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Clinical practice guideline on diagnosis and treatment of hyponatraemia. - PubMed - NCBI

Clinical practice guideline on diagnosis and treatment of hyponatraemia. - PubMed - NCBI

 2014 Apr;29 Suppl 2:i1-i39. doi: 10.1093/ndt/gfu040. Epub 2014 Feb 25.

Clinical practice guideline on diagnosis and treatment of hyponatraemia.

Erratum in

  • Nephrol Dial Transplant. 2014 Jun;40(6):924.


Hyponatraemia, defined as a serum sodium concentration <135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.

Comment in

[PubMed - indexed for MEDLINE]
2014 Jun 18 8:58 p.m. 3 of 3 people found this helpful
This guideline was discussed on June 10th 2014 on the open online nephrology journal club, #NephJC, on twitter. Introductory comments are available on PBFluids and at the NephJC website. It was quite a spirited discussion, with participation from nephrologists, clinical pharmacologists, internists, and more. A transcript and three different curated (i.e. Storified) versions of the tweetchat are available at the same NephJC link.
On June17th 2014, we conducted a video chat via Google Hangout, among the NephJC editors, Dr Richard Sterns and Dr Hatim Hassan, an archived version of which can be viewed on Youtube.
The highlights of the tweetchat and the hangout were: 1. These guidelines are extensive and exhaustive and will serve as an extremely useful resource for students, residents and practicing physicians. 2. There was widespread agreement that 'asymptomatic' hyponatremia is rarely asymptomatic, and doing away with that qualifier is a good move. 3. The recommendation against use of vasopressin antagonists in chronic hyponatremia is appropriate given lack of superiority in comparison against standard treatment, and possibility of neurological sequelae from rapid correction (and the high cost of these agents remains a concern). 4. The empiric treatment with hypertonic saline in hyponatremic patients with moderate to severe symptoms will be quite handy, particularly since the intricate calculations otherwise needed are often found to be daunting. 5. The lack of strong evidence (made especially apparent by the use of the GRADE methodology) is disappointing, especially given how common hyponatremia is, and highlights a need for future research.
Interested individuals can track and join in the conversation by following @NephJC or #NephJC, or visit the webpage at
This comment is cross-posted at the other two versions of the guidelines also.

National Guideline Clearinghouse | Clinical practice guideline on diagnosis and treatment of hyponatraemia.

National Guideline Clearinghouse (NGC)

European Renal Best Practice
Guideline Title

Clinical practice guideline on diagnosis and treatment of hyponatraemia.

Bibliographic Source(s)
Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, Decaux G, Fenske W, Hoorn EJ, Ichai C, Joannidis M, Soupart A, Zietse R, Haller M, van der Veer S, Van Biesen W, Nagler E, Hyponatraemia Guideline Development Group. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant. 2014 Apr;29 Suppl 2:i1-i39. [247 references]PubMed External Web Site Policy

Guideline Status

This is the current release of the guideline.
This guideline meets NGC's 2013 (revised) inclusion criteria.

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