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Hyponatremia: A Prospective Analysis of Its Epidemiology and the Pathogenetic Role of Vasopressin

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▸Requests for reprints should be addressed to Robert J. Anderson, M.D.; University of Colorado Health Sciences Center, 4200 E. Ninth Avenue, Box C280; Denver, CO 80262.

Denver, Colorado

© 1985 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1985;102(2):164-168. doi:10.7326/0003-4819-102-2-164
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We prospectively evaluated the frequency, cause, and outcome of hyponatremia (plasma sodium concentration, < 130 meq/L), as well as the hormonal response to this condition, in hospitalized patients. Daily incidence and prevalence of hyponatremia averaged 0.97% and 2.48%, respectively. Two thirds of all hyponatremia was hospital acquired. Normovolemic states (so-called syndrome of inappropriate secretion of antidiuretic hormone) were the most commonly seen clinical setting of hyponatremia. The fatality rate for hyponatremic patients was 60-fold that for patients without documented hyponatremia. Nonosmotic secretion of vasopressin was present in 97% of hyponatremic patients in whom it was sought. In edematous and hypovolemic patients, plasma hormonal responses (increases in plasma renin activity and aldosterone and norepinephrine levels) were compatible with baroreceptor-mediated release of vasopressin. Hyponatremia is a common hospital-acquired electrolyte disturbance that is an indicator of poor prognosis. Nonosmotic secretion of arginine vasopressin is a major pathogenetic factor in this electrolyte disturbance.





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