Primary prevention
Hyponatremia is associated with multiple disorders; primary prevention is limited to management of associated illness and avoidance of excessive fluid intake. Patients with congestive heart failure, chronic kidney disease, malignancy (especially of pulmonary origin), cirrhosis, and nephrotic syndrome should have their serum sodium concentration tested regularly. In addition, serum sodium concentration should be tested regularly in patients with balance abnormalities (mild hyponatremia has been shown to have effects on gait stability and cognitive function, which could result in falls) and those with osteoporosis (which may be associated with long-term, chronic hyponatremia).[3][23][35][36]
Hospital-acquired hyponatremia is largely preventable with careful monitoring of serum sodium levels.[24] Levels should be assessed on hospital admission.
Mild hyponatremia is a physiologic finding in pregnancy, but hyponatremia may complicate preeclampsia and worsening hyponatremia in pregnancy may indicate other conditions. Maternal dilutional hyponatremia can be prevented by maintaining a neutral fluid balance; there is a 1% incidence of hyponatremia at delivery with fluid intake of up to 1 L during labor, increasing to 26% at >2.5 L fluid intake.[13] Therefore, fluid balance charts have a key role in any labor management strategy (low or high risk) to help prevent hyponatremia and any associated adverse effects on maternal or fetal outcomes.[37]
Patients receiving intravenous fluids, particularly fluids that are hypotonic to plasma, should have their serum electrolytes checked on a daily basis, and urgently if signs of cerebral edema occur. This applies particularly to the administration of hypotonic intravenous fluids in the setting of pain and opioid analgesic use, or the postoperative state. There is evidence to suggest that in hospitalized children (surgical and medical), isotonic saline reduces the risk of hyponatremia compared with hypotonic saline, without a concomitant increase in the risk of hypernatremia.[38][39]
Serum sodium levels should be assessed regularly in patients that are taking medications known to cause hyponatremia (e.g., selective serotonin-reuptake inhibitors, thiazide diuretics).
Avoiding large amounts of fluid intake during physical exercise may prevent exercise-induced hyponatremia.[40]
Secondary prevention
Once hyponatremia has been diagnosed, avoiding excessive water intake may prevent further episodes. Medications that are known to cause hyponatremia should also be avoided.
Use of this content is subject to our disclaimer