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Electrolyte disturbances with HIV infection

Richard H Sterns, MD
Section Editor
Michael Emmett, MD
Deputy Editor
Albert Q Lam, MD


Hyponatremia and hyperkalemia are the two major electrolyte disorders that may be associated with human immunodeficiency virus (HIV) infection. They are more likely to occur in sicker patients, with the highest rates in those who are hospitalized. In addition, hypokalemia, Fanconi syndrome, lactic acidosis, and 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. Patients with HIV infection may be more susceptible to developing hyponatremia if water intake is high because even stable patients with normal renal function who are not receiving medications have been shown to have an impaired response to a water load, with free water clearance that is three times lower than in healthy volunteers despite normal osmolar clearance [4].

Syndrome of inappropriate ADH secretion — The syndrome of inappropriate ADH secretion (SIADH) is usually due to pneumonia (with Pneumocystis jirovecii [formerly called 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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Literature review current through: Dec 2017. | This topic last updated: Jan 15, 2018.
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