Figure 717

Hyponatremia pathogenesis in AIDS. Single and mixed acid-base disturbances, as well as all types of electrolyte disorders, can be observed in patients with AIDS. These disturbances and disorders develop spontaneously in patients with complications of AIDS or follow pharmacologic interventions and usually are not associated with structural lesions in the kidneys unless renal failure also is present. Hyponatremia is the most prevalent electrolyte abnormality, occurring in 36% to 56% of patients hospitalized with AIDS [118-122]. In the absence of an evident source of fluid loss, volume depletion may be related to renal sodium wasting as a result of Addison's disease or hyporeninemic hypoaldosteronism [123-125]. In euvolemic patients, hyponatremia is compatible with nonosmolar inappropriate secretion of antidiuretic hormone [120,121,126]. Hyponatremia in patients with hypervolemia is dilutional in origin as a result of excessive free water intake in a context of renal insufficiency [122].

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