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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 | Source: | 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. | Keywords: | arginine vasopressin; distal; diuretics; kidney tubules; physiopathology; sodium | Document URI: | http://hdl.handle.net/1942/18662 | ISSN: | 0735-1097 | e-ISSN: | 1558-3597 | DOI: | 10.1016/j.jacc.2014.12.010 | ISI #: | 000348667000014 | Rights: | © 2015 by the American College of Cardiology Foundation. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2016 |
Appears in Collections: | Research publications |
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