Enfrentamiento fisiopatológico del paciente con hiponatremia. Diagnóstico diferencial y tratamiento
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2025
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Abstract
La hiponatremia ([Na+] plasmático <135 mEq/L) es el trastorno hidroelectrolítico más frecuente, sin embargo, no siempre traduce un estado de hipotonía del agua corporal (Osm plasmática <275 mOsm/kg). Los mecanismos subyacentes a una hiponatremia hipotónica son la sobrecarga acuosa y/o una excreción ineficiente de agua libre a nivel renal. Múltiples causas pueden provocar este trastorno, pero reconocer su etiología es un gran desafío. Se requiere una evaluación clínica completa junto a un análisis de laboratorio exhaustivo, ya que no basta un parámetro aislado. La severidad de una hiponatremia depende de la etiología, intensidad y velocidad de instauración, así, un diagnóstico inadecuado junto con una corrección apresurada pueden generar más daño. Por otro lado, existen muchas contro-versias respecto a la mejor forma de realizar un tratamiento óptimo. En esta revisión se presenta un enfoque fisiopatológico que permite interpretar los mecanismos patogénicos, diagnosticar el trastorno y sus causas específicas, corregir el estado de hipotonía y gestionar de manera adecuada y segura al paciente con hiponatremia
Hyponatremia (plasma [Na+] <135 mEq/L) is the most frequent hydroelectrolytic disorder, however, it does not always indicate a state of hypotonic body water (plasma Osm <275 mOsm/kg). The underlying mechanisms of hypotonic hyponatremia are: aqueous over-load and/or inefficient excretion of free water by the kidneys. Multiple diseases can cause this disorder, but recognizing its etiology is a great challenge. A complete clinical evaluation is required along with an exhaustive laboratory analysis, since a single parameter is not enough. The severity of hyponatremia depends on the etiology, intensity and onset speed, thus, an inadequate diagnosis along with a hasty correction can cause more damage. On the other hand, there are many controversies regarding the best way to carry out optimal treatment. This review presents a pathophysiological approach that allows us to interpret the pathogenic mechanisms, diagnose the disorder and its specific causes, correct the state of hypotonia, and adequately and safely manage the patient with hyponatremia
Hyponatremia (plasma [Na+] <135 mEq/L) is the most frequent hydroelectrolytic disorder, however, it does not always indicate a state of hypotonic body water (plasma Osm <275 mOsm/kg). The underlying mechanisms of hypotonic hyponatremia are: aqueous over-load and/or inefficient excretion of free water by the kidneys. Multiple diseases can cause this disorder, but recognizing its etiology is a great challenge. A complete clinical evaluation is required along with an exhaustive laboratory analysis, since a single parameter is not enough. The severity of hyponatremia depends on the etiology, intensity and onset speed, thus, an inadequate diagnosis along with a hasty correction can cause more damage. On the other hand, there are many controversies regarding the best way to carry out optimal treatment. This review presents a pathophysiological approach that allows us to interpret the pathogenic mechanisms, diagnose the disorder and its specific causes, correct the state of hypotonia, and adequately and safely manage the patient with hyponatremia
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Hiponatremia, Osmolalidad, Fisiopatología, SIADH, Solución salina hipertónica, Hyponatremia, Osmolality, Physiopathology, Saline Hypertonic Solutions