Figure 128

Management of noneuvolemic hyponatremia. Hypovolemic hyponatremia results from the loss of both water and solute, with relatively greater loss of solute. The nonosmotic release of antidi-uretic hormone stimulated by decreased arterial circulating blood volume causes antidiuresis and perpetuates the hyponatremia. Most of these patients are asymptomatic. The keystone of therapy is isotonic saline administration, which corrects the hypovolemia and removes the stimulus of antidiuretic hormone to retain fluid. Hypervolemic hyponatremia occurs when both solute and water are increased, but water more than solute. This occurs with heart failure, cirrhosis and nephrotic syndrome. The cornerstones of treatment include fluid restriction, salt restriction, and loop diuretics [20]. (Adapted from Lauriat and Berl [20]; with permission.)

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