Disorders of sodium balance

doi:10.1136/bmj.332.7543.702

BMJ 2006;332:702-705 (25 March), doi:10.1136/bmj.332.7543.702

Clinical review

Disorders of sodium balance

Rebecca M Reynolds, senior lecturer in endocrinology and diabetes¹, Paul L Padfield, consultant physician², Jonathan R Seckl, Moncrieff-Arnott professor of molecular medicine¹

¹ Endocrinology Unit, Centre for Cardiovascular Sciences, University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, ² Metabolic Unit, Western General Hospital, Edinburgh EH4 2XU

Correspondence to: J R Seckl j.seckl@ed.ac.uk

The first 150 words of the full text of this article appear below.

Introduction

Disorders of plasma sodium are the most common electrolyte disturbancesin clinical medicine, yet they remain poorly understood. Severehyponatraemia and hypernatraemia are associated with considerablemorbidity and mortality,^1-3 however, and even mild hyponatraemiais associated with worse outcomes when it complicates conditionssuch as heart failure,⁴ although which is cause and which effectis often uncertain. Distinguishing the cause(s) of hyponatraemiamay be challenging in clinical practice, and controversies surroundingits management remain. Here, we describe the common causes ofdisorders of plasma sodium, offer guides to their investigationand management, and highlight areas of recent advance and ofuncertainty.

Sources and selection criteria

We incorporated the latest consensus from systematic reviewsand publications identified by a literature search through Medlineand Web of Science with the search strategy terms "hyponatraemia,""hypernatraemia," and "sodium." We found fewer than a dozenrandomised controlled trials of treatment of any description.Despite their frequency, plasma sodium . . . [Full text of this article]

Control of sodium balance

Hyponatraemia

History, examination, and investigation
Management of hyponatraemia
New developments for management of hyponatraemia

Hypernatraemia

History, examination, and investigation
Management

Final thoughts

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Hyponatraemia and hypernatraemia: pitfalls in testing: W Stuart A Smellie and A Heald
BMJ 2007 334: 473-476. [Extract] [Full Text] [PDF]

Hit parade
BMJ 2006 332: 1100. [Extract] [Full Text]

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BMJ 2006 332: 853. [Extract] [Full Text]

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Disorders of sodium balance: Hypothyroidism and hyponatraemia: an old wives' tale?: Eric S Kilpatrick
BMJ 2006 332: 854. [Extract] [Full Text]

Disorders of sodium balance: Management of hypernatraemic dehydration differs in children: Jarlath McAloon
BMJ 2006 332: 854. [Extract] [Full Text]

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Rapid Responses:

Read all Rapid Responses

Hyponatremia and the "TUR" syndrome: William H Konarzewski
bmj.com, 24 Mar 2006 [Full text]
Hypothyroidism and hyponatraemia: an old wives' tale?: Eric S. Kilpatrick
bmj.com, 27 Mar 2006 [Full text]
Iatrogenic hyponatraemia- vital learning point: jane e milton
bmj.com, 27 Mar 2006 [Full text]
Hypernatraemic Dehydration in Children, management differs: Jarlath McAloon
bmj.com, 28 Mar 2006 [Full text]
Teaching Hyponatraemia: Robert Lord
bmj.com, 28 Mar 2006 [Full text]
Iatrogenic hyponatraemia: John A W Wildsmith
bmj.com, 28 Mar 2006 [Full text]
Hyponatreamia and drug use (and abuse): Gerard McDade
bmj.com, 28 Mar 2006 [Full text]
Pseudohyponatraemia: Forgotten but not gone?: William G Simpson, et al.
bmj.com, 29 Mar 2006 [Full text]
Re: Iatrogenic hyponatraemia - 3 litres a day is not too much!: William H Konarzewski
bmj.com, 29 Mar 2006 [Full text]
There is some guidance: Kolja Stille
bmj.com, 31 Mar 2006 [Full text]
Treatment of Hypernatraemia: Anthony O Oke
bmj.com, 1 Apr 2006 [Full text]
Causes of Hyponatraemia: Hannah L Delaney, et al.
bmj.com, 11 Apr 2006 [Full text]
Cerebral Salt Wasting Syndrome: Martin M Tisdall, et al.
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Dysnatraemia: Balance or Concentration?: Eric J Will
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Disorders of Sodium "concentration": Gerardo O. Mogni
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Re: disorders of sodium concentration: Richard G Fiddian-Green
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