Palabras clave
hiponatremia en adultos
síndrome de secreción inadecuada de hormona antidiurética
síndrome de secreción inadecuada de hormona antidiurética
Cómo citar
Rojas, W., Tovar, H., Alvarado, A., Tejada, M., & Rivera, A. (2017). Diagnóstico y manejo de la hiponatremia en adultos. Énfasis en síndrome de secreción inadecuada de hormona antidiurética. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 2(3), 56–62. https://doi.org/10.53853/encr.2.3.97
Resumen
Caso Clínico
Paciente de 60 años de edad, quien ingresa al servicio de urgencias por cuadro de cinco días de evolución, caracterizado por sensación de dolor abdominal, náuseas, vómito y dolor muscular generalizado; refiere en la última semana presencia de síntomas respiratorios caracterizados por tos seca asociada a disnea.
Antecedentes personales: leucemia linfocítica crónica, riesgo intermedio con último ciclo de quimioterapia en agosto del 2014. Actualmente se encuentra en estudio por hipereosinofilia. Desde su ingreso se encuentran paraclínicos con valores de sodio plasmáticos disminuidos por lo que se solicita concepto al servicio de endocrinología.
Al interrogatorio, el paciente refiere cefalea generalizada pero niega alteraciones cognitivas, convulsiones o pérdida del estado de conciencia. Al realizar el examen físico se encontraron signos vitales estables, alerta, hidratado, presencia de dolor abdominal generalizado a la palpación superficial, no presenta signos de irritación peritoneal, adecuada perfusión distal sin déficit neurológico. Se evaluaron paraclínicos de ingreso
Citas
1. Harring TR, Deal NS, Kuo DC. Disorders of sodium and water balance. Emerg Med Clin North Am [Internet]. Elsevier Inc; 2014;32(2):379–401. Available from: http://dx.doi.org/10.1016/j.emc.2014.01.001
2. Thompson C, Hoorn EJ. 1 Hyponatraemia: An overview of frequency, clinical presentation and complications. Best Pract Res Clin Endocrinol Metab [Internet]. Elsevier Ltd; 2012;26(SUPPL. 1):S1–6. Available from: http:// dx.doi.org/10.1016/S1521-690X(12)00019-X
3. Assadi F. Hyponatremia: A problem-solving approach to clinical cases. J Nephrol. 2012;25(4):473–80.
4. Ingelfinger JR, Sterns RH. Disorders of Plasma Sodium – Causes, Consequences, and Correction. N Engl J Med [Internet]. 2015 Jan 1 [cited 2015 Jan 1];372(1):55– 65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25551526
5. Edmonds Z V. Pathophysiology, impact, and management of hyponatremia. J Hosp Med. 2012;7(SUPPL. 4):1–5.
6. Lee JJY, Kilonzo K, Nistico A, Yeates K. Management of hyponatremia. CMAJ [Internet]. 2014;186(8):E281–6. Available from: http://www.ncbi.nlm.nih. gov/pubmed/24344146
7. Moran D, Fronk C, Mandel E. Managing hyponatremia in adults. JAAPA [In- ternet]. 2014 Apr [cited 2015 May 22];27(4):23–9; quiz 30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24622398
8. Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol. 2014;170(3).
9. Adrogué HJ, Madias NE. Hyponatremia. N Engl J Med [Internet]. 2000 May 25 [cited 2015 Apr 24];342(21):1581–9. Available from: http://www.ncbi. nlm.nih.gov/pubmed/10824078
10. Juul KV, Bichet DG, Nielsen S, Nørgaard JP. The physiological and pathophysiological functions of renal and extrarenal vasopressin V2 receptors. Am J Physiol Renal Physiol [Internet]. 2014;306(9):F931–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24598801
11. Editor EES. Hyponatremia. 2013. 1-263 p.
12. Kengne FG, Decaux G. Hyponatremia. 2013; Available from: http://link. springer.com/10.1007/978-1-4614-6645-1
13. Hew TD, Chorley JN, Cianca JC, Divine JG. The incidence, risk factors, and clinical manifestations of hyponatremia in marathon runners. Clin J Sport Med. 2003;13(1):41–7.
14. Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med [Internet]. 2006 Jan [cited 2015 May 17];119(1):71.e1–8. Avail- able from: http://www.ncbi.nlm.nih.gov/pubmed/16431193
15. Sterns RH, Cappuccio JD, Silver SM, Cohen EP. Neurologic sequelae after treatment of severe hyponatremia: a multicenter perspective. J Am Soc Nephrol. 1994;4(8):1522–30.
16. Snell DM, Bartley C. Osmotic demyelination syndrome following rapid correction of hyponatraemia. Anaesthesia. 2008;63(1):92–5.
17. Lee YJ, Lee SG, Kwon TW, Park KM, Kim SC, Min PC. Neurologic complications after orthotopic liver transplantation including central pontine myelinolysis. Transplant Proc [Internet]. 1996 Jun [cited 2015 May 24];28(3):1674– 5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8658834
18. Sterns RH. Severe symptomatic hyponatremia: treatment and outcome. A study of 64 cases. Ann Intern Med [Internet]. 1987 Nov [cited 2015 May 24];107(5):656–64. Available from: http://www.ncbi.nlm.nih.gov/ pubmed/3662278
19. Norenberg MD, Papendick RE. Chronicity of hyponatremia as a factor in experimental myelinolysis. Ann Neurol [Internet]. 1984 Jun [cited 2015
May 24];15(6):544–7. Available from: http://www.ncbi.nlm.nih.gov/ pubmed/6742788
20. Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, et al. Diagnosis, evaluation, and treatment of hyponatremia: Expert panel recommendations. Am J Med. 2013;126(10 SUPPL.1).
21. Edelman I, Leibman J, O’meara M, Birkenfeld O. Interrelations between serum sodium concentration, serum osmolality and total exchangeable sodium, total exchangeable potassium and total body water. J Clin Invest [Internet]. 1958;37(9):1236–56. Available from: http://www.ncbi.nlm.nih. gov/pubmed/13575523
22. Cohen DM, Ellison DH. Evaluating Hyponatremia. 2015;(Table 2):30–1.
23. Braun MM, Barstow CH, Pyzocha NJ. Diagnosis and Management of Sodium Disorders: Hyponatremia and Hypernatremia. 2015;
24. Rasouli M, Kalantari KR. Comparison of methods for calculating serum osmolality: multivariate linear regression analysis. Clin Chem Lab Med.
2005;43(6):635–40.
25. Worthley LI, Guerin M, Pain RW. For calculating osmolality, the simplest formula is the best. Anaesth Intensive Care [Internet]. 1987 May [cited 2015 Apr 27];15(2):199–202. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3605570
26. Garc LF, Ru F, Paula A, Mart M. Artículo de revisión Actualidades en el estudio y manejo de la hiponatremia. 2007;138–50. Available from: http:// www.medigraphic.com/pdfs/medintmex/mim-2007/mim072i.pdf
27. Kim JS, Lee JY, Park H, Han BG, Choi SO, Yang JW. Estimation of body fluid volume by bioimpedance spectroscopy in patients with hyponatremia. Yonsei Med J. 2014;55(2):482–6.
28. Boursier G, Alméras M, Buthiau D, Jugant S, Daubin D, Kuster N, et al. CT- pro-AVP as a tool for assessment of intravascular volume depletion in severe hyponatremia. Clin Biochem [Internet]. The Canadian Society of Clinical Chemists; 2015;d. Available from: http://linkinghub.elsevier.com/ retrieve/pii/S0009912015000909
29. Alcázar R, Albalate M, Sequera P De. Aspectos actuales en el tratamiento del síndrome de secreción inadecuada de hormona antidiurética . Los antagonistas de los receptores de la vasopresina en el tratamiento de los trastornos del agua. 2011;75–83.
30. Sterns RH, Nigwekar SU, Hix JK. The treatment of hyponatremia. Semin Nephrol [Internet]. 2009 May [cited 2015 Jun 4];29(3):282–99. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19523575
31. Sahay M, Sahay R. Hyponatremia: A practical approach. Indian J Endocri- nol Metab [Internet]. 2014;18(6):760. Available from: http://www.ijem.in/ text.asp?2014/18/6/760/141320
32. Ellison DH, Berl T. Clinical practice. The syndrome of inappropriate antidiuresis. N Engl J Med [Internet]. 2007 May 17 [cited 2015 Jun
4];356(20):2064–72. Available from: http://www.ncbi.nlm.nih.gov/ pubmed/17507705
33. Velasco Cano M V, Runkle de la Vega I. [Current considerations in syndrome of inappropriate secretion of antidiuretic hormone/syndrome of inappropriate antidiuresis]. Endocrinol Nutr [Internet]. 2010 May [cited 2015- Jun 7];57 Suppl 2:22–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21130959
34. Berl T. Vasopressin Antagonists. N Engl J Med. 2015;372:2207–16.
35. Schrier RW, Gross P, Gheorghiade M, Berl T, Verbalis JG, Czerwiec FS, et al. Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med. 2006;355(20):2099–112.
2. Thompson C, Hoorn EJ. 1 Hyponatraemia: An overview of frequency, clinical presentation and complications. Best Pract Res Clin Endocrinol Metab [Internet]. Elsevier Ltd; 2012;26(SUPPL. 1):S1–6. Available from: http:// dx.doi.org/10.1016/S1521-690X(12)00019-X
3. Assadi F. Hyponatremia: A problem-solving approach to clinical cases. J Nephrol. 2012;25(4):473–80.
4. Ingelfinger JR, Sterns RH. Disorders of Plasma Sodium – Causes, Consequences, and Correction. N Engl J Med [Internet]. 2015 Jan 1 [cited 2015 Jan 1];372(1):55– 65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25551526
5. Edmonds Z V. Pathophysiology, impact, and management of hyponatremia. J Hosp Med. 2012;7(SUPPL. 4):1–5.
6. Lee JJY, Kilonzo K, Nistico A, Yeates K. Management of hyponatremia. CMAJ [Internet]. 2014;186(8):E281–6. Available from: http://www.ncbi.nlm.nih. gov/pubmed/24344146
7. Moran D, Fronk C, Mandel E. Managing hyponatremia in adults. JAAPA [In- ternet]. 2014 Apr [cited 2015 May 22];27(4):23–9; quiz 30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24622398
8. Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol. 2014;170(3).
9. Adrogué HJ, Madias NE. Hyponatremia. N Engl J Med [Internet]. 2000 May 25 [cited 2015 Apr 24];342(21):1581–9. Available from: http://www.ncbi. nlm.nih.gov/pubmed/10824078
10. Juul KV, Bichet DG, Nielsen S, Nørgaard JP. The physiological and pathophysiological functions of renal and extrarenal vasopressin V2 receptors. Am J Physiol Renal Physiol [Internet]. 2014;306(9):F931–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24598801
11. Editor EES. Hyponatremia. 2013. 1-263 p.
12. Kengne FG, Decaux G. Hyponatremia. 2013; Available from: http://link. springer.com/10.1007/978-1-4614-6645-1
13. Hew TD, Chorley JN, Cianca JC, Divine JG. The incidence, risk factors, and clinical manifestations of hyponatremia in marathon runners. Clin J Sport Med. 2003;13(1):41–7.
14. Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med [Internet]. 2006 Jan [cited 2015 May 17];119(1):71.e1–8. Avail- able from: http://www.ncbi.nlm.nih.gov/pubmed/16431193
15. Sterns RH, Cappuccio JD, Silver SM, Cohen EP. Neurologic sequelae after treatment of severe hyponatremia: a multicenter perspective. J Am Soc Nephrol. 1994;4(8):1522–30.
16. Snell DM, Bartley C. Osmotic demyelination syndrome following rapid correction of hyponatraemia. Anaesthesia. 2008;63(1):92–5.
17. Lee YJ, Lee SG, Kwon TW, Park KM, Kim SC, Min PC. Neurologic complications after orthotopic liver transplantation including central pontine myelinolysis. Transplant Proc [Internet]. 1996 Jun [cited 2015 May 24];28(3):1674– 5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8658834
18. Sterns RH. Severe symptomatic hyponatremia: treatment and outcome. A study of 64 cases. Ann Intern Med [Internet]. 1987 Nov [cited 2015 May 24];107(5):656–64. Available from: http://www.ncbi.nlm.nih.gov/ pubmed/3662278
19. Norenberg MD, Papendick RE. Chronicity of hyponatremia as a factor in experimental myelinolysis. Ann Neurol [Internet]. 1984 Jun [cited 2015
May 24];15(6):544–7. Available from: http://www.ncbi.nlm.nih.gov/ pubmed/6742788
20. Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, et al. Diagnosis, evaluation, and treatment of hyponatremia: Expert panel recommendations. Am J Med. 2013;126(10 SUPPL.1).
21. Edelman I, Leibman J, O’meara M, Birkenfeld O. Interrelations between serum sodium concentration, serum osmolality and total exchangeable sodium, total exchangeable potassium and total body water. J Clin Invest [Internet]. 1958;37(9):1236–56. Available from: http://www.ncbi.nlm.nih. gov/pubmed/13575523
22. Cohen DM, Ellison DH. Evaluating Hyponatremia. 2015;(Table 2):30–1.
23. Braun MM, Barstow CH, Pyzocha NJ. Diagnosis and Management of Sodium Disorders: Hyponatremia and Hypernatremia. 2015;
24. Rasouli M, Kalantari KR. Comparison of methods for calculating serum osmolality: multivariate linear regression analysis. Clin Chem Lab Med.
2005;43(6):635–40.
25. Worthley LI, Guerin M, Pain RW. For calculating osmolality, the simplest formula is the best. Anaesth Intensive Care [Internet]. 1987 May [cited 2015 Apr 27];15(2):199–202. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3605570
26. Garc LF, Ru F, Paula A, Mart M. Artículo de revisión Actualidades en el estudio y manejo de la hiponatremia. 2007;138–50. Available from: http:// www.medigraphic.com/pdfs/medintmex/mim-2007/mim072i.pdf
27. Kim JS, Lee JY, Park H, Han BG, Choi SO, Yang JW. Estimation of body fluid volume by bioimpedance spectroscopy in patients with hyponatremia. Yonsei Med J. 2014;55(2):482–6.
28. Boursier G, Alméras M, Buthiau D, Jugant S, Daubin D, Kuster N, et al. CT- pro-AVP as a tool for assessment of intravascular volume depletion in severe hyponatremia. Clin Biochem [Internet]. The Canadian Society of Clinical Chemists; 2015;d. Available from: http://linkinghub.elsevier.com/ retrieve/pii/S0009912015000909
29. Alcázar R, Albalate M, Sequera P De. Aspectos actuales en el tratamiento del síndrome de secreción inadecuada de hormona antidiurética . Los antagonistas de los receptores de la vasopresina en el tratamiento de los trastornos del agua. 2011;75–83.
30. Sterns RH, Nigwekar SU, Hix JK. The treatment of hyponatremia. Semin Nephrol [Internet]. 2009 May [cited 2015 Jun 4];29(3):282–99. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19523575
31. Sahay M, Sahay R. Hyponatremia: A practical approach. Indian J Endocri- nol Metab [Internet]. 2014;18(6):760. Available from: http://www.ijem.in/ text.asp?2014/18/6/760/141320
32. Ellison DH, Berl T. Clinical practice. The syndrome of inappropriate antidiuresis. N Engl J Med [Internet]. 2007 May 17 [cited 2015 Jun
4];356(20):2064–72. Available from: http://www.ncbi.nlm.nih.gov/ pubmed/17507705
33. Velasco Cano M V, Runkle de la Vega I. [Current considerations in syndrome of inappropriate secretion of antidiuretic hormone/syndrome of inappropriate antidiuresis]. Endocrinol Nutr [Internet]. 2010 May [cited 2015- Jun 7];57 Suppl 2:22–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21130959
34. Berl T. Vasopressin Antagonists. N Engl J Med. 2015;372:2207–16.
35. Schrier RW, Gross P, Gheorghiade M, Berl T, Verbalis JG, Czerwiec FS, et al. Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med. 2006;355(20):2099–112.
Los autores deben declarar revisión, validación y aprobación para publicación del manuscrito, además de la cesión de los derechos de publicación, mediante un documento que debe ser enviado antes de la aparición del escrito. Puede consultar una copia del documento aquí