Hyponatremia classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Saeedeh Kowsarnia M.D.[2]

Overview

There is no established system for the classification of [disease name].

OR

[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].

OR

[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3]. [Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].

OR

Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.

OR

If the staging system involves specific and characteristic findings and features: According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].

OR

The staging of [malignancy name] is based on the [staging system].

OR

There is no established system for the staging of [malignancy name].

Classification

Hyponatremia is defined as serum sodium less than 135 mEq/L (mmol/L).There are different classifications for hyponatremia based on duration, severity, volume status,ADH level and serum osmolality.

Hyponatremia is classified based on serum sodium level to [1] :

  • Mild : Serum sodium 130– 135 mmol/L
  • Moderate:  Serum sodium ≤125–129 mmol/L
  • Severe: Serum sodium <124 mmol/L

Classification based on duration[2] :

  • Hyper acute [3]: Develops in a few hours, excess water intake, impaired water excretion, runners, users of the recreational drug (Ecstasy)
  • Acute: Rapid onset <48 hours, surgeries, colonoscopy preparation, polydipsia, diuretics
  • Chronic: Gradual onset >48 hours, caused by chronic disease ( including cardiac, renal, hepatic and other conditions)

( Etiologies cause hyper acute and acute hyponatremia are applicable interchangeably to each categories)

Classification based on ADH level :

  • ↑ ADH: Volume depletion (GI loss, Renal loss) , decreased perfusion ( CHF, Cirrhosis), increased ADH secretion, reset osmostat
  • ↓ ADH: Primary polydipsia, ↓ dietary solute intake, advanced renal failure

Classification based upon osmolality [4]:

  • Hypertonic hyponatremia: Serum osmolality >295 mOsm/kg
  • Hypotonic hyponatremia: Serum osmolality < 280 mOsm/kg
  • Norotonic hyponatremia: Serum osmolality 280-295 mOsm/kg

According to volume status :

Volume status Sodium status
  • True volume depletion : GI loss, Renal loss, Insensible loss
Hypovolemic

Hyponatremia

  • total body water ↓
  • total body sodium ↓↓
Hypervolemic

Hyponatremia

  • total body water ↑↑
  • total body sodium ↑
  • Decreased effective arterial volume : Cirrhosis, Renal disease, CHF
Euvolemic

Hyponatremia

  • total body water ↑
  • total body sodium ↔
  • Drugs ,Increased ADH level, Reset osmostat, Low dietary salt intake

References

  1. Laczi, Ferenc (2008). "Etiology, diagnostics and therapy of hyponatremias". Orvosi Hetilap. 149 (29): 1347–1354. doi:10.1556/OH.2008.28409. ISSN 0030-6002.
  2. Sterns, Richard H.; Ingelfinger, Julie R. (2015). "Disorders of Plasma Sodium — Causes, Consequences, and Correction". New England Journal of Medicine. 372 (1): 55–65. doi:10.1056/NEJMra1404489. ISSN 0028-4793.
  3. Thomas, Sarah Beth (2017). "Acute hypervolemic hyponatremia". Nursing. 47 (10): 53–57. doi:10.1097/01.NURSE.0000522006.83149.20. ISSN 0360-4039.
  4. A. I. Arieff & H. J. Carroll (1972). "Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acid-base balance, plasma-cerebrospinal fluid equilibria and the effects of therapy in 37 cases". Medicine. 51 (2): 73–94. PMID 5013637. Unknown parameter |month= ignored (help)

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