Diagnosis and Management of Disorders of Body Tonicity-Hyponatremia and Hypernatremia: Core Curriculum 2020

Am J Kidney Dis. 2020 Feb;75(2):272-286. doi: 10.1053/j.ajkd.2019.07.014. Epub 2019 Oct 10.


Overall body fluid concentration is regulated within a narrow range by the concerted action of the hypothalamic-pituitary axis to influence water intake through thirst and water excretion via the effect of vasopressin, or antidiuretic hormone, on renal collecting duct water permeability. Sodium is the principal extracellular cation; abnormalities in overall effective body fluid concentration, or tonicity, manifest as disturbances in serum sodium concentration. Depending on its severity and chronicity, hyponatremia can lead to significant symptoms, primarily related to central nervous system function. Failure to correct hyponatremia can lead to permanent neurologic damage, as can over rapid correction. It is thus essential to stay within specific limits for correction, particularly for chronic hyponatremia. Hypernatremia also leads to central nervous system dysfunction, although goals for its correction rate are less well established. This Core Curriculum article discusses the normal regulation of tonicity and serum sodium concentration and the diagnosis and management of hypo- and hypernatremia.

Keywords: Hyponatremia; anti-diuretic hormone (ADH); arginine vasopressin (AVP); diabetes insipidus; diagnosis of hypernatremia; diagnosis of hyponatremia; hypernatremia; hypertonic; hypertonic saline; hypervolemia; hypotonic; hypovolemia; osmolality; osmolarity; osmotic demyelination syndrome; primary polydipsia; pseudohyponatremia; review; serum sodium; syndrome of inappropriate anti-diuretic hormone secretion (SIADH); tonicity; treatment of hypernatremia; treatment of hyponatremia; vaptan; vasopressin receptor inhibitor; volume depletion.

Publication types

  • Review

MeSH terms

  • Curriculum*
  • Disease Management*
  • Humans
  • Hypernatremia / blood
  • Hypernatremia / diagnosis*
  • Hypernatremia / therapy
  • Hyponatremia / blood
  • Hyponatremia / diagnosis*
  • Hyponatremia / therapy
  • Sodium / blood*
  • Water-Electrolyte Imbalance


  • Sodium