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A new look at an old problem: therapy of chronic hyponatremia

Nature Clinical Practice Nephrology volume 3, pages 2–3 (2007)Cite this article

There is general agreement that the rate of correction of plasma sodium (Na+) concentration (PNa) in patients with chronic hyponatremia should be slow; nevertheless, some patients still develop osmotic demyelination. As hyponatremia is not a specific disease, evidence for appropriate correction rates was gathered from a heterogeneous population, in which only very obvious cases of osmotic demyelination were diagnosed. Thus the proposed rates of correction should be considered as upper limits rather than targets, recognizing that the initial PNa might not be a steady-state value (e.g. the brachial venous PNa can temporarily rise by ∼10 mmol/l after a seizure).1 In addition, the brachial venous PNa might not reflect the arterial PNa to which the brain is exposed.2 The rise in PNa and subsequent osmotic demyelination usually occurs as a result of a large negative water balance; therefore, a water diuresis must be avoided.

If a patient with chronic hyponatremia presents with severe symptoms (e.g. a seizure), the clinician should suspect that an element of acute hyponatremia, and/or an underlying central nervous system disorder, is present. This raises two opposing issues for therapy: first, an immediate danger from the high intracranial pressure, and second, osmotic demyelination because of an overly rapid rise in PNa.

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Authors and Affiliations

  1. ML Halperin is Emeritus Professor of Medicine at the University of Toronto and Head of the Division of Nephrology at St Michael's Hospital, Toronto, ON, Canada.,

    Mitchell L Halperin

  2. KS Kamel is Professor of Medicine at the University of Toronto and Head of the Division of Nephrology at St Michael's Hospital, Toronto, ON, Canada.,

    Kamel S Kamel

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  1. Mitchell L Halperin
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  2. Kamel S Kamel
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Correspondence to Mitchell L Halperin.

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The authors declare no competing financial interests.

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Halperin, M., Kamel, K. A new look at an old problem: therapy of chronic hyponatremia. Nat Rev Nephrol 3, 2–3 (2007). https://doi.org/10.1038/ncpneph0375

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