A 41 year old Jordanian gentleman known case of osteogenesis imperfecta presented with vomiting, decreased oral intake followed by confusion. At presentation he was found to have signs of hypogonadism with severe hyponatremia. [ncbi.nlm.nih.gov]

• Fatigue

  Our patient complained of left knee pain, fatigue, and bilateral lower limb cramps. No pertinent medical history was recorded and her vital signs were within normal limits. [ncbi.nlm.nih.gov]

  […] hy·po·na·tre·mia | \ ˌhī-pō-nā-ˈtrē-mē-ə \ variants: or chiefly British hyponatraemia medical : the condition of having an abnormally low level of sodium in the blood that is typically marked by nausea, vomiting, headache, confusion, fatigue, and muscle [merriam-webster.com]

  Symptoms Hyponatremia can cause fatigue and headaches. Mild hyponatremia may not cause symptoms. [medicalnewstoday.com]

  Cramps may be more associated with neuromuscular fatigue than dehydration/electrolyte losses, and mild dehydration is not associated with increased cramping (3). [diabetesincontrol.com]

• Hypothermia

  However, he returned with hypothermia, hyponatremia, and status epilepticus resulting in intubation. [ncbi.nlm.nih.gov]

  Keith Roach, oregonlive, 29 Nov. 2021 Hikers should also watch out for health hazards including heat exhaustion, heatstroke, hyponatremia and hypothermia. [merriam-webster.com]

  Clinically there is muscle weakness, hypothermia and dehydration. Patient discussion about hyponatremia Q. What steps do you take when your physician says your sodium is low A. [medical-dictionary.thefreedictionary.com]

  This could be due to overdose of certain medications, hypothermia or severe anoxia (lack of oxygen). [en.wikipedia.org]

• Dyspnea

  Eventually, the fluid enters the air spaces in the lungs (pulmonary edema) reduces the amount of oxygen that can enter the blood, and causes shortness of breath (dyspnea) or enters pleural space by transudation (pleural effusion which also causes dyspnea [en.wikipedia.org]

  […] paresteziile si potasium si calciul parestezii = hiperK / hipoCalcemie Pancreatita acuta si calciul Pancreatita acuta --> HIPOcalcemie Hipocalcemie = hipotensiune abdominal pain tetany muscle cramps dyspnea perioral tingling convulsions mental status [quizlet.com]

  Box 2: Applying the results of this review in clinical practice A 60-year-old man presents with increasing dyspnea on exertion. [doi.org]

  He presented with intense dyspnea and cough with greenish expectoration. The only finding of note on physical examination was the presence of disperse rhonchi in both hemithoraxes and the absence of edema or signs of fluid overload. [archbronconeumol.org]

  CASE An 53-year-old woman was seen in an emergency department for evaluating a chest pain and dyspnea for the past two months. [scielo.br]

• Rales

  Signs of hypervolaemia - pulmonary rales, S3 gallop (third heart sound), jugular venous distention, peripheral oedema, ascites. [patient.info]

  Pulmonary rales, S3 gallop, jugular venous distention, peripheral edema, or ascites suggest hypervolemic hyponatremia due to excess retention of sodium and free water (ie, cirrhosis, nephrotic syndrome, congestive heart failure). [emedicine.medscape.com]

• Cheyne-Stokes Respiration

  […] symptoms[edit] Gastro-intestinal[edit] Anorexia Nausea Musculoskeletal[edit] Muscle aches Generalized muscle weakness[3] Neuro-muscular[edit] Myoclonus[3] Decreased reflexes[3] Ataxia[3] Pathological reflexes[3] Tremor[3] Asterixis[3] Respiratory[edit] Cheyne-Stokes [en.wikipedia.org]

• Vomiting

  A 41 year old Jordanian gentleman known case of osteogenesis imperfecta presented with vomiting, decreased oral intake followed by confusion. At presentation he was found to have signs of hypogonadism with severe hyponatremia. [ncbi.nlm.nih.gov]

  After one run when her muscles started to cramp and she started vomiting, she decided it was time to visit a doctor to make sure there was nothing more serious going on. [study.com]

• Nausea

  […] hy·po·na·tre·mia | \ ˌhī-pō-nā-ˈtrē-mē-ə \ variants: or chiefly British hyponatraemia medical : the condition of having an abnormally low level of sodium in the blood that is typically marked by nausea, vomiting, headache, confusion, fatigue, and muscle [merriam-webster.com]

  […] for anyone who develops severe signs and symptoms of hyponatremia, such as nausea and vomiting, confusion, seizures, or lost consciousness. [mayoclinic.org]

  His small-bowel obstruction, abdominal pain, and nausea resolve. In acute hyponatremia, the serum sodium level drops abruptly over less than 24 hours. The most common causes are nausea, vomiting, and diarrhea. [americannursetoday.com]

• Loss of Appetite

  A 69-year-old previously well Sinhalese man presented with lethargy, loss of appetite, vomiting, and altered behavior of 1 week's duration. An examination revealed Glasgow Coma Scale of 13/15 and marginally low blood pressure. [ncbi.nlm.nih.gov]

  […] of appetite Irritability Restlessness Sluggishness Confusion Muscle twitching Hallucinations Seizures Diagnosis You will be asked about your symptoms and health history. [winchesterhospital.org]

  […] of inappropriate antidiuretic hormone secretion (SIADH) Sweating Vomiting Symptoms Common symptoms include: Confusion, irritability, restlessness Convulsions Fatigue Headache Loss of appetite Muscle weakness, spasms, or cramps Nausea, vomiting Exams [mountsinai.org]

  They include: headache nausea, loss of appetite, vomiting malaise lethargy weakness poor coordination muscle cramps somnolence disorientation personality change Physical Exam Volume status assessment is important to determine cause. [sharinginhealth.ca]

  Common signs and symptoms of low sodium include: Headaches Fatigue or low energy Drowsiness Irritability or restlessness Dizziness or loss of balance Loss of appetite Nausea or vomiting Reduced urine output Profuse or sudden sweating Muscle cramps or [verywellhealth.com]

• Hiccup

  Signs and symptoms include2: Nausea, vomiting Headache Confusion Seizures Abnormal somnolence, coma Cardiorespiratory distress Hiccups Ataxia, falls Slow decision making Brain cells adjust to hyponatremia within 24-48 hours by reducing intracellular concentration [canadiem.org]

  […] treatment of schizophrenia, bipolar disorder and other affective psychoses, but also in other neuropsychiatric disorders (such as dementia and autism), symptomatic treatment of acute confusional symptoms and other conditions not psychiatric (nausea, hiccups [intechopen.com]

• Hypotension

  After several weeks of suffering from gastroenteritis with vomiting, she presented with disturbance of consciousness, hypotension, dehydration, and severe hyponatremia (108 mEq/L) and a markedly increased serum vasopressin concentration (45.5 pg/mL). [ncbi.nlm.nih.gov]

  Hypovolemia or Hypotension: For patients who develop hypovolemia or hypotension while receiving VAPRISOL, VAPRISOL should be discontinued, and volume status and vital signs should be monitored. [vaprisol.com]

  Udgivelsesdato: 2008-Dec-8 AB - Acute adrenal insufficiency is a life threatening disease with dehydration, hypotension, cerebral dysfunction and gastrointestinal symptoms accompanied by low plasma sodium and high plasma potassium. [pure.au.dk]

• Orthostatic Hypotension

  Patients presenting with orthostatic hypotension and normal plasma sodium concentrations are frequently admitted to the hospital with a diagnosis of dehydration. [annals.org]

  同时专家们还提出了两个新概念，我觉得也很有意思： 起始体位性低血压（initial orthostatic hypotension） Initial orthostatic hypotension is defined as a transient blood pressure decrease (40 mmHg systolic blood pressure and/or 20 mmHg diastolic blood pressure) within 15 s of standing. [news.medlive.cn]

  hypotension, decreased skin turgor, dry mucous membranes. [unboundmedicine.com]

  ADVERSE REACTIONS The most common adverse reactions (incidence ≥10%) reported in clinical trials were infusion site reactions (including phlebitis), pyrexia, hypokalemia, headache and orthostatic hypotension. [vaprisol.com]

• Jugular Venous Distention

  Signs of hypervolaemia - pulmonary rales, S3 gallop (third heart sound), jugular venous distention, peripheral oedema, ascites. [patient.info]

  Pulmonary rales, S3 gallop, jugular venous distention, peripheral edema, or ascites suggest hypervolemic hyponatremia due to excess retention of sodium and free water (ie, cirrhosis, nephrotic syndrome, congestive heart failure). [emedicine.medscape.com]

• Muscle Cramp

  […] hy·po·na·tre·mia | \ ˌhī-pō-nā-ˈtrē-mē-ə \ variants: or chiefly British hyponatraemia medical : the condition of having an abnormally low level of sodium in the blood that is typically marked by nausea, vomiting, headache, confusion, fatigue, and muscle [merriam-webster.com]

  And contrary to popular belief, muscle cramps and fatigue aren't caused by dehydration but from pushing too hard. If an athlete starts to experience these symptoms, he should be allowed to sit it out for a few minutes. [mnn.com]

  Anthropomorphic characteristics, exercise time, and post-exercise ratings of thermal sensation, perceived exertion and muscle cramp were similar for LC, AM and CON. [ncbi.nlm.nih.gov]

• Muscle Weakness

  A 52-year-old Sri Lankan man presented with anorexia, nausea, fatigue, generalized muscle weakness, and cramps for 1 week. The onset of his illness had been preceded by vomiting and diarrhea for 1 day which he attributed to food poisoning. [ncbi.nlm.nih.gov]

  weakness, spasms, or cramps Nausea, vomiting Exams and Tests The health care provider will perform a complete physical examination and ask about your symptoms. [mountsinai.org]

  Other symptoms include: Fatigue Convulsions Headache Muscle weakness or spasms Nausea and vomiting Restlessness Confusion Decreased consciousness Treatment of Hyponatremia Under no circumstances should the individual be given hypotonic or isotonic fluids [sportsinjuryclinic.net]

  Sodium is an electrolyte that helps the regulation of body fluids, therefore in electrolyte imbalances like hyponatremia lead to signs and symptoms of headache, confusion, loss of energy, muscle weakness, coma, and even seizures! [youtube.com]

• Muscle Hypotonia

  Motor delays and waddling gait have been attributed to muscle hypotonia. In severe cases, impaired hearing can develop over time. [biodonsys.com]

• Seizure

  PURPOSE: To evaluate the safety of eslicarbazepine acetate (ESL) in new onset elderly poststroke seizure patients, especially with respect to hyponatremia. [ncbi.nlm.nih.gov]

  Answer and interpretation Exercise-associated hyponatremia (EAH) complicated by encephalopathy (confusion and seizure). There is also evidence of seizure-induced or exercise-induced rhabdomyolysis and mild renal impairment. [lifeinthefastlane.com]

  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. [merckmanuals.com]

• Confusion

  A 41 year old Jordanian gentleman known case of osteogenesis imperfecta presented with vomiting, decreased oral intake followed by confusion. At presentation he was found to have signs of hypogonadism with severe hyponatremia. [ncbi.nlm.nih.gov]

  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. [merckmanuals.com]

  […] hy·po·na·tre·mia | \ ˌhī-pō-nā-ˈtrē-mē-ə \ variants: or chiefly British hyponatraemia medical : the condition of having an abnormally low level of sodium in the blood that is typically marked by nausea, vomiting, headache, confusion, fatigue, and muscle [merriam-webster.com]

  Cognitive impairment (eg, short-term memory loss, disorientation, confusion, depression). Focal or generalised seizures. [patient.info]

• Headache

  […] hy·po·na·tre·mia | \ ˌhī-pō-nā-ˈtrē-mē-ə \ variants: or chiefly British hyponatraemia medical : the condition of having an abnormally low level of sodium in the blood that is typically marked by nausea, vomiting, headache, confusion, fatigue, and muscle [merriam-webster.com]

  A 37-year-old woman presented to the emergency department with severe headache, which quickly progressed to altered mental status and seizure activity in hospital. Her initial serum sodium concentration ([Na]) was 126 mmol/L. [ncbi.nlm.nih.gov]

  Symptoms can be very nonspecific and can include: headache, confusion or altered mental state, seizures, and decreased consciousness, which can proceed to coma and death. [medicinenet.com]

• Lethargy

  Patients may complain of headache, nausea and vomiting, lethargy, and confusion. If the sodium concentration drops quickly to critical levels, seizures, coma, and death may occur. [emedicinehealth.com]

  Thirteen months later, he was hospitalized for lethargy and hyponatremia of 108 mEq/L, with an antidiuretic hormone level of 2.5 pg/mL, which suggested syndrome of inappropriate antidiuretic hormone secretion (SIADH). [ncbi.nlm.nih.gov]

  The symptoms can also be accompanied by headaches, lethargy and fatigue as the body fights to correct the sodium imbalance. In more serious instances, the brain swells, and confusion and dementia can set it as it presses against the skull. [health.howstuffworks.com]

• Altered Mental Status

  Her serum [Na] and altered mental status corrected slowly over the next 48 hours with furosemide, hypertonic saline, and fluid restriction. [ncbi.nlm.nih.gov]

  Less common but still belonging in the differential are pseudohyponatremia secondary to alcohol-induced severe hypertriglyceridemia and cerebral salt wasting syndrome. 2,3 Beer potomania usually manifests as altered mental status, weakness, and gait disturbance [mdedge.com]

Yield of performed workup for hypothyroidism and hypoadrenalism in euvolemic hyponatremia was low. [ncbi.nlm.nih.gov]

After a thorough workup, he was diagnosed to have reset osmostat. Reset osmostat is an uncommon and under recognised cause of hyponatremia which does not require any treatment. [hindawi.com]

Your provider will do a diagnostic workup if your blood sodium is low. The workup will include measuring urine sodium, potassium and creatinine concentrations. [my.clevelandclinic.org]

Simon EE, Hamrahian SM, Teran FJ.Hyponatremia workup. http://emedicine.medscape.com/article/242166-workup#a0719. Accessed December 10, 2013. 37. Agrawal V, Agarwal M, Joshi SR, Ghosh AK. Hyponatremia and hypernatremia: disorders of water balance. [journals.lww.com]

That diagnostic workup is important because isotonic (0.9%) saline therapy is ineffective for treating hyponatremia associated with SIADH, as the 2013 expert panel recommendations note. [acphospitalist.org]

• Urine Sodium Decreased

  Additionally, urine osmolality increased from 365 mOsm/kg (IQR, 361–561) to 546 mOsm/kg (IQR, 542–602; P=0.13), whereas urine sodium decreased from 75 mEq/L (IQR, 42–105) to 50 mEq/L (IQR, 37–76; P=0.06). [cjasn.asnjournals.org]

• Hyponatriuria

  Regarding the differential diagnosis of hyponatremia, diabetes insipidus could be excluded because he had hypernatriuria instead of hyponatriuria, syndrome of inappropriate antidiuretic hormone (SIADH) was not likely because he was dehydrated. [tandfonline.com]

Treatment If the decision is made to go ahead with treatment, keep the following principles in in mind. Decide whether treatment is required in the ED at all. Treatment should be focussed on the individual patient, not lab values. [canadiem.org]

Current HN treatment varies widely, with no consensus. This study recorded treatment practices currently used for patients hospitalized with acute heart failure and HN. [ncbi.nlm.nih.gov]

Treatment of symptomatic hyponatremia Treatment goals in symptomatic hyponatremia Severely symptomatic HN as defined in Table 1 is a medical emergency and physicians must make themselves familiar with the treatment. [ec.bioscientifica.com]

Hyponatremia in acute decompensated heart failure (HF) is indicative of a poor prognosis and predicts morbidity and mortality. [ncbi.nlm.nih.gov]

The diverse etiologies and comorbidities associated with hyponatremia pose substantial challenges in managing this disorder. [ncbi.nlm.nih.gov]

Furthermore, we analyzed whether etiology of hyponatremia or comorbidities assessed by the Charlson Comorbidity Index (CCI) were outcome predictors. [eje.bioscientifica.com]

Epidemiological, comorbidity and admis sion-related data were collected, including type of solution received, sodium and chlorine values in the first 72 hours of hospitalization and the incidence of extravasation of peripheral intravenous lines. [ncbi.nlm.nih.gov]

Original research, case studies, reviews and commentaries are welcome that will better define the epidemiology, pathogenesis, prevention, evaluation and treatment of hyponatremia. [frontiersin.org]

The AVP activity combines with other dilutional pathophysiologies to result in hyponatremia. Pathophysiology of hyponatremia in cirrhosis 3 Multiple factors lead to the development of hyponatremia in cirrhotic patients. [vaprisol.com]

Because age-related changes and chronic diseases are often associated with impairment of water metabolism in elderly patients, it is absolutely essential for clinicians to be aware of the pathophysiology of hyponatremia and hypernatremia in the elderly [ncbi.nlm.nih.gov]

Seldin and Giebisch's The Kidney Physiology & Pathophysiology (5th ed.). Burlington: Elsevier Science. ISBN 978-0123814630. ^ Kwon, TH; Hager, H; Nejsum, LN; Andersen, ML; Frøkiaer, J; Nielsen, S (May 2001). [en.wikipedia.org]

Exploration of the development of new drugs that can effectively resolve the pathophysiology of systemic vasodilation in patients with cirrhosis is an additional avenue for study. [aasldpubs.onlinelibrary.wiley.com]

The precise pathophysiology is mostly unknown. [revportcardiol.org]

Although there are various suggested treatment strategies in the setting of a medical ward or intensive care unit, reports of intraoperative management to prevent rapid increases in serum sodium are lacking. [ncbi.nlm.nih.gov]

While relatively less probable to occur compared to dehydration, prevention is key to avoid hyponatremia related illness. Hyponatremia FAQs How do you prevent hyponatremia? Know thyself. [guenergy.com]