European societies release guideline on diagnosis, treatment of hyponatremia
Three European societies recently released a clinical practice guideline on the diagnosis and treatment of hyponatremia.
Three European societies recently released a clinical practice guideline on the diagnosis and treatment of hyponatremia.
The guideline, which was developed by the European Society of Intensive Care Medicine, the European Society of Endocrinology, and the European Renal Association-European Dialysis and Transplant Association, focused on diagnosis and treatment of hyponatremia in adults and is intended to support clinical decision making in all health care professionals caring for inpatients and outpatients with this disorder. The guideline steering committee developed clinical questions about the diagnosis and differential diagnosis of hyponatremia, as well as acute and chronic treatment of hypotonic hyponatremia. Overall evidence for the guideline recommendations was graded from A, or high, to D, or very low, and recommendations were classified as strong (1) or weak (2). The guideline was published online by the European Journal of Endocrinology.
The guideline defined mild hyponatremia as a serum sodium concentration between 130 and 135 mmol/L, moderate hyponatremia as a serum sodium concentration between 125 and 129 mmol/L, and profound hyponatremia as a serum sodium concentration less than 125 mmol/L. Acute hyponatremia was defined as that existing less than 48 hours, and chronic hyponatremia was defined as that existing for at least 48 hours. The guideline defined moderately symptomatic hyponatremia as “any biochemical degree of hyponatremia in the presence of moderately severe symptoms of hyponatremia” and severely symptomatic hyponatremia as “any biochemical degree of hyponatremia in the presence of severe symptoms of hyponatremia.”
In addition to recommendations on diagnosis, the guideline offered detailed recommendations for first-hour and follow-up management of acute or chronic hyponatremia with severe symptoms, as well as diagnostic assessment and treatment recommendations for hyponatremia with moderately severe symptoms and acute hyponatremia without severe or moderately severe symptoms. Recommendations on general management of chronic hyponatremia without severe or moderately severe symptoms were also given, along with recommendations for managing this disorder in patients with expanded extracellular fluid, patients with syndrome of inappropriate antidiuresis, and patients with reduced circulating volume. The guideline also offered recommendations on what clinicians can do if hyponatremia is corrected too rapidly.
The complete guideline, which includes algorithms for diagnosis and management, is available free of charge online.