Hyponatremia in patients with decompensated heart failure

Main Article Content

V. I. Tseluyko
N. E. Mishchuk
L. V. Ivanitska


Lecture is devoted to hyponatremia (HNa), the most common electrolyte disturbance in hospitalized patients, which is related to the risk of potentially life-threatening complications and prognosis worsening. Etiology factors and pathophysiological mechanisms of HNa development, particularly in patients with decompensated heart failure (HF), are considered, as well as clinical manifestations of acute and chronic HNa. Clinical interpretation algorithm for HNa, diagnostics and differential diagnostic, principles of initial and long-term management of HF patients with certain type of HNa are discussed. Practical management of the patient with severe HF complicated with HNa is illustrated with clinical case.

Article Details


electrolyte disturbances, hyponatremia, heart failure


Настанова 00506. Гіпонатріємія / Настанови на засадах доказової медицини. Створені DUODECIM Medical Publications, 2018-08-22 http://guidelines.moz.gov.ua/documents/ 2918?id=ebm00506&format=pdf

Abebe T.B., Gebreyohannes E.A., Tefera Y.G., Bhagavathula A.S., Erku D.A., Belachew S.A., et al. (2018) The prognosis of heart failure patients: Does sodium level play a significant role? PLoS ONE 13(11): e0207242. https://doi.org/10.1371/ journal.pone.0207242.

Adrogué H.J., Tucker B.M., Madias N.E. Diagnosis and Management of Hyponatremia: A Review. JAMA. 2022;328(3):280-91. doi: https://doi.org/10.1001/jama.2022.11176. PMID: 35852524 Review.

Agrawal V., Agarwal M., Joshi S.R., Ghosh A.K. Hyponatremia and hypernatremia: disorders of water balance. J Assoc Physicians India. 2008 Dec;56:956-64. PMID: 19322975 Review.

Assadi F.J. Hyponatremia: a problem-solving approach to clinical cases. Nephrol. 2012;25(4):473-80. doi: https://doi.org/10.5301/jn.5000060.

Broun M.M., Barstow C.H., Pyzocha N.J. Diagnosis and management of sodium disorders: hyponatremia and hypernatremia. Am Fam Physician. 2015;91(5):299-307.

Braun M.M., Mahowald M. Electrolytes: Sodium Disorders. FP Essent. 2017;459:11-20.

Dunlap M.E., Hauptman P.J., Amin A.N., Chase S.L., Chiodo J.A. 3rd, Chiong JR, Dasta JF. Current management of hyponatremia in acute heart failure: A report from the hyponatremia registry for patients with euvolemic and hypervolemic hyponatremia (HN Registry). J Am Heart Assoc. 2017;6(8):e005261. doi: https://doi.org/10.1161/JAHA.116.005261. PMID: 28775063; PMCID: PMC5586406.

Filippatos T.D., Elisaf M.S. Hyponatremia in patients with heart failure / World J Cardiol 2013; 5(9): 317-328 Available from: URL: http://www.wjgnet.com/1949-8462/full/v5/i9/317.htm DOI: http://dx.doi.org/10.4330/wjc.v5.i9.317.

Greenberg A., Verbalis J.G., Amin A.N. Current treatment practice and outcomes. Report of the hyponatremia registry / Kidney Int. 2015 Jul;88(1):167-77. doi: https://doi.org/10.1038/ki.2015.4.

Jao G.T., Chiong J.R. Hyponatremia in acute decompensated heart failure: mechanisms, prognosis, and treatment options. Clin Cardiol. 2010;33(11):666-71. doi: https://doi.org/10.1002/clc.20822. PMID: 21089110; PMCID: PMC6653540.

Kheetan M., Ogu I., Shapiro J.I., Khitan Z.J. Acute and Chronic Hyponatremia. Front Med (Lausanne). 2021;8:693738.

doi: https://doi.org/10.3389/fmed.2021.693738. PMID: 34414205; PMCID: PMC8369240.

Lawless S.J., Thompson C., Garrahy A. The management of acute and chronic hyponatraemia. Ther Adv Endocrinol Metab. 2022;13:20420188221097343. doi: https://doi.org/10.1177/20420188221097343. PMID: 35586730; PMCID: PMC9109487.

Martin-Grace J., Tomkins M., O’Reilly M.W. et al. Approach to the Patient: Hyponatremia and the Syndrome of Inappropriate Antidiuresis (SIAD). J Clin Endocrinol Metab. 2022;107(8):2362-2376. doi: 10.1210/clinem/dgac245.

Mohiuddin N., Frinak S., Yee J. Sodium-based osmotherapy for hyponatremia in acute decompensated heart failure. Heart Fail Rev 27, 379–391 (2022). https://doi.org/10.1007/s10741-021-10124-7.

Saepudin S., Ball P.A., Morrissey H. Hyponatremia during hospitalization and in-hospital mortality in patients hospitalized from heart failure. BMC Cardiovasc Disord. 2015;15:88. doi: https://doi.org/10.1186/s12872-015-0082-5. PMID: 26271263; PMCID: PMC4542119.

Sahay M., Sahay R. Hyponatremia: A practical approach. Indian J Endocrinol Metab. 2014;18(6):760-71. doi: https://doi.org/10.4103/2230-8210.141320. PMID: 25364669; PMCID: PMC4192979.

Urso C, Brucculeri S, Caimi G. Acid-base and electrolyte abnormalities in heart failure: pathophysiology and implications. Heart Fail Rev. 2015 Jul;20(4):493-503. doi: https://doi.org/10.1007/s10741-015-9482-y. PMID: 25820346; PMCID: PMC4464645.

Verbrugge F.H., Steels P., Grieten L., Nijst P., Tang W.H., Mullens W. Hyponatremia in acute decompensated heart failure: depletion versus dilution. J Am Coll Cardiol. 2015;65(5):480-92. doi: https://doi.org/10.1016/j.jacc.2014.12.010. PMID: 25660927.

Wang J., Zhou W., Yin X. Improvement of hyponatremia is associated with lower mortality risk in patients with acute decompensated heart failure: a meta-analysis of cohort studies. Heart Fail Rev 24:209–217. https://doi.org/10.1007/s10741-018-9753-5.

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