream. Like aldosterone, vasopressin acts in the kidney, but it causes it to reduce the amount of water released into urine. With more vasopressin production, the body conserves water, resulting in a lower concentration of plasma sodium. Certain types of cancer cells produce vasopressin, leading to hyponatremia.
Symptoms of moderate hyponatremia include tiredness, disorientation, headache, muscle cramps, and nausea. Severe hyponatremia can lead to seizures and coma. These neurological symptoms are thought to result from the movement of water into brain cells, causing them to swell and disrupt their functioning.
In most cases of hyponatremia, doctors are primarily concerned with discovering the underlying disease causing the decline in plasma sodium levels. Death that occurs during hyponatremia is usually due to other features of the disease rather than to the hyponatremia itself.


Hyponatremia is diagnosed by acquiring a blood sample, preparing plasma, and using a sodium-sensitive electrode for measuring the concentration of sodium ions. Unless the cause is obvious, a variety of tests are subsequently run to determine if sodium was lost from the urine, diarrhea, or from vomiting. Tests are also used to determine abnormalities in aldosterone or vasopressin levels. The patient's diet and use of diuretics must also be considered.

Key terms

Blood plasma and serum — Blood plasma, or plasma, is prepared by obtaining a sample of blood and removing the blood cells. The red blood cells and white blood cells are removed by spinning with a centrifuge. Chemicals are added to prevent the blood's natural tendency to clot. If these chemicals include sodium, than a false measurement of plasma sodium content will result. Serum is prepared by obtaining a blood sample, allowing formation of the blood clot, and removing the clot using a centrifuge. Both plasma and serum are light yellow in color.


Severe hyponatremia can be treated by infusing a solution of 5% sodium chloride in water into the bloodstream. Moderate hyponatremia due to use of diuretics or an abnormal increase in vasopressin is often treated by instructions to drink less water each day. Hyponatremia due to adrenal gland insufficiency is treated with hormone injections.


Hyponatremia is just one manifestation of a variety of disorders. While hyponatremia can easily be corrected, the prognosis for the underlying condition that causes it varies.


Patients who take diuretic medications must be checked regularly for the development of hyponatremia.



Fried, L. F., and P. M. Palevsky. "Hyponatremia and Hypernatremia." Medical Clinics of North America 81 (1997): 585-609.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.


deficiency of sodium in the blood, considered to be present when the sodium concentration is less than 135 mEq per liter. See table of Electrolyte Imbalances at electrolyte. It can occur as a result of inadequate sodium intake, as in a sodium-restricted diet, excessive water ingestion or retention, or excessive wasting of salt. Symptoms include muscular weakness and twitching, progressing to convulsions if unrelieved; alterations in level of consciousness; mental confusion; and anxiety. When its cause is salt wasting, there is an accompanying loss of body fluids. Treatment is based on correction of the underlying cause.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.


Abnormally low concentrations of sodium ions in circulating blood.
[hypo- + natrium, + G. haima, blood]
Farlex Partner Medical Dictionary © Farlex 2012


An abnormally low plasma concentration of sodium ions.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.


↓ Sodium. See Sodium.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.


Abnormally low concentrations of sodium ions in the circulating blood.
Synonym(s): hyponatraemia.
[hypo- + natrium, + G. haima, blood]
Medical Dictionary for the Health Professions and Nursing © Farlex 2012


Abnormally low concentrations of sodium ions in circulating blood.
Synonym(s): hyponatraemia.
[hypo- + natrium, + G. haima, blood]
Medical Dictionary for the Dental Professions © Farlex 2012

Patient discussion about hyponatremia

Q. What steps do you take when your physician says your sodium is low

A. Drugs That May Be Prescribed By Your Doctor for Hyponatremia(low sodium):

Sodium levels must be corrected carefully. If your blood test results indicate you have a very low sodium level, your healthcare provider will cautiously correct the levels, to a "safe level."

Intravenous (IV) fluids with a high-concentration of sodium, and/or diuretics to raise your blood sodium levels.

Loop Diuretics - also known as "water pills" as they work to raise blood sodium levels, by making you urinate out extra fluid. The fluid that is lost (called "free water") is usually replaced with an IV solution that contains a high level of sodium.

A common example of this type of medication is Furosemide (e.g Lasix). You may receive this medication alone or in combination with other medications.

More discussions about hyponatremia
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References in periodicals archive ?
(2,15) Jimenez's criteria include hyponatremia (plasma Na<130 mEq/L), increased urine sodium level (>120 mEq/L), increased urinary osmolarity (>300 mOsm/kg[H.sub.2]O), increased urine volume (>3 mL/kg/h), and negative liquid balance in the last 24 hours.
Tolvaptan has been approved by the FDA for adults since 2009 and has been successfully used in the treatment of hyponatremia due to SIADH and autosomal dominant polycystic kidney disease (1,9,11,12).
Acute hyponatremia poses an immediate danger to the central nervous system.
(16) The primary theory for the decreased incidence of SIADH with use of atypical antipsychotics is related to decreased rates of psychogenic polydipsia leading to lower incidence of hyponatremia.
Experts advise that anyone who develops severe signs and symptoms of hyponatremia should seek immediate emergency care.
A total of 100 patients with hyponatremia (serum [Na.sup.+][less than or equal to]130 mEq/L) were included in the study.
Supplemental Table 1: this table provides the clinical characteristics, LOS, and mortality of cirrhotic patients in the Hyponatremia Registry.
SIADH is defined as euvolemic hypotonic hyponatremia (serum sodium level of less than 135mmol/L), inappropriately elevated urine osmolality (usually more than 200 mmol/kg) relative to plasma osmolality, and an elevated urine sodium level (typically greater than 20 mmol/L) with normal renal, adrenal, and thyroid functions.
Additionally, hyponatremia which responded moderately to fluid restriction gradually normalized after the onset of metabolic alkalosis (Figure 2).
In the article titled "Amiodarone Induced Hyponatremia Masquerading as Syndrome of Inappropriate Antidiuretic Hormone Secretion by Anaplastic Carcinoma of Prostate" [1], the discussion section was similar to that of Pham et al.