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Hyponatremia (Low Level of Sodium in the Blood)


James L. Lewis III

, MD, Brookwood Baptist Health and Saint Vincent’s Ascension Health, Birmingham

Reviewed/Revised Sep 2023

In hyponatremia, the level of sodium in blood is too low.

  • A low sodium level has many causes, including consumption of too many fluids, kidney failure, heart failure, cirrhosis, and use of diuretics.

  • Symptoms result from brain dysfunction.

  • At first, people become sluggish and confused, and if hyponatremia worsens, they may have muscle twitches and seizures and become progressively unresponsive.

  • The diagnosis is based on blood tests to measure the sodium level.

  • Restricting fluids and stopping use of diuretics can help, but severe hyponatremia is an emergency requiring use of medications, intravenous fluids, or both.

Causes of Hyponatremia

Hyponatremia occurs when the body contains too little sodium Overview of Sodium's Role in the Body Sodium is one of the body's electrolytes, which are minerals that the body needs in relatively large amounts. Electrolytes carry an electric charge when dissolved in body fluids such as blood... read more for the amount of fluid it contains. The body may have too much, too little, or a normal amount of fluid. In all cases, however, sodium is diluted. For example, people with severe vomiting or diarrhea lose sodium. If they replace their fluid losses with just water, sodium is diluted.

Certain conditions may cause people to drink too much water (polydipsia), which can contribute to the development of hyponatremia.

Thiazide diuretics (sometimes called water pills) are a common cause of hyponatremia. These medications increase sodium excretion, which increases water excretion. Thiazide diuretics are usually well-tolerated but can cause hyponatremia in people prone to low sodium, particularly older adults.

Role of vasopressin

Vasopressin (also called antidiuretic hormone) is a substance naturally produced in the body that helps regulate the amount of water in the body by controlling how much water is excreted by the kidneys. Vasopressin decreases water excretion by the kidneys, which retains more water in the body and dilutes the sodium. The pituitary gland produces and releases vasopressin when the blood volume (amount of fluid in the blood vessels) or blood pressure goes down or when levels of electrolytes (such as sodium) become too high.

Pain, stress, exercise, a low blood sugar level, and certain disorders of the heart, thyroid gland, kidneys, or adrenal glands can stimulate the release of vasopressin from the pituitary gland. The following are some of the medications that stimulate the release of vasopressin or enhance its action at the kidney:

  • Antipsychotic and antidepressant medications

  • Aspirin, ibuprofen, and many other nonprescription pain relievers

  • Carbamazepine (an antiseizure medication)

  • Chlorpropamide (which lowers the blood sugar level)

  • Oxytocin (used to induce labor)

  • Vasopressin (synthetic antidiuretic hormone)

  • Vincristine (a chemotherapy drug)

Methylenedioxymethamphetamine (MDMA; also called ecstasy), a drug that causes excitement and disinhibition (a loosening of control over behaviors), causes people to drink excess water or other beverages and increases vasopressin secretion, causing hyponatremia.

Other causes of hyponatremia include

Symptoms of Hyponatremia

The brain is particularly sensitive to changes in the sodium level in blood. Therefore, symptoms of brain dysfunction, such as sluggishness (lethargy) and confusion, occur first. If the sodium level in blood falls quickly, symptoms tend to develop rapidly and be more severe. Older adults are more likely to have severe symptoms.

As hyponatremia becomes more severe, muscle twitching and seizures may occur. People may become unresponsive, aroused only by vigorous stimulation (stupor Stupor and Coma Stupor is unresponsiveness from which a person can be aroused only by vigorous, physical stimulation. Coma is unresponsiveness from which a person cannot be aroused and in which the person's... read more ), and eventually cannot be aroused (coma). Death may follow.

Diagnosis of Hyponatremia

  • Measurement of sodium level in the blood

Hyponatremia is diagnosed by measuring the sodium level in blood. Determining the cause is more complex. Doctors consider the person’s circumstances, including other disorders present and medications or illicit drugs taken. Blood and urine tests are done to evaluate the amount of fluid in the body, the concentration of blood, and content of urine.

Treatment of Hyponatremia

  • Restricting fluid intake

Mild hyponatremia can be treated by restricting fluid intake to less than 1 quart (about 1 liter) per day. If a diuretic or other medication is the cause, the dose is reduced or the medication is stopped. If the cause is a disorder, it is treated.

Occasionally, people are given a sodium solution intravenously, a diuretic to increase excretion of fluid, or both, usually slowly, over several days. These treatments can correct the sodium level.

Some people, especially those with the syndrome of inappropriate secretion of antidiuretic hormone Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH) The syndrome of inappropriate secretion of antidiuretic hormone develops when too much antidiuretic hormone (vasopressin) is released by the pituitary gland under certain inappropriate conditions... read more , need long-term treatment for hyponatremia. Fluid restriction alone is often not enough to prevent recurrence of hyponatremia. Salt tablets can be used in people with mild to moderate chronic hyponatremia. Depending on the cause of hyponatremia and the amount of fluid in the person' body, several medications are available for treatment.

Severe hyponatremia is an emergency. To treat it, doctors slowly increase the level of sodium in the blood with intravenous fluids and sometimes with a diuretic. Medications called vaptans, which block vasopressin receptors and prevent the kidneys from responding tovasopressin, are sometimes needed. Increasing the sodium level too rapidly can result in severe and often permanent brain damage.

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