Hyponatremia history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Saeedeh Kowsarnia M.D.[2]

Overview

Symptoms associated with hyponatremia are caused mostly by impairment of brain function. There is a spectrum of signs from no detectable presentation to death. To evaluate the causes of hyponatremia, careful history has to be taken. Drug history and past medical history can lead to the most common causes of hyponatremia.

History and Symptoms

Drug history
Diet history
History of volume loss: Diarrhea, vomiting
History of decreased urine output
Chronic illnesses: CHF, RF
History of endocrine disorders
History of malignancy
History of infectious diseases
History of psychiatric illnesses
History of diagnostic procedures or operations
History of blood disorders
History of CNS disorders
History of pulmonary diseases
History of genetic diseases: Hyperlipidemia, nephrogenic SIAD, RTA
History of diabetes
History of GI disorders

To see the different causes of hyponatremia, click here.

Common Symptoms

The clinical signs and symptoms of hyponatremia are related to the degree of brain compensation to hypoosmolarity. Development of cerebral edema, increased intracerebral pressure and cerebral hypoxia are responsible for hyponatremia presentation. Also see the complications of hyponatremia.

Asymptomatic
Acute neurologic changes: seizures, altered mental status, coma , focal neurologic signs like one-sided facial droop, opposite-sided hemiparesis, dysarthria and aphasia in hyperacute hyponatremia. ^[1]

Moderate symptoms
- Nausea
- Malaise
- Headache
- Confusion
- Loss of energy and fatigue
- Restlessness and irritability
- Muscle weakness, spasms or cramps
- Fatigue
- Lethargy
- Dizziness
- Gait disturbances
- Forgetfulness

Severe
- Vomiting
- Cardio-respiratory distress
- Abnormal and deep somnolence
- Seizures ^[2]
- Coma (Glasgow Coma Scale 8)
- Delirium
- Impaired consciousness

Mild chronic hyponatremia (plasma sodium 125–135 mEq/L) may cause subtle neurocognitive deficits that can be detected by careful testing ,these deficits improve when the plasma sodium is normalized.^[3]
COVID-19 pneumonia patients have been found to develop SIADH and severe hyponatremia in some cases causing seizures. ^[2]

Less Common Symptoms

Cardiorespiratory arrest

References

↑ Balbi, Alanna; Sadowski, Jennifer A.; Torrens, Daniel; Jacoby, Jeanne L.; Yacoub, Hussam A.; Eygnor, Jessica K. (2021). “Hyperacute hyponatremia mimicking acute ischemic stroke: A case report”. The American Journal of Emergency Medicine. doi:10.1016/j.ajem.2021.07.017. ISSN 0735-6757.
↑ ^2.0 ^2.1 Habib, Mhd Baraa; Hamad, Mohammad Khair; Kalash, Tarif; Ahmed, Ashraf; Mohamed, Mouhand F (2021). “COVID-19 Pneumonia Complicated by Seizure Due to Severe Hyponatremia”. Cureus. doi:10.7759/cureus.15603. ISSN 2168-8184.
↑ F. C. Bartter & W. B. Schwartz (1967). “The syndrome of inappropriate secretion of antidiuretic hormone”. The American journal of medicine. 42 (5): 790–806. PMID 5337379. Unknown parameter |month= ignored (help)

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[BalbiSadowski2021-1] Balbi, Alanna; Sadowski, Jennifer A.; Torrens, Daniel; Jacoby, Jeanne L.; Yacoub, Hussam A.; Eygnor, Jessica K. (2021). “Hyperacute hyponatremia mimicking acute ischemic stroke: A case report”. The American Journal of Emergency Medicine. doi:10.1016/j.ajem.2021.07.017. ISSN 0735-6757.

[HabibHamad2021-2] 2.0 ^2.1 Habib, Mhd Baraa; Hamad, Mohammad Khair; Kalash, Tarif; Ahmed, Ashraf; Mohamed, Mouhand F (2021). “COVID-19 Pneumonia Complicated by Seizure Due to Severe Hyponatremia”. Cureus. doi:10.7759/cureus.15603. ISSN 2168-8184.

[3] F. C. Bartter & W. B. Schwartz (1967). “The syndrome of inappropriate secretion of antidiuretic hormone”. The American journal of medicine. 42 (5): 790–806. PMID 5337379. Unknown parameter |month= ignored (help)

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