What is the relationship between hyponatremia and alcoholism (alcohol use disorder)?

From the Guidelines

Hyponatremia in patients with alcoholism is a significant concern that requires careful management to prevent osmotic demyelination syndrome (ODS) and other complications, with a goal to correct serum sodium levels by 4-8 mEq/L per day, not to exceed 10-12 mEq in a 24-hour period, as recommended by a US expert panel 1. The relationship between hyponatremia and alcoholism is complex, with multiple mechanisms contributing to the development of hyponatremia, including beer potomania, inappropriate ADH secretion, and malnutrition leading to decreased effective circulating volume.

• Alcohol cessation and fluid restriction to 1-1.5 L/day may be sufficient for mild to moderate hyponatremia (sodium 125-135 mEq/L) 1.
• For severe hyponatremia (sodium <125 mEq/L) or symptomatic cases with seizures or altered mental status, 3% hypertonic saline should be administered at 1-2 mL/kg/hr with close monitoring to raise sodium by 4-6 mEq/L in the first 24 hours, not exceeding 8 mEq/L/day to prevent ODS 1.
• Thiamine 100 mg IV or IM daily for 3-5 days should be given before glucose administration to prevent Wernicke's encephalopathy, as patients with alcoholism are prone to deficiencies in water-soluble vitamins, particularly thiamine (B1) 1.
• Concurrent potassium, magnesium, and phosphate deficiencies should be corrected, and long-term management includes nutritional support with B-complex vitamins, alcohol abstinence programs, and regular electrolyte monitoring during the first weeks of sobriety as electrolyte levels may fluctuate during recovery. The risk of ODS may be mitigated with multidisciplinary, coordinated care, and liver transplantation (LT) need not be prohibited by hyponatremia alone, but the decision to proceed with LT must be individualized based on urgency for transplant, severity of hyponatremia, and local expertise 1.

From the FDA Drug Label

You may be more at risk for ODS if you have: • liver disease • not eaten enough for a long period of time (malnourished) • very low sodium level in your blood • been drinking large amounts of alcohol for a long period of time (chronic alcoholism)

The relationship between hyponatremia and alcoholism is that chronic alcoholism may increase the risk of osmotic demyelination syndrome (ODS) in patients with hyponatremia who are being treated with tolvaptan tablets. This is because chronic alcoholism can contribute to the development of hyponatremia and may also increase the risk of complications when treating the condition with tolvaptan 2 2. Key points to consider include:

• Chronic alcoholism is a risk factor for ODS
• Hyponatremia can be a complication of chronic alcoholism
• Tolvaptan tablets may be used to treat hyponatremia, but require careful monitoring and management to minimize the risk of ODS.

From the Research

Relationship between Hyponatremia and Alcoholism

The relationship between hyponatremia and alcoholism is complex, with several factors contributing to the development of hyponatremia in individuals with alcohol use disorder.

• Excessive alcohol consumption can lead to hyponatremia due to several mechanisms, including:
  • Impaired water excretion
  • Increased antidiuretic hormone (ADH) secretion
  • Decreased sodium intake
  • Increased sodium loss
• Hyponatremia can be classified into three types: hypovolemic, euvolemic, and hypervolemic, each with different underlying causes and treatment approaches 3.
• Euvolemic hyponatremia, which is often associated with the syndrome of inappropriate antidiuresis (SIAD), can be caused by various factors, including excessive alcohol consumption 4, 5.
• The diagnosis and treatment of hyponatremia depend on the underlying cause, severity, and symptoms, and may involve fluid restriction, hypertonic saline infusion, or vasopressin antagonists 6, 7.
• Alcohol use disorder is a common cause of hyponatremia, particularly in individuals with liver disease, such as cirrhosis, which can lead to hypervolemic hyponatremia 3, 5.
• The management of hyponatremia in individuals with alcohol use disorder requires a comprehensive approach, including treatment of the underlying liver disease, correction of sodium and water balance, and addressing other comorbidities 3, 7.