Appropriate treatment of hyponatremic disorders is de pendent on an understanding of the mechanisms that cause these abnormalities. This article offers a patho physiological approach to hypoosmolar syndromes. Common causes of hyponatremia are reviewed with particular emphasis on congestive heart failure, ad vanced liver disease, diuretic use, and the syndrome of inappropriate antidiuretic hormone secretion. New con cepts in treatment are discussed with the aid of clinical examples that emphasize critical information. A number of recent studies have questioned the safety of rapidly correcting hyponatremia; recommendations based on our current understanding of these risks are proposed. Pitfalls in the diagnosis and management of patients with hyponatremic disorders are also discussed.
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