Hiponatremia: patogenia, diagnóstico y tratamiento
Resumen
La hiponatremia es quizás el trastorno electrolítico mas frecuente, habitualmente es asintomática y tiene una evolución autolimitada.
La Hiponatremia es una condición comunmente observada en las Unidades de Cuidados Intensivos. Esta ocUirre cuando la concentración plasmática de sodio,
es menor de 135 mEq 1.
El Manejo adecuado depende de la causa subyacente, dé manera que un conocimiento completo de la patogenia es necesario para el diagnóstico y tratamiento correcto.
Este artículo hace una revisión fisiopatológica en profulldidad, analizando las diferentes causas de hiponatrehiia, cpn énfasis en la secreción inadecuada de Hormona Antidiurética (SIH.\D) y la complicación de su manejo la Mielinolisis Pónlica Central (MFC).
Palabras Claves: Hiponatremia. Secreción Inadecuada de Hormona Antidiurética. SIMAD, Mielinolisis Póntica CentraL MPC.
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Incorporated, 22-43, 1968.
2. Black RM Diagnosis and Management of Hyponatremia. J Intensiva care Medicine 1989; 4: 205-220.
3. Buckalew VM: Hiponatremia: patogenia y tratamiento. Hospital Practice (Esp) 2:51-58, 1987.
4. Goldstein MB. Hyponatremia. in Taylor (ed): Difficult Medical Management, Philadelphia, W.B. Saunders Company 1991 341-347.
5. Dixon BS, Berl T. Hyponatremia, in Glassock (ed): Current Therapy in Nephrology and Hypertension 1984-1985, Philadelphia, B.C. Decker Inc, 7-13, 1984.
6. Black RM: Disorders of Plasma Soidum and Plasma potassium,in Rippe JM, Irwin RS, Alpert JS, Fink MP, (Bds),Intensive Care Medicine, 2ed. Boston, Little Brown and Company, 795-810, 1991.
7. Rose B; Hypoosmolal states-hyponatremia, in Rose Bd (ed) Clinical Physiology of Acid-Base and Electrolyte Disorders. New York, NcGraw-Hill, 601-1989.
8. Weisberg LS. Pseudohyponatremia: a reappraisal. Am J. Med 86: 315-318, 1989.
9. Sunderrajan s, Bauer JH, Vopat RI, et al. Posttranurethral prostatic resection hyponatremic syndrome. Case report and review of the literatura. Am J Kid Dis; 4:80-84, 1984.
10. Ashouri Os. Severe diuretic-induced Hyponatremia in the eldery. Arch Intern Med; 146: 1355-1357, 1986.
11. Rose BD. Clinical use of diuretics. In Brenner Bm, Stein JH, (eds): Body fluid homeostasis. New York: Churchill Livingstone, 409-454, 1987.
12. Skowsky WR, Kijuchi TA. The role of vasopressin in the impaired water excretion of mixedema. Am J Med; 64: 613-621, 1978.
13. Linas SL, Berl, Robertson GL, et al. Role of vasopressin in impaired water excretion of glucocorticoid deficiency. Kid Int; 18:58-67, 1980.
14. Lingbeil CK, Kleil LC, Chang D, et al. Effects of CRF and ANG II on ACTH and vasopressin reléase in connscious dogs. Am J Physiol; 255:E46-E53; 1988.
15. Dubovsky R, Goldberg M. Syndrome of inappropiate antidiuretic hormone with exacerbated psychosis. Ann Int Med; 79:551-555, 1973.
16. Gennari F , Kassirer J Osmotic diuresis, N Engl J Med; 291:714-719, 1974.
17. Hariprased M. Hyponatremia in psychogenic polidipsia, Arch Inter Med; 140: 1639-1649, 1980.
18. Schier R. Pathogenesis of sodium and water retention in high output and low output cardiac failure, nephrotic syndrome, cirrhosis and pregnancy, N Engl J Med; 140: 1639-1649, 1980.
19. Mann J F E , Johnson AK, Canten U, Ritz E. Thrist and the renin angiotensin system. Kidney Int; 32: (suppl 21): S27-S34, 1987.
20. Berry P. Hiponatremia, Clínicas Pediátricas de Norteamérica; 2:263-378, 1990.
21. Sterns R, Riggs J . Osmotic demyelination syndrome following correction of hyponatremia, N Engl J Med; 314: 1635-1541, 1986.
22. Kaplan SL, Fergin RD. Syndrome of inaproppiate antidiuretic hormone in children, Ady Pediatr; 27:247-255, 1980.
23. Maldonado M. inapropiate antidiuretic hormone secretion of unknown origin. Kidney Inte; 17 :554-562, 1980.
24. Vokes TJ, Robertson GL. Disorders of antidiuretic hormone, Endocrinol metab Clin North Am; 17:554, 1988.
25. Robertson GL, Aycinena P, Zerbe RL. Neurogenics disorders of osmoregulation, Am J Med ;72:339-353,1982.
26. Kusano E , Brawn-Werness J L , Vick DJ, et al. Chlrpropamide action on renal concentration mechanism in rats with hipothalamic diabetes insipidus. J Clin Invest; 72: 1298-1313, 1983.
27. Rose BD, Black RM. Manual of clinical problems in nephrology. Boston: Little, Brown, 3-10, 1983.
28. De Franzo R, Goldberg M. Normal diluting capacity in hyponatremic patients: reset osmostat or a variant of SIADH, Ann Inter Med; 84:538-542, 1976.
29. Melton J , Patlak C, Pettigrew K, et al. Volumen regulatory loss of Na, Cl, and K from rat brain during hyponatremia Am J Physiol; 252 :F661, 1987.
30. Arieff AI. Osmotic failure: physiology and strategies for treatment. Hosp Pract; 23:173-178, 1988.
31. Verbalis JG, Dutarosky MD. Adaptation to chronic hyoosmolality in rats. Kidney Int 34:351-360, 1988.
32. Arieff AI. Hyponatremia, convulsions, respiratory arrest and permanent brain damage after elective surgery in helathy women, N Engl J Med; 314:1529-1533, 1986.
33. Ayus JC, Arieff AI. Symptomatic hyponatremia: correcting sodium déficits safely. The Journal of Criticall Hiñes; 5:905-918, 1990.
34. Sterns RH. Severe symptomatic hyponatremia: treatment and outcome. A study of 64 cases. Ann Intern Med; 107:656-664, 1987.
35. Ayus JC, Krothapalli RK, Armstrong DL. Rapid correction of severe hyponatremia in the rat: Histopathological changes in the brain. Am J Physiol; 17 F711-F719,
1985.
36. Ayus JC, Krothapalli RK: Symptomatic hyponatremia in rats: Effect of treatment on mortality and brain lesions. Am J Physiol 26:F18-F22, 1989.
37. Arieff AI, Llach F, Massry SG. Neurologic manifestations and morbidity of hyponatremia: Correlation with brain water and electrolytes. Medicine (Baltimore); 55; 121-129, 1976.
38. Ayus JC, Krothapolli RK, Arieff AI. Treatment of symp- 45. tomatic hyponatremia and its relation to brain damage: a prospective study. N Engl J Med; 317:1190-195, 1987.
39. Laureno R, Karp BI., Pontine and extrapontine myelino- 46. lysis following rapid correction of hyponatremia. Lancet; 1:1439-1440, 1988.
40. Sterns R, Thomas D. Rapid correction of hyponatremia: 47. risk without benefit. Kidney Int; 33:210 (abs), 1988.
41. Tien R, Arieff A: Hyponatremic encephalopathy: Is central pontine myelinolysis a component?. The American J of Med; 92:513-517, 1992. 48.
42. Sterns R: The treatment of hyponatremia: first, do no harm. The Amer J of Med; 78:897-901, 1985.
43. Brummer, Redmond, huggar: Central pontine myelino- 49. lysis lesions after correction of hyponatremia. Ann Neurol; 27:6-12, 1991.
44. Aye C Radha K: Changing concepts in treatment of severe symptomatic hyponatremia. The American J of Med.; 78 897-892, 1985.
45.Man S, Hug J, Carroll m: Disorders of sodium metabolism; hypernatremia and hyponatremia, Critical Care; 20:194, 1992.
46.Worthley LI, Thomas PD. Treatment of hyponatremic seizures with intravenous 29.2 o/o saline. Br Med J; 292: 168-170, 1986.
47.Wijdicks EF, Vermeulen M, Hijdra A, et al. Hyponatremia and cerebral infarction in patients with ruptured intracranial aneurysms: is fluid restriction harmful?. Ann Neurol; 17:137-140,1985.
48.Ashouri OS. Severe diuretic-induced hyponatremia in the eldery: A series of eight patients. Arch Intern Med: 146:1355-1357, 1986.
49.Decaux G, nger J, Brimioulle, et al. Hyponatremia in the syndrome of inappropiate secretion of antidiuretic hormone. Rapid corection with urea, sodium chloride, and water restriction therapy. JAMA; 247:471-474, 1982.
Incorporated, 22-43, 1968.
2. Black RM Diagnosis and Management of Hyponatremia. J Intensiva care Medicine 1989; 4: 205-220.
3. Buckalew VM: Hiponatremia: patogenia y tratamiento. Hospital Practice (Esp) 2:51-58, 1987.
4. Goldstein MB. Hyponatremia. in Taylor (ed): Difficult Medical Management, Philadelphia, W.B. Saunders Company 1991 341-347.
5. Dixon BS, Berl T. Hyponatremia, in Glassock (ed): Current Therapy in Nephrology and Hypertension 1984-1985, Philadelphia, B.C. Decker Inc, 7-13, 1984.
6. Black RM: Disorders of Plasma Soidum and Plasma potassium,in Rippe JM, Irwin RS, Alpert JS, Fink MP, (Bds),Intensive Care Medicine, 2ed. Boston, Little Brown and Company, 795-810, 1991.
7. Rose B; Hypoosmolal states-hyponatremia, in Rose Bd (ed) Clinical Physiology of Acid-Base and Electrolyte Disorders. New York, NcGraw-Hill, 601-1989.
8. Weisberg LS. Pseudohyponatremia: a reappraisal. Am J. Med 86: 315-318, 1989.
9. Sunderrajan s, Bauer JH, Vopat RI, et al. Posttranurethral prostatic resection hyponatremic syndrome. Case report and review of the literatura. Am J Kid Dis; 4:80-84, 1984.
10. Ashouri Os. Severe diuretic-induced Hyponatremia in the eldery. Arch Intern Med; 146: 1355-1357, 1986.
11. Rose BD. Clinical use of diuretics. In Brenner Bm, Stein JH, (eds): Body fluid homeostasis. New York: Churchill Livingstone, 409-454, 1987.
12. Skowsky WR, Kijuchi TA. The role of vasopressin in the impaired water excretion of mixedema. Am J Med; 64: 613-621, 1978.
13. Linas SL, Berl, Robertson GL, et al. Role of vasopressin in impaired water excretion of glucocorticoid deficiency. Kid Int; 18:58-67, 1980.
14. Lingbeil CK, Kleil LC, Chang D, et al. Effects of CRF and ANG II on ACTH and vasopressin reléase in connscious dogs. Am J Physiol; 255:E46-E53; 1988.
15. Dubovsky R, Goldberg M. Syndrome of inappropiate antidiuretic hormone with exacerbated psychosis. Ann Int Med; 79:551-555, 1973.
16. Gennari F , Kassirer J Osmotic diuresis, N Engl J Med; 291:714-719, 1974.
17. Hariprased M. Hyponatremia in psychogenic polidipsia, Arch Inter Med; 140: 1639-1649, 1980.
18. Schier R. Pathogenesis of sodium and water retention in high output and low output cardiac failure, nephrotic syndrome, cirrhosis and pregnancy, N Engl J Med; 140: 1639-1649, 1980.
19. Mann J F E , Johnson AK, Canten U, Ritz E. Thrist and the renin angiotensin system. Kidney Int; 32: (suppl 21): S27-S34, 1987.
20. Berry P. Hiponatremia, Clínicas Pediátricas de Norteamérica; 2:263-378, 1990.
21. Sterns R, Riggs J . Osmotic demyelination syndrome following correction of hyponatremia, N Engl J Med; 314: 1635-1541, 1986.
22. Kaplan SL, Fergin RD. Syndrome of inaproppiate antidiuretic hormone in children, Ady Pediatr; 27:247-255, 1980.
23. Maldonado M. inapropiate antidiuretic hormone secretion of unknown origin. Kidney Inte; 17 :554-562, 1980.
24. Vokes TJ, Robertson GL. Disorders of antidiuretic hormone, Endocrinol metab Clin North Am; 17:554, 1988.
25. Robertson GL, Aycinena P, Zerbe RL. Neurogenics disorders of osmoregulation, Am J Med ;72:339-353,1982.
26. Kusano E , Brawn-Werness J L , Vick DJ, et al. Chlrpropamide action on renal concentration mechanism in rats with hipothalamic diabetes insipidus. J Clin Invest; 72: 1298-1313, 1983.
27. Rose BD, Black RM. Manual of clinical problems in nephrology. Boston: Little, Brown, 3-10, 1983.
28. De Franzo R, Goldberg M. Normal diluting capacity in hyponatremic patients: reset osmostat or a variant of SIADH, Ann Inter Med; 84:538-542, 1976.
29. Melton J , Patlak C, Pettigrew K, et al. Volumen regulatory loss of Na, Cl, and K from rat brain during hyponatremia Am J Physiol; 252 :F661, 1987.
30. Arieff AI. Osmotic failure: physiology and strategies for treatment. Hosp Pract; 23:173-178, 1988.
31. Verbalis JG, Dutarosky MD. Adaptation to chronic hyoosmolality in rats. Kidney Int 34:351-360, 1988.
32. Arieff AI. Hyponatremia, convulsions, respiratory arrest and permanent brain damage after elective surgery in helathy women, N Engl J Med; 314:1529-1533, 1986.
33. Ayus JC, Arieff AI. Symptomatic hyponatremia: correcting sodium déficits safely. The Journal of Criticall Hiñes; 5:905-918, 1990.
34. Sterns RH. Severe symptomatic hyponatremia: treatment and outcome. A study of 64 cases. Ann Intern Med; 107:656-664, 1987.
35. Ayus JC, Krothapalli RK, Armstrong DL. Rapid correction of severe hyponatremia in the rat: Histopathological changes in the brain. Am J Physiol; 17 F711-F719,
1985.
36. Ayus JC, Krothapalli RK: Symptomatic hyponatremia in rats: Effect of treatment on mortality and brain lesions. Am J Physiol 26:F18-F22, 1989.
37. Arieff AI, Llach F, Massry SG. Neurologic manifestations and morbidity of hyponatremia: Correlation with brain water and electrolytes. Medicine (Baltimore); 55; 121-129, 1976.
38. Ayus JC, Krothapolli RK, Arieff AI. Treatment of symp- 45. tomatic hyponatremia and its relation to brain damage: a prospective study. N Engl J Med; 317:1190-195, 1987.
39. Laureno R, Karp BI., Pontine and extrapontine myelino- 46. lysis following rapid correction of hyponatremia. Lancet; 1:1439-1440, 1988.
40. Sterns R, Thomas D. Rapid correction of hyponatremia: 47. risk without benefit. Kidney Int; 33:210 (abs), 1988.
41. Tien R, Arieff A: Hyponatremic encephalopathy: Is central pontine myelinolysis a component?. The American J of Med; 92:513-517, 1992. 48.
42. Sterns R: The treatment of hyponatremia: first, do no harm. The Amer J of Med; 78:897-901, 1985.
43. Brummer, Redmond, huggar: Central pontine myelino- 49. lysis lesions after correction of hyponatremia. Ann Neurol; 27:6-12, 1991.
44. Aye C Radha K: Changing concepts in treatment of severe symptomatic hyponatremia. The American J of Med.; 78 897-892, 1985.
45.Man S, Hug J, Carroll m: Disorders of sodium metabolism; hypernatremia and hyponatremia, Critical Care; 20:194, 1992.
46.Worthley LI, Thomas PD. Treatment of hyponatremic seizures with intravenous 29.2 o/o saline. Br Med J; 292: 168-170, 1986.
47.Wijdicks EF, Vermeulen M, Hijdra A, et al. Hyponatremia and cerebral infarction in patients with ruptured intracranial aneurysms: is fluid restriction harmful?. Ann Neurol; 17:137-140,1985.
48.Ashouri OS. Severe diuretic-induced hyponatremia in the eldery: A series of eight patients. Arch Intern Med: 146:1355-1357, 1986.
49.Decaux G, nger J, Brimioulle, et al. Hyponatremia in the syndrome of inappropiate secretion of antidiuretic hormone. Rapid corection with urea, sodium chloride, and water restriction therapy. JAMA; 247:471-474, 1982.
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2017-06-16
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1.
Pazmiño L, Pancho M, Del Salto C, Bucheli C. Hiponatremia: patogenia, diagnóstico y tratamiento. Rev Fac Cien Med (Quito) [Internet]. 16 de junio de 2017 [citado 19 de diciembre de 2024];19(1-4):69-83. Disponible en: https://revistadigital.uce.edu.ec/index.php/CIENCIAS_MEDICAS/article/view/789
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