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Considerations In The Diagnosis Of Hyponatremia

Considerations In The Diagnosis Of Hyponatremia

The concentration of sodium in plasma is maintained within a relatively narrow range by homeostatic mechanisms involving thirst, arginine vasopressin (AVP, also called antidiuretic hormone), and renal control of water excretion.1 Hyponatremia may result from an inappropriate hypotonic fluid intake, inappropriate fluid retention by excessive ADH, or inadequate renal reabsorption of sodium. It is defined as a serum sodium <135 mEq/L, severe hyponatremia is defined as a serum sodium <125 mEq/L. Patients with hyponatremia have increased morbidity and mortality compared with patients without hyponatremia.2 Hyponatremia is often associated with arginine vasopressin (AVP) dysregulation. AVP is a polypeptide hormone released from the hypothalamus, or hypothalamo-neurohypophyseal tract, in response to decreases in blood pressure, plasma volume, and/or increases in plasma osmolality. AVP secretion is suppressed when serum osmolality drops below normal.3 This webinar will review pathophysiology as well as various factors that contribute to the development of hyponatremia. References:

  1. Adrogué H et al. (2005). Consequences of Inadequate Management of Hyponatremia. Am J Nephrol. 25:240–249.
  2. Spasovski G et al. (2014). Clinical practice guideline on diagnosis and treatment of hyponatremia. Eur J Endocrinol. 170: G1-G47.
  3. Rai A. et al. (2006). Hyponatremia, Arginine Vasopressin Dysregulation, and Vasopressin Receptor Antagonism. Am J Nephrol. 26:579–589.


Arthur Greenberg

Arthur Greenberg, MD

Professor of Medicine, Emeritus, Division of Nephrology

Duke University School of Medicine, Durham, NC*

Arthur Greenberg, MD is Professor Emeritus of Medicine in the Division of Nephrology, Department of Medicine, Duke University School of Medicine. Prior to coming to Duke, he was Professor of Medicine and Nephrology Fellowship Program Director at the University of Pittsburgh. In addition to being an active clinician, he has published numerous papers on a variety of topics with a focus on fluid and electrolyte disorders and hyponatremia, in particular. He was a member of the steering committee of the multinational Hyponatremia Registry. In addition, he was the founding Editor of the National Kidney Foundation Primer on Kidney Diseases and Editor-in-Chief of its first five editions.

Lisa Voigt

Lisa Voigt, PharmD, BCPS, BCCCP, FASHP

Nephrology Senior Medical Science Liaison

Otsuka Pharmaceutical Development & Commercialization, Inc.*

Lisa Voigt is a PharmD who works as a Medical Science Liaison in Nephrology with Otsuka Pharmaceutical Development & Commercialization, Inc. Prior to joining Otsuka in 2019, Dr Voigt practiced as a Medical Intensive Care Unit and Surgical Intensive Care Unit Pharmacist for 15 years at a tertiary medical center in Buffalo, NY. She earned her Bachelor of Science degree in Pharmaceutics and PharmD from the SUNY Buffalo School of Pharmacy and Pharmaceutical Sciences. She completed a Post-Graduate year 1 Pharmacy Residency and Post-Graduate year 2 Critical Care/Emergency Medicine Pharmacy Residency at the University of Rochester Medical Center in Rochester, NY. Dr Voigt is a Past-President of the New York State Council of Health-system Pharmacists and has served on the Board of Directors for the past 10 years. She is also Past-President of the Western New York Society of Health-system Pharmacists. She is an Adjunct Assistant Professor at SUNY Buffalo, School of Pharmacy and Pharmaceutical Sciences. Dr Voigt holds board certifications in pharmacotherapy as well as critical care pharmacotherapy.

*Dr Greenberg is a paid consultant of Otsuka Pharmaceutical Development & Commercialization, Inc. (OPDC). Dr Voigt is an employee of OPDC.

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