Hyponatremia Symptoms, Complications, and Risks
Hyponatremia can result in poor patient outcomes due to the following complications and risks:
Hyponatremia in the elderly has been associated with increased falls and fractures.6-8
- Bone fracture risk with hyponatremia is not only due to fall risk, but also due to an increase in bone fragility as a result of the hyponatremia9,10
Hyponatremia signs and symptoms can range from mild or nonspecific to severe
Mild or nonspecific signs and symptoms include the following3:
- Muscle aches
Nonspecific or mild symptoms of hyponatremia may progress quickly to severe symptoms. The more severe symptoms are often neurologic complications due to brain edema and increased intracranial pressure from severe and rapidly evolving hyponatremia.2-4
These severe symptoms or complications include2-4:
- Abnormal or severe somnolence
- Respiratory arrest
Some patients with hyponatremia are considered to be asymptomatic11
Patients considered to be asymptomatic may not be fully asymptomatic.2,5,8 There are many subtle signs or symptoms that may be present in “asymptomatic” chronic hyponatremia. These signs and symptoms include5-7,12:
- Gait instability
- Cognitive deficits
- Falls and fractures
These subtle signs can exist even in patients with mild hyponatremia.
- A case-control study of 513 patients with bone fractures found that 13% (n=67) had hyponatremia (mean serum [Na+]: 131±3 mEq/L)6
- The bone fractures in these patients were attributed to hyponatremia in 72.5% of all cases6
- Arieff AI, Guisado R. Effects on the central nervous system of hypernatremia and hyponatremic states. Kidney Int. 1976;10(1):104-116.
- Verbalis JG, Goldsmith SR, Greenberg A, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013;126(10 Suppl 1):S1-S42. doi:10.1016/j.amjmed.2013.07.006.
- Adrogué HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;343(21):1581-1589.
- Adrogué HJ, Madias NE. The challenge of hyponatremia. J Am Soc Nephrol. 2012;23(7):1140-1148.
- Wald R, Jaber BL, Price LL, Upadhyay A, Madias NE. Impact of hospital-associated hyponatremia on selected outcomes. Arch Intern Med. 2010;170(3);294-302. doi: 10.1001/archinternmed.2009.513.
- Gankam Kengne F, Andres C, Sattar L, Melot S, Decaux G. Mild hyponatremia and risk of fracture in the ambulatory elderly. QJM. 2008;101(7):583-588. doi:10:1093/qjmed/hcn061.
- Kinsella S, Moran S, Sullivan MO, Molloy MG, Eustace JA. Hyponatremia independent of osteoporosis is associated with fracture occurrence. Clin J Am Soc Nephrol. 2010;5(2):275-280. doi:10.2215/CJN.06120809.
- Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med. 2006;119(1):71.e1-71.e8. doi:10.1016/j.amjmed.2005.09.026.
- Ayus JC, Moritz ML. Bone disease as a new complication of hyponatremia: moving beyond brain injury. Clin J Am Soc Nephrol. 2010;5:167-168. doi:10.2215/CJN.09281209.
- Verbalis JG, Barsony J, Sugimura Y, et al. Hyponatremia-induced osteoporosis. J Bone Miner Res. 2010;25(3):554-563. doi:10.1359/jbmr.090827.
- Douglas I. Hyponatremia: why it matters, how it presents, how we can manage it. Cleve Clin J Med. 2006;73(Suppl 3):S4-S12.
- Sandhu HS, Gilles E, DeVita MV, Panagopoulos G, Michelis MF. Hyponatremia associated with large-bone fracture in elderly patients. Int Urol Nephrol. 2009;41(3):733-737. doi: 10.1007/s11255-009-9585-2.