II. Pathophysiology

  1. Edematous State reduces effective circulating volume
  2. Decreased flow to nephron diluting segment
  3. Stimulates ADH release

VI. Management

  1. See Hyponatremia Management
  2. Congestive Heart Failure
    1. Salt Restriction <2 to 3 grams/day
    2. Water restriction <1 Liter per day
    3. Decrease contributing Diuretics
    4. Optimize Cardiac Output
  3. Cirrhosis
    1. Water restriction <750 ml per day
    2. Loop Diuretics may be used cautiously in mild Hyponatremia (avoid in moderate to severe Hyponatremia)
  4. Severe Renal Insufficiency
    1. Consider Hemodialysis

VII. References

  1. Kone in Tisher (1993) Nephrology, p. 87-100
  2. Levinsky in Wilson (1991) Harrison's IM, p. 281-84
  3. Rose (1989) Acid-Base and Electrolytes, p. 601-38
  4. Braun (2015) Am Fam Physician 91(5): 299-307 [PubMed]
  5. Miller (2023) Am Fam Physician 108(5): 476-86 [PubMed]

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