How does hyponatremia cause death

The link between chronic hyponatremia and senescence seems to be supported by the recent evidence that chronic hyponatremia exacerbated multiple manifestations of senescence, such as osteoporosis, hypogonadism, increased body fat and sarcopenia, in male rats [ 79 ].

In this new scenario, the understanding of the potential direct effects of chronic hyponatremia on the brain, which is one of the main targets of both hyponatremia and senescence, appears to be of particular interest.

Interestingly, the expression of the heme oxygenase HMOX-1 gene showed the highest increase. HMOX-1 encodes an inducible stress protein involved in heme turnover [ 81 ], which exerts a potent antioxidant and anti-apoptotic activity in various cells, in particular in neurons [ 82 ]. In the brain, HMOX-1 expression increases in response to oxidative stress and protects neuronal cells from oxidative damage such as that caused by cerebral ischemia [ 83 ] or ethanol intoxication [ 84 ].

These findings are in agreement with those demonstrated by Barsony et al. Admittedly, these original results may be a key to understanding the presence of signs and symptoms in chronic hyponatremia despite the presence of adaptive mechanisms.

Hyponatremia is a very common electrolyte disorder, especially in the elderly. The consequences of hyponatremia, in particular when acute, on the brain may be clinically evident and severe, including permanent disability or death. An overly rapid correction of hyponatremia may also expose patients to dramatic consequences.

Furthermore, it is necessary to also carefully consider chronic hyponatremia, apparently a benign condition, which has been found to be associated with systemic detrimental effects and with a senescence effect. Recent findings indicated that low sodium per se is able to disrupt cell homeostasis and this may explain some of the signs and symptoms described in mild chronic hyponatremia.

Nevertheless, further studies are necessary to clearly elucidate the molecular mechanisms involved in the response to low sodium and their reversibility following correct therapeutic strategies. The authors wish to thank Susanna Benvenuti, Paola Luciani, Cristiana Deledda, Benedetta Fibbi, Giulia Modi and Alessandro Bossio for their essential support in performing the experimental work reported in this review. Drafting of the manuscript: Corinna Giuliani; Critical revision of the manuscript for important intellettual content: Alessandro Peri; Experimental work: Corinna Giuliani; Experimental supervision: Alessandro Peri.

Alessandro Peri is on the Otsuka Pharmaceutical advisory board for tolvaptan and has received honoraria from Otsuka Pharmaceutical for speaking at symposia; Corinna Giuliani has no competing interests. National Center for Biotechnology Information , U. Journal List J Clin Med v. J Clin Med. Published online Oct Lewis S.

Blevins, External Editor. Author information Article notes Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Hyponatremia is a very common electrolyte disorder, especially in the elderly, and is associated with significant morbidity, mortality and disability. Keywords: hyponatremia, hyponatremic encephalopathy, osmotic demyelination syndrome, brain. Open in a separate window. Figure 1. Figure 2. Figure 3. From Pathophysiology to Clinical Practice 3.

Hyponatremic Encephalopathy Hyponatremic encephalopathy is defined as central nervous system dysfunction due to hyponatremia and occurs when brain fails in regulating its volume, such as in acute hyponatremia or when other risk factors are present [ 8 ].

Table 1 Clinical features of hyponatremic encephalopathy. Chronic Hyponatremia Chronic hyponatremia has been traditionally defined as an asymptomatic condition because of the previously described adaptive mechanisms that counteract brain swelling. Osmotic Demyelination Syndrome ODS was recognized for the first time as a complication of an overly rapid correction of hyponatremia in [ 59 ].

Table 2 Signs and symptoms of osmotic demyelination syndrome ODS. Conclusions Hyponatremia is a very common electrolyte disorder, especially in the elderly. Author Contributions Drafting of the manuscript: Corinna Giuliani; Critical revision of the manuscript for important intellettual content: Alessandro Peri; Experimental work: Corinna Giuliani; Experimental supervision: Alessandro Peri. Conflicts of Interest Alessandro Peri is on the Otsuka Pharmaceutical advisory board for tolvaptan and has received honoraria from Otsuka Pharmaceutical for speaking at symposia; Corinna Giuliani has no competing interests.

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Schrier R. Gankam K. Mild hyponatremia and risk of fracture in the ambulatory elderly. Kinsella S. Hyponatremia independent of osteoporosis is associated with fracture occurrence. Hyponatremia-induced osteoporosis. Bone Miner. Barsony J. Depending on the extent and duration of these signs and symptoms, your doctor may recommend seeking immediate medical care.

Sodium plays a key role in your body. It helps maintain normal blood pressure, supports the work of your nerves and muscles, and regulates your body's fluid balance. In chronic hyponatremia, sodium levels drop gradually over 48 hours or longer — and symptoms and complications are typically more moderate. In acute hyponatremia, sodium levels drop rapidly — resulting in potentially dangerous effects, such as rapid brain swelling, which can result in a coma and death.

Premenopausal women appear to be at the greatest risk of hyponatremia-related brain damage. This may be related to the effect of women's sex hormones on the body's ability to balance sodium levels. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

This content does not have an English version. This content does not have an Arabic version. Overview Hyponatremia occurs when the concentration of sodium in your blood is abnormally low.

Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Jameson JL, et al. Hyponatremia and hypernatremia. In: Endocrinology: Adult and Pediatric. Philadelphia, Pa. Accessed April 6, Bope ET, et al. In: Conn's Current Therapy