Hyponatremia natural history, complications and prognosis

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

Overview

If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

Natural History, Complications, and Prognosis

Natural History

  • acute hyponatraemia, the main pathological consequence is the development of cerebral edema, which leads to raised intracranial pressure with the risk of cerebral herniation,hypoxia and even death [1].
  • The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.
  • The symptoms of (disease name) typically develop ___ years after exposure to ___.
  • If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

Complications

Hyponatremic Encephalopathy :

Osmotic Demyelination :Hyponatremia, serum sodium < 135 mEq/L, causes brain edema due to shift of water from extracellular in to the brain cells. In the next 24 to 48 hours, brain starts to compensate by excreting solutes and water. If serum sodium is corrected too rapidly, brain cells do not have time to replace the solutes which results in dehydration of the brain cells and osmotic demyelination syndrome [2].

Signs and symptoms of ODS
  • Change in mental status
  • Dysphagia
  • Reduced attention span
  • Loss of memory
  • Rapid development of quadriparesis
  • Dysarthria
  • Reduced speed of processing information
  • Ataxia and Parkinson-like symptoms

Risk of developing Osmotic Demyelination Syndrome:

  • Serum sodium concentration ≤105 mmol/L
  • Hypokalemia
  • Alcoholism
  • Malnutrition
  • Advanced liver disease

Brain herniation :In acute hyponatremia, if the brain adaptation to hyponatremia is impaired especially solute excretion of brain cells to achieve osmotic equilibrium, it causes brain cells swelling, increased intracranial pressure, cerebral edema, and eventual tentorial herniation [3].

Hyponatremia, even chronic mild causes osteoporosis, fall and hip fracture.[4]

Prognosis

  • Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
  • Depending on the extent of the [tumor/disease progression/etc.] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.
  • The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].
  • [Subtype of disease/malignancy] is associated with the most favorable prognosis.
  • The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.

References

  1. S. J. Ellis (1995). "Severe hyponatraemia: complications and treatment". QJM : monthly journal of the Association of Physicians. 88 (12): 905–909. PMID 8593551. Unknown parameter |month= ignored (help)
  2. King, Joshua D.; Rosner, Mitchell H. (2010). "Osmotic Demyelination Syndrome". The American Journal of the Medical Sciences. 339 (6): 561–567. doi:10.1097/MAJ.0b013e3181d3cd78. ISSN 0002-9629.
  3. A. I. Arieff, F. Llach & S. G. Massry (1976). "Neurological manifestations and morbidity of hyponatremia: correlation with brain water and electrolytes". Medicine. 55 (2): 121–129. PMID 1256311. Unknown parameter |month= ignored (help)
  4. Benoit Renneboog, Wim Musch, Xavier Vandemergel, Mario U. Manto & Guy Decaux (2006). "Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits". The American journal of medicine. 119 (1): 71. doi:10.1016/j.amjmed.2005.09.026. PMID 16431193. Unknown parameter |month= ignored (help)

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