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Vol. 57. Núm. S2.
Hiponatremia y síndrome de secreción inadecuada de ADH (SIADH)
Páginas 30-40 (Mayo 2010)
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Vol. 57. Núm. S2.
Hiponatremia y síndrome de secreción inadecuada de ADH (SIADH)
Páginas 30-40 (Mayo 2010)
DOI: 10.1016/S1575-0922(10)70020-6
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Managing hyponatremia in patients with syndrome of inappropriate antidiuretic hormone secretion
Manejo de la hiponatremia en pacientes con síndrome de secreción inadecuada de hormona antidiurética
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Joseph G. Verbalis
Division of Endocrinology and Metabolism, Department of Medicine, Georgetown University Medical Center, Washington DC, USA
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Abstract

Disorders of sodium [Na+] and water metabolism are commonly encountered in the hospital setting due to the wide range of disease states that can disrupt the balanced control of water and solute intake and output. In particular, the prompt identification and appropriate management of abnormally low serum [Na+] is critical if we are to reduce the increased morbidity and mortality that accompany hyponatremia in hospitalized patients. Use of an algorithm that is based primarily on the symptomatology of hyponatremic patients, rather than the serum [Na+] or the chronicity of the hyponatremia, will help to choose the correct initial therapy in hospitalized hyponatremic patients. However, careful monitoring of serum [Na+] responses is required in all cases to adjust therapy appropriately in response to changing clinical conditions. Although this approach will enable efficacious and safe treatment of hyponatremic patients with syndrome of inappropriate antidiuretic hormone secretion (SIADH) at the present time, evolving knowledge of the consequences of chronic hyponatremia will likely alter treatment indications and guidelines in the future.

Keywords:
Hiponatremia
Arginina-vasopresina
Osmolalidad
Concentración sérica de sodio
Síndrome de secreción inadecuada de hormona antidiurética
Antagonistas del receptor de la vasopresina
Resumen

Los trastornos del metabolismo del sodio y el agua son habituales en el entorno hospitalario, debido a la amplia gama de estados de la enfermedad que pueden alterar el control equilibrado de la ingesta y salida de solutos y del agua. Concretamente, la identificación inmediata y el manejo adecuado de una concentración sérica de [Na+] anormalmente baja es crucial para reducir el aumento de la morbimortalidad que acompaña a la hiponatremia en los pacientes hospitalizados. El uso de un algoritmo que se basa principalmente en la sintomatología de los pacientes hiponatrémicos, en vez de en el [Na+] sérico o la cronicidad de la hiponatremia, ayudará a elegir el tratamiento correcto inicial para los pacientes hiponatrémicos hospitalizados. Sin embargo, en todos los casos, es preciso realizar una supervisión cuidadosa de la respuesta del [Na+] sérico para ajustar el tratamiento de forma adecuada, dependiendo de los cambios observados en las condiciones clínicas. Aunque en la actualidad este enfoque permitirá un tratamiento más eficaz y seguro de los pacientes hiponatrémicos con SIADH, la evolución del conocimiento sobre las consecuencias de la hiponatremia crónica, probablemente, alterará en el futuro las indicaciones y las directrices para el tratamiento.

Palabras clave:
Hyponatremia
Arginine vasopressin
Osmolality
Serum sodium concentration
Syndrome of inappropriate antidiuretic hormone secretion
Vasopressin receptor antagonists
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