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Hyponatremia in Heart Failure: Pathogenesis and Management

[ Vol. 15 , Issue. 4 ]

Author(s):

Mario Rodriguez, Marcelo Hernandez, Wisit Cheungpasitporn, Kianoush B. Kashani, Iqra Riaz, Janani Rangaswami, Eyal Herzog, Maya Guglin and Chayakrit Krittanawong*   Pages 252 - 261 ( 10 )

Abstract:


Hyponatremia is a very common electrolyte abnormality, associated with poor short- and long-term outcomes in patients with heart failure (HF). Two opposite processes can result in hyponatremia in this setting: Volume overload with dilutional hypervolemic hyponatremia from congestion, and hypovolemic hyponatremia from excessive use of natriuretics. These two conditions require different therapeutic approaches. While sodium in the form of normal saline can be lifesaving in the second case, the same treatment would exacerbate hyponatremia in the first case. Hypervolemic hyponatremia in HF patients is multifactorial and occurs mainly due to the persistent release of arginine vasopressin (AVP) in the setting of ineffective renal perfusion secondary to low cardiac output. Fluid restriction and loop diuretics remain mainstay treatments for hypervolemic/ dilutional hyponatremia in patients with HF. In recent years, a few strategies, such as AVP antagonists (Tolvaptan, Conivaptan, and Lixivaptan), and hypertonic saline in addition to loop diuretics, have been proposed as potentially promising treatment options for this condition. This review aimed to summarize the current literature on pathogenesis and management of hyponatremia in patients with HF.

Keywords:

Hyponatremia, sodium, heart failure, congestive heart failure, vaptans, pathogenesis.

Affiliation:

Department of Internal Medicine, Icahn School of Medicine at Mount Sinai St' Luke and Mount Sinai West, New York, NY, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai St' Luke and Mount Sinai West, New York, NY, Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, MS, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, Department of Nephrology, Einstein Medical Center, Philadelphia, PA, Department of Nephrology, Einstein Medical Center, Philadelphia, PA, Cardiac Intensive Care Unit, Mount Sinai St' Luke, Mount Sinai Heart, New York, NY, Division of Cardiology, Mechanical Assisted Circulation, Gill Heart Institute, University of Kentucky, Kentucky, KY, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai St' Luke and Mount Sinai West, New York, NY

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