HIV: Watch Velocity of Change in Falling Sodium Levels

People living with HIV are at elevated risk for hyponatremia, the most common electrolyte disorder seen in hospitals.

People living with HIV are at elevated risk for hyponatremia, the most common electrolyte disorder seen in hospitals. This risk increases if they are hospitalized

.

If hyponatremia is severe, morbidity and mortality risk escalates.

Velocity of change is key when it comes to falling sodium levels. Hyponatremia (sodium level lower than 135 mEq/L) is the most common electrolyte disorder seen in hospitals. Patients whose sodium levels fall gradually tend not to experience hyponatremia’s hallmark signs: altered mental status, confusion, cramps, falls, headache, obtundation (mental blunting with mild to moderate reduction in alertness, and a diminished sensation of pain), and possibly coma, and status epilepticus.

Researchers from China-Japan Friendship Hospital in Beijing, China have assembled a comprehensive review of hyponatremia in PLWH. Published in the journal

Renal Failure

, the review describes current knowledge of this imbalance and its repercussions in the HIV-infected individual.

Serum sodium levels seem to correlate with infection severity in PLWH. The researchers report that infection is a leading cause of hyponatremia. Pulmonary tract, and central nervous infections in particular can cause release of excess antidiuretic hormome (ADH). Pulmonary infection may reduce pulmonary venous return, activate volume receptors, and increase ADH secretion. Clinicians should monitor patients who have tuberculous meningitis, encephalitis or abscesses, closely for syndrome of inappropriate ADH secretion (SIADH) and cerebral salt wasting syndrome (CSWS).

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