Review article Korean J Pediatr 2013;56(12):519-522 http://dx.doi.org/10.3345/kjp.2013.56.12.519 pISSN 1738-1061•eISSN 2092-7258

Korean J Pediatr

Inflammation and hyponatremia: an underrecognized condition? Se Jin Park, MD, PhD1, Jae Il Shin, MD, PhD2 1

Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, 2Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea

Timely diagnosis of hyponatremia is important for preventing potential morbidity and mortality as it is often an indicator of underlying disease. The most common cause of eurvolemic hyponatremia is the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Recent studies have demonstrated that proinflammatory cytokines such as interleukin (IL) 1β and IL-6 are involved in the development of hyponatremia, a condition that is associated with severe inflammation and is related to antidiuretic hormone (ADH) secretion. Serum sodium levels in hyponatremia are inversely correlated with the percentage of neutrophils, C-reactive protein, and N-terminal-pro brain type natriuretic peptide. Additionally, elevated levels of serum IL-6 and IL-1β are found in inflammatory diseases, and their levels are higher in patients with hyponatremia. Because it is significantly correlated with the degree of inflammation in children, hyponatremia could be used as a diagnostic marker of pediatric inflammatory diseases. Based on available evidence, we hypothesize that hyponatremia may be associated with inflammatory diseases in general. Understanding the mechanisms responsible for augmented ADH secretion during inflammation, monitoring patient sodium levels, and selecting the appropriate intravenous fluid treatment are important components that may lower the morbidity and mortality of patients in a critical condition.

Corresponding author: Jae Il Shin, MD, PhD Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea Tel: +82-2-2228-2050 Fax: +82-2-393-9118 E-mail: [email protected] Received: 13 June 2013 Accepted: 12 September 2013

Key words: Hyponatremia, Inappropriate ADH Syndrome, Cytokines, Inflammatory disease, Critical condition

Introduction Hyponatremia, characterized by a serum sodium level that is less than 135 mEq/L, is one of the most commonly diagnosed electrolyte disorders in clinical medicine1). Although sodium deficiency leads to hyponatremia, this condition is more commonly caused by solute dilution resulting from excessive consumption of water. Severe hyponatremia, where serum sodium level falls below

Inflammation and hyponatremia: an underrecognized condition?

Timely diagnosis of hyponatremia is important for preventing potential morbidity and mortality as it is often an indicator of underlying disease. The ...
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