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Overview of the treatment of hyponatremia in adults

Richard H Sterns, MD
Section Editor
Michael Emmett, MD
Deputy Editor
John P Forman, MD, MSc


Hyponatremia represents a relative excess of water in relation to sodium. It can be induced by a marked increase in water intake (primary polydipsia) and/or by impaired water excretion resulting from advanced renal failure or from persistent release of antidiuretic hormone (ADH). (See "Causes of hyponatremia in adults".)

This topic provides an overview of the treatment of adults with hyponatremia, including the pretreatment evaluation, selection of initial and subsequent therapy, goals of therapy, and common pitfalls.

The causes, clinical manifestations, and evaluation of hyponatremia, as well as detailed discussions about specific causes of hyponatremia, are presented in other topics. (See "Causes of hyponatremia in adults" and "Manifestations of hyponatremia and hypernatremia in adults" and "Diagnostic evaluation of adults with hyponatremia" and "Hyponatremia in children" and "Treatment of hyponatremia: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and reset osmostat" and "Hyponatremia in patients with heart failure" and "Hyponatremia in patients with cirrhosis" and "Diuretic-induced hyponatremia" and "Hyponatremia and hyperkalemia in adrenal insufficiency" and "Hyponatremia following transurethral resection or hysteroscopy" and "Exercise-associated hyponatremia".)


Our approach to treating patients with hyponatremia depends upon the duration of the hyponatremia, the severity of the hyponatremia, the presence and severity of symptoms, and the presence of preexisting intracranial pathology such as recent traumatic brain injury, recent intracranial surgery or hemorrhage, or an intracranial neoplasm or other space-occupying lesion (algorithm 1). Following initial therapy, the subsequent treatment can vary with the cause of hyponatremia.

Determine the duration of hyponatremia — Therapy for hyponatremia depends in part upon the acuity:

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Literature review current through: Dec 2017. | This topic last updated: Oct 31, 2017.
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