Electrolyte disturbances with HIV infection
- Richard H Sterns, MD
Richard H Sterns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Professor Emeritus
- University of Rochester School of Medicine and Dentistry
Hyponatremia and hyperkalemia are the two major electrolyte disorders that may be associated with HIV infection. They are more likely to occur in sicker patients, with the highest rates in those who are hospitalized. In addition, lactic acidosis, hypophosphatemia have been described.
The major electrolyte disorders that occur in patients with HIV infection will be reviewed here. A discussion of the endocrine changes seen in these patients is presented separately. (See "Pituitary and adrenal gland dysfunction in HIV-infected patients".)
Hyponatremia occurs in as many as 35 to 55 percent of hospitalized HIV-infected patients, but it can also be seen in ambulatory patients [1-3]. The hyponatremia is usually due to one or more of three disorders, each of which is associated with an impaired ability to excrete water due to increased release of antidiuretic hormone (ADH): syndrome of inappropriate ADH secretion (SIADH), volume depletion, and adrenal insufficiency.
Syndrome of inappropriate ADH secretion — The syndrome of inappropriate ADH secretion (SIADH) is usually due to pneumonia (with Pneumocystis carinii or other organisms), malignancy, or occult or symptomatic infection of the central nervous system [1-3]. Among patients treated with intravenous trimethoprim-sulfamethoxazole, the fluid required to dilute the drug may contribute to the development of hyponatremia. (See "Pathophysiology and etiology of the syndrome of inappropriate antidiuretic hormone secretion (SIADH)".)
Volume depletion — Volume depletion in HIV-infected patients is most often caused by gastrointestinal fluid losses, primarily from diarrhea [1,3]. Hypovolemia can be distinguished from the SIADH by a low urine sodium concentration (usually below 15 meq/L) and correction of the hyponatremia with volume repletion. (See "Diagnostic evaluation of adults with hyponatremia".)
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