Hypervolemic hypotonic hyponatremia

Patients with hypervolemic hypotonic hyponatremia should be treated with 3% saline and prompt initiation of fluid restriction. Loop diuretic therapy will also likely be required to facilitate urinary excretion of free water. 

Treatment of asymptomatic hypervolemic hypotonic hyponatremia involves correction of the underlying cause and restriction of water intake to less than 1,000 to 1,200 mL/day. Dietary intake of sodium chloride should be restricted to 1,000 to 2,000 mg/day. 

Hypervolemic hypotonic hyponatremia— increase in water without an equal increase in sodium. Occurs with cirrhosis, hypoproteinemia (low albumin), heart failure, and nephrotic syndrome. 

Hypotonic hyponatremia, the most common form of hyponatremia, can be further classified as hypovolemic, euvolemic, or hypervolemic hyponatremia. 

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