Hyponatremia in psychiatric patients: update on evaluation and management.

Harvard Medical School and McLean Hospital, Belmont, MA 02478, USA.
Harvard Review of Psychiatry (Impact Factor: 2.49). 01/2008; 16(1):13-24. DOI: 10.1080/10673220801924308
Source: PubMed

ABSTRACT Hyponatremia (serum sodium concentration < 136 mEq/L) is a prevalent and potentially dangerous medical comorbidity in psychiatric patients.
MEDLINE was used to identify peer-reviewed publications that described the role of arginine vasopressin (AVP) in the pathogenesis of hyponatremia, the presentation and treatment of hyponatremia in psychiatric patients, and promising new treatment options.
Polydipsia may lead to hyponatremia in patients with schizophrenia, which is mediated, in part, by a reduced osmotic threshold for the release of AVP and by a defect in the osmoregulation of thirst. Acute-onset hyponatremia may require emergent treatment with hypertonic (3%) saline, whereas chronic cases mandate gradual correction to minimize the risk of osmotic demyelination. The AVP-receptor antagonists, including conivaptan, tolvaptan, lixivaptan, and satavaptan, represent a therapeutic advance in the treatment of dilutional hyponatremia.
Based on the role of AVP in the development of hyponatremia, further studies are warranted to determine the efficacy of the AVP-receptor antagonists in psychiatric patients with hyponatremia.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Hyponatremia at time of inpatient admission is associated with increased severity of illness and mortality in patients hospitalized for treatment of medical conditions. This study was conducted to determine the clinical outcome of psychiatric inpatients with admission hyponatremia. The cohort comprised 1000 adults consecutively admitted to a free-standing psychiatric hospital in 2010. Emergency transfer to a general hospital was used as a proxy marker for poor medical outcome. The point prevalence of hyponatremia (sodium level <136mEq/l) at admission was 6.49%. Older age and a diagnosis of arterial hypertension were independent correlates of admission hyponatremia. Medical deteriorations occurred in 26.7% of hyponatremic patients and 13.1% of those with normal sodium levels. Admission hyponatremia is associated with an increased rate of significant medical deteriorations of psychiatric inpatients and should trigger enhanced clinical monitoring to identify and treat somatic disorders.
    03/2012; 198(1):24-7. DOI:10.1016/j.psychres.2012.01.022
  • Source
    Miscellanea on Encephalopathies - A Second Look, 04/2012; , ISBN: 978-953-51-0558-9
  • [Show abstract] [Hide abstract]
    ABSTRACT: A 70-year-old male presented with first episode mania and hyponatremia, which were later corrected with an infusion of hypertonic saline. His clinical condition deteriorated because of adipsic hypernatremia associated with hypokalemic periodic paralysis. Hypernatremia correction and potassium supplementation were started but could not be achieved because of manic symptoms as the patient's oral intake was poor. He was restarted on sodium valproate and olanzapine. Over the next few days, the patient's manic symptoms improved significantly and oral intake improved, which eventually led to correction of hypernatremia. Clinicians should evaluate the existence of electrolyte imbalance while dealing with a case of geriatric mania.
    06/2014; DOI:10.1016/j.jcgg.2013.10.001