Hyponatremia: Mechanisms and Newer Treatments |
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| Affiliation: | 1. Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark;2. Department of Endocrinology, Amager and Hvidovre University Hospital, Copenhagen, Denmark;3. Copenhagen General Practitioners Laboratory, Copenhagen, Denmark;4. Faculty of Health and Medical Sciences, University of Copenhagen, Denmark;5. Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark;6. National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark;7. Department of Endocrinology, Herlev University Hospital, Herlev, Denmark;1. Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany;2. Department for Experimental and Clinical Biomedical Sciences “Mario Serio,” University of Florence, Italy;3. Institute of Medical Statistics and Computational Biology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany |
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| Abstract: | ObjectiveTo review the neural and renal mechanisms of osmotic homeostasis, provide a rationale for the sensitivity of the central nervous system to hyponatremia, and outline modern approaches to therapy of acute and chronic hyponatremia.MethodsReview of relevant literature with focus on physiologic mechanisms.ResultsWith careful monitoring, acute hyponatremia can be managed, while minimizing risks both of continued hyponatremia and the osmotic demyelination that can occur with overly rapid correction of severe hyponatremia. Chronic hyponatremia due to disorders of volume regulation (congestive heart failure or cirrhosis) or to syndrome of inappropriate antidiuretic hormone release can be managed effectively with vasopressin V2 receptor antagonists, but there is no evidence that controlling the hyponatremia enhances survival associated with the underlying diseases.ConclusionsTherapy in the acute setting balances the risk of the osmotic disturbance with the risk of overly rapid correction. The V2 receptor antagonist tolvaptan has enhanced our ability to improve chronic hyponatremia in conditions such as congestive heart failure, cirrhosis, and syndrome of inappropriate antidiuretic hormone hypersecretion. (Endocr Pract. 2010;16:882-887) |
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