Hyponatremia is a very common
electrolyte abnormality, associated with poor short- and long-term outcomes in patients with
heart failure (HF). Two opposite processes can result in
hyponatremia in this setting: Volume overload with dilutional hypervolemic
hyponatremia from congestion, and
hypovolemic hyponatremia from excessive use of natriuretics. These two conditions require different therapeutic approaches. While
sodium in the form of
normal saline can be lifesaving in the second case, the same treatment would exacerbate
hyponatremia in the first case. Hypervolemic
hyponatremia in HF patients is multifactorial and occurs mainly due to the persistent release of
arginine vasopressin (AVP) in the setting of ineffective renal perfusion secondary to
low cardiac output. Fluid restriction and
loop diuretics remain mainstay treatments for hypervolemic/ dilutional
hyponatremia in patients with HF. In recent years, a few strategies, such as AVP antagonists (
Tolvaptan,
Conivaptan, and
Lixivaptan), and hypertonic saline in addition to
loop diuretics, have been proposed as potentially promising treatment options for this condition. This review aimed to summarize the current literature on pathogenesis and management of
hyponatremia in patients with HF.