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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/18662

Title: Hyponatremia in Acute Decompensated Heart Failure Depletion Versus Dilution
Authors: VERBRUGGE, Frederik
STEELS, Paul
GRIETEN, Lars
NIJST, Petra
Tang, W. H. Wilson
MULLENS, Wilfried
Issue Date: 2015
Publisher: ELSEVIER SCIENCE INC
Citation: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 65 (5), p. 480-492
Abstract: Hyponatremia frequently poses a therapeutic challenge in acute decompensated heart failure (ADHF). Treating physicians should differentiate between depletional versus dilutional hyponatremia. The former is caused by diuretic agents, which enhance sodium excretion, often with concomitant potassium/magnesium losses. This can be treated with isotonic saline, whereas potassium/magnesium administration may be helpful if plasma concentrations are low. In contrast, as impaired water excretion, rather than sodium deficiency, is the culprit in dilutional hyponatremia, isotonic saline administration may further depress the serum sodium concentration. Because free water excretion is achieved by continuous sodium reabsorption in distal nephron segments with low water permeability, diuretic agents that impair this mechanism (e.g., thiazide-type diuretic agents and mineralocorticoid receptor antagonists) should be avoided, and proximally acting agents (e.g., acetazolamide and loop diuretic agents) are preferred. Vasopressin antagonists, which promote low water permeability in the collecting ducts and, hence, free water excretion, remain under investigation for dilutional hyponatremia in ADHF. (C) 2015 by the American College of Cardiology Foundation.
Notes: [Verbrugge, Frederik H.; Grieten, Lars; Nijst, Petra; Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, B-3600 Genk, Belgium. [Verbrugge, Frederik H.; Steels, Paul; Nijst, Petra] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Mullens, Wilfried] Hasselt Univ, Doctoral Sch Med & Life Sci, Fac Med & Life Sci, Biomed Res Inst, Diepenbeek, Belgium. [Tang, W. H. Wilson] Cleveland Clin, Inst Heart & Vasc, Dept Cardiovasc Med, Cleveland, OH USA.
URI: http://hdl.handle.net/1942/18662
DOI: 10.1016/j.jacc.2014.12.010
ISI #: 000348667000014
ISSN: 0735-1097
Category: A1
Type: Journal Contribution
Validation: ecoom, 2016
Appears in Collections: Research publications

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