Hypotonic Hyponatremia: Diagnosis and Management
10 affiliations
- 1Trauma Research, Swedish Medical Center, Englewood, CO 80113, USA
- 2Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87122, USA
- 3Kidney Institute of New Mexico, University of New Mexico Health Sciences Center, Albuquerque, NM 87122, USA
- 4Raymond G. Murphy Veterans Affairs Medical Center, Albuquerque, NM 87108, USA
- 5Division of Nephrology, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California in San Francisco School of Medicine, San Francisco, CA 94110, USA
- 6Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87122, USA
- 7Division of Renal Diseases and Hypertension, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
- 8Division of Nephrology, Department of Medicine, University of Toledo School of Medicine, Toledo, OH 43614, USA
- 9Division of Nephrology, Department of Medicine, Raymond G. Murphy Veterans Affairs Medical Center, University of New Mexico School of Medicine, Albuquerque, NM 87108, USA
- 10Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
Abstract
The diagnosis and treatment of hyponatremia present challenges to clinicians and opportunities to improve our understanding of body water, sodium and potassium homeostasis and disorders. The first step in the diagnosis of every case of hyponatremia is to categorize it as hypotonic hyponatremia, hypertonic hyponatremia, or pseudohyponatremia. The diagnostic steps that follow the verification of hypotonic hyponatremia include: (a) the identification of the medical condition that caused the hyponatremia; (b) the evaluation of the mechanism of hyponatremia, including the computation of the magnitude of the changes in body water, sodium, and potassium that were responsible for the hyponatremia. Whether the extracellular volume is low, normal, or high provides key information for the determination of the mechanism of hyponatremia and the choice of its treatment method; and (c) the determination of the duration of hyponatremia. Whether hyponatremia is acute or chronic (i.e., lasting more than 48 h) has important implications for its manifestations and management. This perspective reviews the diagnostic categories and various aspects of treatment strategies of hypotonic hyponatremia, including choosing the method(s) for increasing the electrolyte-free renal water clearance, decreasing this clearance during treatment to prevent excessively rapid correction of hyponatremia, determining the type and amount of saline infused for correction of the hyponatremia (choice of isotonic versus hypertonic saline and of the target rise in serum sodium, which determines, along with other parameters, the volume of saline infused), and dialytic methods for correcting hyponatremia. The aim of this perspective is to identify topics that require further research, including diagnostic topics and treatment areas.
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BibTeX
@article{garrett2026hypotonic,
title = {{Hypotonic Hyponatremia: Diagnosis and Management}},
author = {Raymond E. Garrett and Brent Wagner and Ramin Sam and Mark L. Unruh and Susie Q. Lew and Christos P. Argyropoulos and Maria-Eleni Roumelioti and Deepak Malhotra and Mark Rohrscheib and Darlene Vigil and Todd S. Ing and Antonios H. Tzamaloukas},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208056},
url = {https://www.mdpi.com/2077-0383/15/20/8056},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Hypotonic Hyponatremia: Diagnosis and Management
AU - Raymond E. Garrett
AU - Brent Wagner
AU - Ramin Sam
AU - Mark L. Unruh
AU - Susie Q. Lew
AU - Christos P. Argyropoulos
AU - Maria-Eleni Roumelioti
AU - Deepak Malhotra
AU - Mark Rohrscheib
AU - Darlene Vigil
AU - Todd S. Ing
AU - Antonios H. Tzamaloukas
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208056
UR - https://www.mdpi.com/2077-0383/15/20/8056
AB - The diagnosis and treatment of hyponatremia present challenges to clinicians and opportunities to improve our understanding of body water, sodium and potassium homeostasis and disorders. The first step in the diagnosis of every case of hyponatremia is to categorize it as hypotonic hyponatremia, hypertonic hyponatremia, or pseudohyponatremia. The diagnostic steps that follow the verification of hypotonic hyponatremia include: (a) the identification of the medical condition that caused the hyponatremia; (b) the evaluation of the mechanism of hyponatremia, including the computation of the magnitude of the changes in body water, sodium, and potassium that were responsible for the hyponatremia. Whether the extracellular volume is low, normal, or high provides key information for the determination of the mechanism of hyponatremia and the choice of its treatment method; and (c) the determination of the duration of hyponatremia. Whether hyponatremia is acute or chronic (i.e., lasting more than 48 h) has important implications for its manifestations and management. This perspective reviews the diagnostic categories and various aspects of treatment strategies of hypotonic hyponatremia, including choosing the method(s) for increasing the electrolyte-free renal water clearance, decreasing this clearance during treatment to prevent excessively rapid correction of hyponatremia, determining the type and amount of saline infused for correction of the hyponatremia (choice of isotonic versus hypertonic saline and of the target rise in serum sodium, which determines, along with other parameters, the volume of saline infused), and dialytic methods for correcting hyponatremia. The aim of this perspective is to identify topics that require further research, including diagnostic topics and treatment areas.
SN - 2077-0383
ER -