Sodium Homeostasis, a Balance Necessary for Life

Nutrients. 2023 Jan 12;15(2):395. doi: 10.3390/nu15020395.


Body sodium (Na) levels must be maintained within a narrow range for the correct functioning of the organism (Na homeostasis). Na disorders include not only elevated levels of this solute (hypernatremia), as in diabetes insipidus, but also reduced levels (hyponatremia), as in cerebral salt wasting syndrome. The balance in body Na levels therefore requires a delicate equilibrium to be maintained between the ingestion and excretion of Na. Salt (NaCl) intake is processed by receptors in the tongue and digestive system, which transmit the information to the nucleus of the solitary tract via a neural pathway (chorda tympani/vagus nerves) and to circumventricular organs, including the subfornical organ and area postrema, via a humoral pathway (blood/cerebrospinal fluid). Circuits are formed that stimulate or inhibit homeostatic Na intake involving participation of the parabrachial nucleus, pre-locus coeruleus, medial tuberomammillary nuclei, median eminence, paraventricular and supraoptic nuclei, and other structures with reward properties such as the bed nucleus of the stria terminalis, central amygdala, and ventral tegmental area. Finally, the kidney uses neural signals (e.g., renal sympathetic nerves) and vascular (e.g., renal perfusion pressure) and humoral (e.g., renin-angiotensin-aldosterone system, cardiac natriuretic peptides, antidiuretic hormone, and oxytocin) factors to promote Na excretion or retention and thereby maintain extracellular fluid volume. All these intake and excretion processes are modulated by chemical messengers, many of which (e.g., aldosterone, angiotensin II, and oxytocin) have effects that are coordinated at peripheral and central level to ensure Na homeostasis.

Keywords: excitatory and inhibitory circuits; hypernatremia; hyponatremia; kidney; natriuresis; posterior hypothalamus; salt intake; sodium homeostasis; taste.

Publication types

  • Review

MeSH terms

  • Angiotensin II / metabolism
  • Homeostasis
  • Kidney / metabolism
  • Oxytocin*
  • Sodium* / metabolism


  • Sodium
  • Oxytocin
  • Angiotensin II

Grants and funding

This research was funded by Spanish Ministry of Economy, Industry and Competitiveness grant number PSI2017-89324-C2-1-P and The APC was funded by University of Granada.