Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations

Am J Med. 2013 Oct;126(10 Suppl 1):S1-42. doi: 10.1016/j.amjmed.2013.07.006.


Hyponatremia is a serious, but often overlooked, electrolyte imbalance that has been independently associated with a wide range of deleterious changes involving many different body systems. Untreated acute hyponatremia can cause substantial morbidity and mortality as a result of osmotically induced cerebral edema, and excessively rapid correction of chronic hyponatremia can cause severe neurologic impairment and death as a result of osmotic demyelination. The diverse etiologies and comorbidities associated with hyponatremia pose substantial challenges in managing this disorder. In 2007, a panel of experts in hyponatremia convened to develop the Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations that defined strategies for clinicians caring for patients with hyponatremia. In the 6 years since the publication of that document, the field has seen several notable developments, including new evidence on morbidities and complications associated with hyponatremia, the importance of treating mild to moderate hyponatremia, and the efficacy and safety of vasopressin receptor antagonist therapy for hyponatremic patients. Therefore, additional guidance was deemed necessary and a panel of hyponatremia experts (which included all of the original panel members) was convened to update the previous recommendations for optimal current management of this disorder. The updated expert panel recommendations in this document represent recommended approaches for multiple etiologies of hyponatremia that are based on both consensus opinions of experts in hyponatremia and the most recent published data in this field.

Keywords: Antidiuretic hormone; Aquaretics; Hypo-osmolality; Natriuresis; Syndrome of inappropriate antidiuretic hormone secretion; Vasopressin; Volume regulation.

Publication types

  • Consensus Development Conference
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Insufficiency / complications
  • Antidiuretic Hormone Receptor Antagonists
  • Clinical Trials as Topic
  • Diagnosis, Differential
  • Diuretics / adverse effects
  • Diuretics / therapeutic use
  • Gastrointestinal Diseases / complications
  • Genetic Diseases, X-Linked / complications
  • Humans
  • Hyponatremia / diagnosis*
  • Hyponatremia / drug therapy*
  • Hyponatremia / etiology
  • Hyponatremia / pathology
  • Hypothyroidism / complications
  • Hypovolemia / complications
  • Inappropriate ADH Syndrome / complications
  • Liver Cirrhosis / complications
  • Polydipsia / complications
  • Receptors, Vasopressin / metabolism
  • Sodium Chloride / therapeutic use*
  • Vasopressins / metabolism


  • Antidiuretic Hormone Receptor Antagonists
  • Diuretics
  • Receptors, Vasopressin
  • Vasopressins
  • Sodium Chloride

Supplementary concepts

  • Nephrogenic Syndrome of Inappropriate Antidiuresis