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Several clinical conditions and drugs are associated with either increased (e.g. diabetes insipidus, hypodipsia, modulation of renal sodium and water excretion by drugs) or decreased (e.g. syndrome of inappropriate secretion of ADH (SIADH), congestive heart failure, liver cirrhosis) serum sodium concentrations. Both hyponatraemia and hypernatraemia are associated with increased mortality.

SIADH is considered to be the leading cause for hyponatraemia and hypochloraemia and can be induced by drugs or comorbidity. SIADH is defined by decreased serum osmolality, coexisting urine osmolality above 100 mOsm/kg, urinary sodium above 40 mmol/L, euvolaemia, and the absence of other causes for hyponatraemia.

Considerable variation in serum sodium (Na) and chloride (Cl) is found in patients at hospital admission. The aim of this study was to determine the relative contributions of drugs, comorbidities, and environmental factors on serum sodium and chloride in a large, and unselected cohort of patients admitted to a representative tertiary referral centre.

Lower weight, lower blood pressure, kidney dysfunction, fever, and diabetes were associated with both lower Na and Cl. Higher ambient temperature and higher air humidity preceding admission were associated with both higher Na and Cl values. The distribution of Na and Cl in persons exposed to risk factors for SIADH suggests that SIADH may only affect a genetically distinct vulnerable subpopulation (a subgroup of about 25% of the European population show a higher susceptibility to SIADH triggers). Further studies are needed to identify the (genetic) basis for these findings and the consequences for individual treatment decisions.

Clinical Biochemistry, Volume 47, Issues 7–8, May 2014, Pages 618-624

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