From the Guidelines
Hyponatremia symptoms vary depending on severity and how quickly sodium levels drop, with mild symptoms including headache, nausea, vomiting, fatigue, muscle cramps, and irritability, and more severe symptoms such as confusion, disorientation, seizures, and in severe cases, coma or death, as noted in the 2021 guidelines by the American Association for the Study of Liver Diseases 1.
Symptoms of Hyponatremia
The symptoms of hyponatremia can be categorized based on the severity of the condition.
- Mild symptoms:
- Headache
- Nausea
- Vomiting
- Fatigue
- Muscle cramps
- Irritability
- Severe symptoms:
- Confusion
- Disorientation
- Seizures
- Coma or death
Severity and Onset of Symptoms
Symptoms typically appear when blood sodium levels fall below 135 mEq/L and become more pronounced below 130 mEq/L, as stated in the example answer. The brain is particularly sensitive to sodium imbalances, which explains the neurological symptoms, and rapid drops in sodium are more dangerous than gradual decreases, as the brain has less time to adapt 1.
Risk Factors
Risk factors for hyponatremia include certain medications (diuretics, antidepressants, pain medications), excessive water intake, heart failure, kidney disease, liver disease, and hormonal conditions like SIADH (Syndrome of Inappropriate Antidiuretic Hormone secretion) 1. If you experience these symptoms, especially neurological ones, seek immediate medical attention as proper diagnosis requires blood tests and treatment depends on the underlying cause and severity, as emphasized in the guidelines by the American Association for the Study of Liver Diseases 1.
From the Research
Symptoms of Hyponatremia
The symptoms of hyponatremia can range from mild to severe and life-threatening. Some common symptoms include:
- Nausea and vomiting
- Weakness
- Headache
- Mild neurocognitive deficits
- Delirium
- Confusion
- Impaired consciousness
- Ataxia
- Seizures
- Brain herniation and death in severe cases 2, 3
Severity of Symptoms
The severity of symptoms depends on the rapidity of development, duration, and severity of hyponatremia. Mild chronic hyponatremia can cause:
- Cognitive impairment
- Gait disturbances
- Increased rates of falls and fractures 2 Severe hyponatremia can cause somnolence, obtundation, coma, seizures, or cardiorespiratory distress, which is a medical emergency 2, 3
Classification of Hyponatremia
Hyponatremia can be classified into three categories based on fluid volume status:
- Hypovolemic hyponatremia
- Euvolemic hyponatremia
- Hypervolemic hyponatremia Each category has different treatment approaches, including fluid restriction, diuretics, and vasopressin receptor antagonists 2, 3, 4
Treatment of Hyponatremia
Treatment of hyponatremia depends on the underlying cause and severity of symptoms. For severely symptomatic hyponatremia, bolus hypertonic saline is recommended to reverse hyponatremic encephalopathy 2, 3. Vasopressin receptor antagonists can be effective in managing euvolemic and hypervolemic hyponatremia 4, 5, 6