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Dehydration with hyponatremia: Hyponatremia (Low Sodium) Treatment, Causes, Symptoms

Hypernatremia and Hyponatremia: What Is the Difference?

Written by WebMD Editorial Contributors

  • What Is Dehydration?
  • Types of Dehydration
  • Treatment for Dehydration
  • When to Call a Doctor

It’s a well-known fact that the human body is more than 60% fluid. In addition to water, your bodily fluids contain vitamins, minerals, and other nutrients that keep the body functioning well. Sodium – an electrolyte – is a critical nutrient for all people. Everyone needs a certain amount of it in their bodies.

If the balance of fluids and sodium is upset, you can experience hypernatremia – having too much sodium and not enough fluid. Or you can experience hyponatremia – having too much fluid and not enough sodium. Both of these conditions can be the result of dehydration.

Dehydration is what happens when your body doesn’t have enough fluids to carry out all its normal functions. Your body needs a balance of water and enough of the nutrients known as electrolytes to work properly. If you dip below the ideal levels for either of those things, you can experience symptoms of dehydration. 

You become dehydrated when you lose fluids and electrolytes, particularly sodium, but you don’t replace them by eating or drinking. Fluids leave your body through sweating, urination, and in the vapor that you breathe out from your lungs. You can lose fluids rapidly due to: 

  • Diarrhea
  • Vomiting
  • Excessive sweating
  • Fever
  • As a side effect of some medications

When you lose a balanced combination of sodium and water, you experience isotonic dehydration. This means both your fluid levels and your sodium levels are lower than they should be. You will need to replace both fluids and sodium if this happens.  

There are also cases where you can lose mainly fluid or mainly sodium. Losing mainly fluid is known as hypertonic dehydration – or hypernatremia. Losing mainly sodium is known as hypotonic dehydration – or hyponatremia.

Hypertonic dehydration (hypernatremia). Hypertonic dehydration happens when you lose water from your body but don’t lose an equal quantity of electrolytes, specifically sodium. You will have too high a sodium concentration in your blood and other bodily fluids. Typically, this causes you to feel thirsty, so that you want to drink water to replace the fluids you lost.

In some cases, you may be losing fluids faster than you can replace them. This may happen due to:‌

  • Vomiting
  • Diarrhea
  • Use of diuretics
  • Excessive sweating
  • Frequent urination due to high blood sugar
  • Kidney disease

If hypernatremia isn’t treated, you could experience worsening thirst. You could go on to develop confusion, muscle twitches, or seizures. In severe cases, hypernatremia can lead to coma and death.

Hypotonic dehydration (hyponatremia). Hyponatremia is what happens when you have too little sodium in your body. This can happen if you lose electrolytes and fluids together but only replace the lost fluids. It may happen if you drink only water and don’t take in other nutrients after losing a lot of fluids from sweating. Doing this will cause an imbalance of fluids and electrolytes.

Hyponatremia can also be the result of some diseases. Some causes of hyponatremia include:‌

  • Kidney failure 
  • Heart failure
  • Liver cirrhosis 
  • Use of diuretics
  • Certain medications, including chemotherapy drugs, anti-seizure medications, or anti-inflammatory drugs
  • Pancreatitis
  • Peritonitis
  • Addison’s disease

You might not feel thirsty if you are experiencing hyponatremia, because your fluid levels may be normal. Instead, the first symptoms of hyponatremia may be sluggishness and confusion. Without treatment, you may develop muscle twitches or seizures. Eventually, you could lapse into a coma or die. 

Treatment for all types of dehydration involves replacing fluids and electrolytes in your body. In the case of mild dehydration, you can drink fluids that contain a combination of water and other ingredients to replace salt and other lost nutrients. Sports drinks or rehydration beverages with electrolytes are one option for rehydrating yourself. 

Another option is to drink water and eat a snack to get fluids and sodium into your body. Juice and soda may make diarrhea worse, so use caution in drinking those.

If you or another adult have the following symptoms of severe dehydration, you should seek medical attention:

  • Confusion
  • Dizziness
  • Infrequent urination
  • Dark-colored urine
  • Fatigue

Severe dehydration symptoms in young children and babies include:‌

  • Sunken soft spot on top of the skull
  • Irritable or listless
  • Dry mouth
  • No tears when crying
  • No wet diapers for 3 hours

A doctor will measure the sodium levels in your blood to determine what type of dehydration you have. Once they know that, they will give you fluids or an electrolyte solution. You may need to have this through an intravenous needle (IV) to speed up your recovery.

Dehydration is a serious health issue. You can prevent dehydration by eating a balanced diet and drinking fluids, especially during exertion or hot weather. If you have underlying conditions that make you susceptible to dehydration, speak to your doctor about what you can do to stay safe. 

Top Picks

Dehydration, Hypernatremia, and Hyponatremia – PubMed


. 2015 Aug;31(3):389-99.

doi: 10. 1016/j.cger.2015.04.007.

Epub 2015 May 11.

John E Morley 



  • 1 Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, 1402 South Grand Boulevard, M238, St Louis, MO 63104, USA. Electronic address: [email protected].
  • PMID:


  • DOI:



John E Morley.

Clin Geriatr Med.

2015 Aug.

. 2015 Aug;31(3):389-99.

doi: 10. 1016/j.cger.2015.04.007.

Epub 2015 May 11.


John E Morley 


  • 1 Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, 1402 South Grand Boulevard, M238, St Louis, MO 63104, USA. Electronic address: [email protected].
  • PMID:


  • DOI:



Disturbances of serum sodium are one of the most common findings in older persons. They are also a major cause of hospital admissions and delirium and are associated with frailty, falls, and hip fractures. Both hypernatremia and hyponatremia are potentially preventable. Treatment involves treating the underlying cause and restoring sodium and volume status to normal. The arginine vasopressin antagonists, vaptans, have increased the therapeutic armamentarium available to physicians.


Aging; Dehydration; Electrolytes; Hypernatremia; Hyponatremia; Osmolality; SIADH; Thirst.

Copyright © 2015 Elsevier Inc. All rights reserved.

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What is hyponatremia and how to avoid it

We have repeatedly mentioned the importance of drinking regimen during sports. The myth that you can’t take a sip of water during training has long been a thing of the past. On the contrary, more and more coaches and doctors are talking about how important it is to stay hydrated during heavy loads.

However, lack of fluid is not the only danger that threatens the long-distance runner. Along with sweat, we also lose salt, and then we exacerbate this process by pouring glass after glass of water on the run. This can lead to a significant reduction in plasma electrolytes and a dangerous state of hyponatremia.

What is this symptom and how to deal with it, we will describe in detail in this article.

Photo: Dina Rudick/Globe Staff

What is hyponatremia?

The term “hyponatremia” itself can be translated as “lack of sodium”, that is, in fact, salt deficiency. Sodium is the key electrolyte found in the intercellular space: it accounts for more than 60% of the total electrolytes. It is necessary in order to transmit impulses from muscle contraction and provide motor activity.

The normal concentration of sodium in human plasma is 135-145 mmol/l. With a slight decrease in these indicators, doctors diagnose a mild form of hyponatremia. The athlete may not even immediately understand that something is wrong with him. In the event that the plasma sodium concentration falls below 125 mmol / l, the symptoms become more pronounced and may require medical attention.

Types of hyponatremia

Depending on the concentration of electrolytes in the blood volume, hyponatremia is divided into three types:

  1. Hypovolemia – insufficient volume of interstitial fluid, dehydration.
  2. Hypervolemia – excess volume of fluid in relation to salts.
  3. Euvolemia is a condition that develops at a normal concentration of sodium in the blood plasma due to an imbalance of the antidiuretic hormone.

For athletes, the first two types are most typical. The risk of hypervolemia during running occurs when an athlete consumes a lot of pure water or other unsalted drinks during the race. At the same time, minerals are excreted from the body along with sweat, and if you do not replenish their supply, then gradually the electrolyte balance in the body is disturbed.

Read on the topic: Isotonic: what is it for, how to choose and use it correctly

Hypovolemia has the opposite causes, but similar symptoms. Non-compliance with the drinking regimen in general and too little water consumed can lead to this condition.

Symptoms of hyponatremia

The severity of symptoms depends on the extent and speed of the fall in plasma sodium levels. Signs of hyponatremia in the initial stages: weakness, irritability, swelling of the extremities. Due to the decrease in concentration, the risk of stumbling and getting injured increases.

But these are all very non-specific signs, especially when it comes to endurance sports. Indeed, for ultramarathon runners, legs tangled from fatigue are a familiar phenomenon.

Experienced runners know that swollen fingers are already a dangerous symptom. This moment is easier to track and even feel if the rings begin to squeeze the skin unpleasantly. Also, scarce and rare excretion of fluid from the body should alert: this means that the kidneys cannot cope with the load.

Photo: trailrunplanet.com

If timely action is not taken, plasma sodium levels will continue to decline. Severe hyponatremia may be accompanied by convulsions, headaches, and vomiting. When the concentration of sodium ions decreases to 115 mmol / l, neurological problems that are life-threatening may occur.

Risk factors

Hyponatremia can affect any athlete, but there are several key risk factors:

  1. Distance

The incidence of hyponatremia has increased more frequently in recent years as endurance sports become more popular. The longer the athlete is on the course, the more attention he needs to pay to electrolytic balance.

  1. Hot weather

Together with sweat, we lose not only fluids, but also salt. When we are thirsty, we often drink more water than we need. And thereby further reduce the concentration of serum sodium.

  1. Excessive or insufficient fluid intake

Dehydration at a distance leads to the same symptoms as excessive drinking: weakness, swelling of the limbs, dullness of attention.

  1. Female gender

According to statistics, women suffer from hyponatremia more often than men. This may be due not only to hormonal characteristics. Even with the same body weight, the amount of intercellular fluid in the female body is less, so reducing its volume is more critical.

How to treat hyponatremia

If the serum sodium concentration has fallen slightly, then the intake of electrolytic solutions and even ordinary table salt will immediately improve the condition. A runner who suspects symptoms of hyponatremia may be helped by a glass of isotonic drink or a salty meal at the food station.

In acute and severe forms of hyponatremia, physicians use intravenous administration of a 3% NaCl solution in a volume of up to 150 ml in 20 minutes with a dropper. After that, the patient’s condition is assessed, and, if necessary, the procedure is repeated until the serum sodium concentration rises by at least 5 mmol / l.

After that, the treatment continues, but a less concentrated solution is used for droppers: only up to 0.9% NaCl. In this case, it is important not to rush, since a sharp increase in serum sodium for the patient is just as dangerous as a decrease.

How to avoid hyponatremia

To maintain the water-salt balance, it is recommended to monitor the level of electrolytes during heavy exercise. This is especially true in summer races during the heat, when sweating is especially active. In this case, it is better to drink often, but a little bit.

Instead of pure water, it is better to use an isotonic solution containing the required portion of electrolytes. Such a drink can not only be purchased at sports nutrition stores, but also prepared independently on the basis of ordinary table salt. A convenient option, especially for long races, will be salt tablets, which contain a concentrated portion of several minerals at once: sodium, potassium, magnesium and calcium.

Useful material: Salt tablets for running: what they are, how they work, when to use them

The organizers know what runners need, so food stations can also find something suitable to maintain electrolyte balance. Usually marathons offer salted peanuts or some snacks, and pickles are especially popular at Russian starts.

Although severe forms of hyponatremia are dangerous and require hospital treatment, the condition is not that difficult to prevent. The main thing is to be attentive to your feelings at a distance and not just hope to endure to the finish line on willpower.

Isotonics, saline tablets and electrolyte gels are not used by runners to splurge on trendy sports nutrition – they are really effective tools that will help to complete the distance without loss.

Read more: How much water should runners drink

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differences, causes and treatments


  • 1 Acute and chronic hyponatremia
    • 1. 1 Hyponatremia: main aspects
    • 1.2 Definition and classification of hyponatremia
    • 1.3 Prevalence of hyponatremia
    • 1.4 Acute acute hyponatremia
    • 1.5 Causes of acute hyponatremia
    • 1.6 Symptoms and diagnosis of acute hyponatremia
    • 1.7 Treatment options for acute hyponatremia
    • 1.8 Chronic hyponatremia
    • 1.9 Causes of chronic hyponatremia
    • 1.10 Symptoms and diagnosis of chronic hyponatremia
    • 1.11 Treatment of chronic hyponatremia
    • 1.12 Related videos:
    • 1.13 Q&A:
        • 1.1 3.0.1 How to distinguish between acute and chronic hyponatremia?
        • What are the causes of acute hyponatremia?
        • How to treat acute and chronic hyponatremia?

Acute and chronic hyponatremia are problems with low sodium levels in the blood that can lead to serious complications. Learn about the causes, symptoms, and treatments for this disease to maintain health and well-being.

Hyponatremia is a condition in which the concentration of sodium in the blood is low. It can be acute or chronic. Acute hyponatremia occurs suddenly and can be caused by a variety of causes, such as dehydration, drinking too much water, or problems with kidney function. Chronic hyponatremia, in turn, develops gradually and may indicate the presence of serious diseases, such as chronic renal failure or diabetes.

Acute hyponatremia is considered a medical emergency requiring immediate attention, as low sodium levels in the blood can seriously affect brain and nervous system function. Treatment for acute hyponatremia often includes water restriction, electrolyte management, and elimination of the underlying cause. Chronic hyponatremia, in contrast, requires a longer and more careful approach to treatment.

Causes of hyponatremia can be varied and depend on the type of disease. Acute hyponatremia is often associated with emergency conditions such as heart failure, acute renal failure, or water intolerance syndrome. Chronic hyponatremia, in turn, can be caused by diseases that interfere with normal kidney or nervous system function, such as diabetes, chronic kidney failure, or uncontrolled water intake.

It is important to note that hyponatremia can be a dangerous condition that requires medical supervision and treatment. Overtreatment or mistreatment of hyponatremia can lead to serious complications such as cerebral edema or heart problems. Therefore, at the first signs of hyponatremia, medical attention should be sought.

Hyponatremia: basics

Hyponatremia is a condition in which the level of sodium in the blood falls below normal. Sodium is one of the main electrolytes in the body and plays an important role in maintaining fluid balance and cell function.

The causes of hyponatremia can be varied. Some of these include loss of sodium through the kidneys, increased drinking of water, malnutrition, and certain medical conditions such as heart failure and inappropriate antidiuretic hormone release syndrome.

Treatment of hyponatremia depends on its cause and severity. In some cases, dietary adjustments and an increase in sodium intake may be required. For an acute case of hyponatremia, drugs may be used to remove excess water from the body and restore normal sodium levels.

Definition and classification of hyponatremia

Hyponatremia is a condition in which there is low sodium in the blood. Sodium is one of the main electrolytes in the body and performs important functions, such as the regulation of water balance and the normalization of pressure. Hyponatremia can occur both due to acute sodium deficiency and due to a chronic decrease in its level in the blood.

Hyponatremia is classified based on the severity and speed of the condition. The severity of hyponatremia is determined by the level of sodium in the blood. The generally accepted classification is as follows:

  • Mild hyponatremia – the sodium content in the blood is 130-134 mmol / l.
  • Moderate hyponatremia – sodium content in the blood is 125-129 mmol/l.
  • Severe hyponatremia – blood sodium is less than 125 mmol/l.

According to the rate of development, hyponatremia can be acute or chronic. Acute hyponatremia develops over hours or days, while chronic hyponatremia develops gradually and may last for months or even years. Depending on the cause of hyponatremia, it may present with different symptoms and require appropriate treatment.

Prevalence of hyponatremia

Hyponatremia, or low sodium levels in the blood, is a fairly common condition. It can occur as an acute pathology or be chronic. Estimating the exact prevalence of hyponatremia is difficult because it can be underestimated or misdiagnosed.

The prevalence of hyponatremia varies by population, age group and the presence of risk factors. For example, in hospitalized patients, the prevalence of hyponatremia is about 15-30%. In older people, this number may be higher, as they often have comorbidities and salt imbalances.

More research and statistics are needed to determine the exact prevalence of hyponatremia, as well as generally accepted criteria for the diagnosis and classification of this disease. This will allow more effective identification of patients with hyponatremia and timely treatment to prevent complications.

Acute hyponatremia

Acute hyponatremia is a body condition in which the level of sodium in the blood falls dangerously low over a short period of time. This can lead to serious health consequences and requires immediate intervention.

In acute hyponatremia, sodium homeostasis in the body is disturbed, which causes an imbalance in water and electrolyte metabolism. An abnormally low sodium level in the blood can be caused by a variety of causes, including sodium loss through the kidneys, increased fluid loss due to vomiting, diarrhea, or sweating, and insufficient dietary sodium intake.

Treatment of acute hyponatremia may include a complication of hyponatremia treatment: correction of the underlying disease, the appointment of a controlled salt load, restriction of fluid intake, the use of intravenous infusion of saline solutions. To prevent acute hyponatremia, it is recommended to maintain an adequate intake of sodium and water, as well as regularly monitor the level of sodium in the blood.

Causes of acute hyponatremia

Acute hyponatremia, characterized by low sodium levels in the blood, can be caused by various factors.

One cause of acute hyponatremia is excessive water intake. In the practice of intensive drinking without adequate compensation for the loss of electrolytes, dilution of blood serum and a decrease in sodium concentration occur.

Acute hyponatremia can also be caused by the ingestion of large volumes of water through intravenous fluids, as well as drinking large volumes of hypotonic drinks.

Another cause of acute hyponatremia may be a lack of salt in the diet. When eating foods low in sodium and salt, the concentration of sodium in the blood decreases.

Some drugs may also cause acute hyponatremia. It can occur as a side effect when taking drugs that affect sodium homeostasis in the body.

In addition, acute hyponatremia may result from endocrine disorders such as antidiuretic hormone deficiency syndrome, incipient diabetes mellitus, and other thyroid and adrenal disorders.

Symptoms and diagnosis of acute hyponatremia

Acute hyponatremia, which is characterized by low levels of sodium in the blood, can cause various symptoms and complications. However, symptoms can vary depending on the rate at which hyponatremia develops and its cause.

Diagnosis of acute hyponatremia requires a blood test for sodium levels. If the sodium level is less than 135 mmol / l, then it is recommended to conduct additional studies to find out the cause of hyponatremia. It is important to determine whether hyponatremia is true or pseudohyponatremia.

Additional tests, such as urinary sodium levels and body fluid volume, are done to assess the severity and presence of complications of hyponatremia. Additional examination methods are also used, including computed tomography of the brain and electrocardiography.

It is important to remember that the treatment of acute hyponatremia must be prescribed by a doctor and depends on the cause. Mild hyponatremia may suffice with changes in drinking and diet, while more severe cases may require hospitalization and fluid therapy.

Treatments for acute hyponatremia

1. Correction of sodium levels in the blood

Treatment of acute hyponatremia is aimed at increasing the level of sodium in the blood to normal values. Various methods can be used for this, including limiting water intake and prescribing drugs that promote sodium retention in the body.

2. Maintaining the correct balance of water and electrolytes

In acute hyponatremia, it is also important to restore not only the level of sodium, but also the correct balance of water and electrolytes in the body. For this, infusion of salts, regulation of the volume of fluid consumed and the appointment of drugs that affect the secretion of vasopressin can be used.

3. Treatment of the underlying disease

Acute hyponatremia may result from other diseases such as extensive burns, heart failure or malignant tumors. In such cases, it is also necessary to treat the underlying disease in order to eliminate the cause of hyponatremia.

4. Long-term observation and correction

After the main treatment, it is necessary to carry out a long-term monitoring of sodium levels in the blood and, if necessary, adjust the treatment. This helps prevent the recurrence of acute hyponatremia and maintain normal sodium levels in the body.

5. Identification and treatment of major risk factors

To prevent recurrence of acute hyponatremia, major risk factors such as long-term use of certain drugs, fluid imbalances, chronic diseases, and others must be identified and treated.

Chronic hyponatremia

Chronic hyponatremia is a condition in which the level of sodium in the blood decreases over an extended period of time. It differs from acute hyponatremia, which develops quickly and requires urgent treatment.

Symptoms of chronic hyponatremia can be varied and include fatigue and weakness, headache, impaired consciousness, convulsions, nausea and vomiting. There may also be disturbances in the functioning of the heart and deterioration in kidney function.

Diagnosis of chronic hyponatremia requires measuring the sodium level in the blood and determining its dynamics over several weeks or months. Additional studies are also being conducted to identify the cause of the development of hyponatremia.

Treatment of chronic hyponatremia may include water restriction, increased salt intake, dietary modification, drugs that increase water retention or increase urinary sodium excretion. In some cases, surgery may be required to correct the cause of the hyponatremia.

Causes of chronic hyponatremia

Chronic hyponatremia is a condition characterized by a low level of sodium in the blood over a long period of time. These may be the following reasons:

  1. Excessive water intake: With prolonged and pathological thirst, a person may consume excess water, which leads to a dilution of electrolytes in the body, including sodium.
  2. Abnormal increase in vasopressin production: Vasopressin, also known as antidiuretic hormone (ADH), controls water regulation in the body. Its excess excretion can reduce the level of sodium in the blood.
  3. Renal insufficiency: chronic renal insufficiency may impair the function of the kidneys to excrete excess water and electrolytes, including sodium.
  4. Use of certain drugs: Some drugs, such as thiazide diuretics, may contribute to sodium loss and chronic hyponatremia.
  5. Insufficient salt intake: Lack of salt in the diet can reduce sodium levels in the body.

Signs of chronic hyponatremia may be subtle and subtle, but prolonged low sodium levels can lead to serious complications such as nervous system disorders, muscle cramps, and even seizures. It is important to see a doctor if you suspect an electrolyte imbalance and get timely treatment to prevent complications.

Symptoms and diagnosis of chronic hyponatremia

Chronic hyponatremia is a condition characterized by low levels of sodium in the blood for a long time. It can manifest itself with various symptoms, which depend on the degree and speed of the disease.

One of the main symptoms of chronic hyponatremia is general weakness and fatigue. Patients may also experience increased drowsiness, low mood, and irritability. In addition, headaches, muscle cramps, and decreased appetite may occur. Some patients have problems with memory and concentration.

To diagnose chronic hyponatremia, doctors do a blood test to check for sodium. If the sodium level is below normal (less than 135 mmol / l), then this is the main indicator of the disease. Hyponatremia can be caused by a variety of factors, so more research is being done to determine the underlying cause of changes in sodium levels in the blood.

Examination of organs such as the kidneys, liver, and thyroid may be required to identify the cause of chronic hyponatremia. Testing for hormones and other biochemical parameters may also be required.

Treatments for chronic hyponatremia

Chronic hyponatremia is treated to restore normal levels of sodium in the body and eliminate the cause of its decrease. The main treatments are:

  1. Water restriction: In case of chronic hyponatremia caused by excessive water intake, the doctor may recommend water restriction. It is important to monitor the level of water in the body and control daily fluid intake.
  2. Use of diuretics: Diuretics help the body get rid of excess water and reduce sodium dilution. Drugs such as furosemide or torasemide may be prescribed by your doctor to control sodium levels in your body.
  3. Proper nutrition: For chronic hyponatremia caused by a low sodium diet, your doctor may recommend dietary changes. Sodium-rich foods such as seafood, cheeses, mushrooms, and sauces should be included in the diet.
  4. Medication: In some cases, medication may be needed to normalize kidney function and restore sodium levels in the body. Drugs such as desmopressin or tovaptan may be prescribed by your doctor to correct hyponatremia.

Self-treatment of chronic hyponatremia can be dangerous, so it is important to seek medical advice and follow their recommendations. Only a professional medical approach and regular monitoring will effectively treat this condition and prevent serious complications.

Related videos:


How to distinguish between acute and chronic hyponatremia?

Acute hyponatremia is characterized by a rapid and abrupt decrease in the level of sodium in the blood, usually within hours or days.