HYPONATREMIA - FOCUS ON THERAPY

Hyponatremia can be a serious medical problem, and severe hyponatremia can be a medical emergency. Nevertheless, considerable controversy re mains with respect to the best way to avoid the important sequelae of hyponatremia, while minimizing the complications of its treatment. Unq uestionably, severe hyponatremia may cause life-threatening and/or per manent neurologic abnormalities. The risk of these untoward events, ho wever, is much greater with acute than with chronic hyponatremia. The adaptive changes in the brain that reduce the hazards of a low serum s odium concentration for patients with chronic hyponatremia increase th e risk for therapy-induced central pontine myelinolysis. In general, a cute, symptomatic hyponatremia should be corrected more rapidly than c hronic hyponatremia, at least until severe symptoms abate. Detailed gu idelines are provided for the management of acute and chronic hyponatr emia. But regardless of guidelines, therapy must be individualized, wi th adjustments based on frequent assessments of clinical condition and laboratory data.