{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T05:01:26Z","timestamp":1792213286760,"version":"4.4.0"},"reference-count":45,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T00:00:00Z","timestamp":1674777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>This article will discuss the consequences of chronic hyponatremia. In conditions such as cancer, heart failure, liver cirrhosis, or chronic kidney disease, the presence and magnitude of hypotonic hyponatremia are considered to reflect the severity of the underlying disease and are associated with increased morbidity as well as mortality. Hyponatremia can be acute (&lt;48 h) or chronic (&gt;2\u20133 days). Chronic hyponatremia is associated with attention deficit, dizziness, tiredness, gait disturbance, falls, sarcopenia, bone fractures, osteoporosis, hypercalciuria (in the syndrome of inappropriate antidiuresis\u2014SIADH), and kidney stones. In vitro studies have shown that cells grown in a low concentration of extracellular sodium have a greater proliferation rate and motility. Patients with chronic hyponatremia are more likely to develop cancer. We will not review the clinical consequences of respiratory arrest and osmotic demyelination syndrome (ODS) of the too-late or excessive treatment of hyponatremia.<\/jats:p>","DOI":"10.3390\/jcm12030978","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T11:19:53Z","timestamp":1675077593000},"page":"978","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Morbidity Associated with Chronic Hyponatremia"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7816-3457","authenticated-orcid":false,"given":"Guy","family":"Decaux","sequence":"first","affiliation":[{"name":"Research Unit for the Study Hydromineral Metabolism, Department of Internal Medicine, Erasmus University Hospital, Moli\u00e8re-Longchamps Hospital, Rue Marconi, 142, B-1190 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,27]]},"reference":[{"key":"ref_1","unstructured":"Gilbert, S.J., and Weiner, D.E. (2018). National Kidney Foundation\u2019s Primer on Kidney Diseases, Elseiver. [4th ed.]."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1056\/NEJM198606123142401","article-title":"Hyponatremia, convulsions, respiratory arrest and permanent brain damage after elective surgery in healthy women","volume":"314","author":"Arieff","year":"1986","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"891","DOI":"10.7326\/0003-4819-117-11-891","article-title":"Postoperative hyponatremic encephalopathy in menstruant woman","volume":"117","author":"Ayus","year":"1992","journal-title":"Ann. Intern. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1056\/NEJM198606123142402","article-title":"Osmotic demyelination syndrome following correction of hyponatremia","volume":"314","author":"Sterns","year":"1986","journal-title":"N. Engl. J. Med."},{"key":"ref_5","first-page":"24","article-title":"Hyponatremia and the brain","volume":"3","author":"Decaux","year":"2017","journal-title":"Kidney Int. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.amjmed.2005.09.026","article-title":"Mild chronic hyponatremia is associated with falls, unsteadiness and attention deficits","volume":"119","author":"Renneboog","year":"2006","journal-title":"Am. J. Med."},{"key":"ref_7","first-page":"748","article-title":"Fall is a frequent motif of admission in patients with chronic hyponatremia (Abstract)","volume":"14","author":"Musch","year":"2003","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1093\/qjmed\/hcn061","article-title":"Mild hyponatremia and risk of fracture in the ambulatory elderly","volume":"101","author":"Andres","year":"2008","journal-title":"Q. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"275","DOI":"10.2215\/CJN.06120809","article-title":"Hyponatremia independent of osteoporosis is associated with fracture occurrence","volume":"5","author":"Kinsella","year":"2010","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1007\/s11255-009-9585-2","article-title":"Hyponatremia associated with large-bone fracture in elderly patients","volume":"41","author":"Sandhu","year":"2009","journal-title":"Intern Urol. Nephrol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1111\/cen.13790","article-title":"Hyponatremia, fall and bone fractures: A systematic review and meta-analysis","volume":"89","author":"Corona","year":"2018","journal-title":"Clin. Endocrinol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1822","DOI":"10.1002\/jbmr.380","article-title":"Mild hyponatremia as a risk factor for fractures: The Rotterdam study","volume":"26","author":"Hoorn","year":"2011","journal-title":"J. Bone Miner. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1530\/EJE-21-0604","article-title":"Effect of hyponatremia normalization on osteoblast function in patient with SIAD","volume":"186","author":"Potasso","year":"2022","journal-title":"Eur. J. Endocrinol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1093\/ndt\/gfw029","article-title":"Mild prolonged chronic hyponatremia and risk of hip fracture in the elderly","volume":"31","author":"Ayus","year":"2016","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1111\/imj.12535","article-title":"Hyponatremia in older medical patients: Implications for fall and adverse outcomes of hospitalization","volume":"44","author":"Ahamed","year":"2014","journal-title":"Intern. Med. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e25","DOI":"10.1016\/j.ejim.2017.02.008","article-title":"Attention and postural balance are much more affected in older than younger adults with mild or moderate chronic hyponatremia","volume":"41","author":"Renneboog","year":"2017","journal-title":"Eur. J. Intern. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"12526","DOI":"10.1038\/s41598-019-49054-8","article-title":"Impact of resolution of hyponatremia on neurocognitive and motor performance in geriatric patients","volume":"9","author":"Brinkkoetter","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1111\/epi.16828","article-title":"Symptomatology of carbamazepine and oxcarbazepine-induced hyponatremia in people with epilepsy","volume":"62","author":"Berghuis","year":"2021","journal-title":"Epilepsia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1111\/eci.12597","article-title":"Impact of hyponatremia on nerve conduction and muscle strength","volume":"46","author":"Vandergheynst","year":"2016","journal-title":"Eur. J. Clin. Invest."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Fujisawa, H., Sugimura, Y., Takagi, H., Mizoguchi, H., Takeuchi, H., Izumida, H., Nakashima, K., Ochiai, H., Takeuchi, S., and Kiyota, A. (2015). Chronic hypontremia causes neurological and psychological impairments. J. Am. Soc. Nephrol.","DOI":"10.1681\/ASN.2014121196"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1002\/mus.880151007","article-title":"Effects of age, sex and anthropometric factors on nerve conduction measures","volume":"15","author":"Stetson","year":"1992","journal-title":"Muscle Nerve"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.1093\/ndt\/gfaa147","article-title":"Low-solute in chronic asymptomatic hyponatremia related to SIADH: Think about food beyond water intake","volume":"35","author":"Decaux","year":"2020","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1093\/ndt\/gfab073","article-title":"Measurement of urinary-creatinine in chronic SIADH can be used to estimate solute and fluid intake","volume":"36","author":"Decaux","year":"2021","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1007\/s11357-011-9347-9","article-title":"Chronic hyponatremia exacerbation multiple manifestations of senescence in males rats","volume":"35","author":"Barsony","year":"2013","journal-title":"Age"},{"key":"ref_25","first-page":"1551","article-title":"Mild hyponatremia is associated with low skeletal muscle mass, physical function impairrment, and depressive mood in the elderly","volume":"36","author":"Fujisawa","year":"2021","journal-title":"BMC Geriatr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.jocd.2012.07.010","article-title":"Sarcopenia is related to increased risk for low bone mineral density","volume":"16","author":"Wu","year":"2013","journal-title":"J. Clin. Densitom."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1159\/000519049","article-title":"Low creatininuria due to hyponatremia is reversible in many patients","volume":"146","author":"Decaux","year":"2002","journal-title":"Nephron"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3021","DOI":"10.1210\/jc.2015-1261","article-title":"Hyponatremia is associated with increased osteoporosis and bone fractures in a large US health system population","volume":"100","author":"Usala","year":"2015","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1359\/jbmr.090827","article-title":"Hyponatremia-induced osteoporosis","volume":"25","author":"Verbalis","year":"2010","journal-title":"J. Bone Miner. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"10864","DOI":"10.1074\/jbc.M110.155002","article-title":"Osteoclast response to low extracellular sodium and the mechanisms of hyponatremia-induced bone loss","volume":"286","author":"Barsony","year":"2011","journal-title":"J. Biol. Chem."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"18644","DOI":"10.1073\/pnas.1318257110","article-title":"Regulation of bone remodeling by vasopressin explains the bone loss in hyponatremia","volume":"110","author":"Tamma","year":"2013","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_32","first-page":"192","article-title":"Hypercalciuria in the syndrome of inappropriate secretion of antidiuretic hormone","volume":"7","author":"Decaux","year":"1982","journal-title":"Miner. Electrolyte Metab."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3161","DOI":"10.1007\/s00198-017-4186-x","article-title":"Syndrome of inappropriate anti-diuresis induces volume-dependent hypercalciuria","volume":"28","author":"Grellier","year":"2017","journal-title":"Osteoporos. Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.semnephrol.2008.01.006","article-title":"Bone disease and idiopathic hypercalciuria","volume":"28","author":"Zerwekh","year":"2008","journal-title":"Sem. Nephrol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Tominaga, N., Fernandez, S.J., Mete, M., Shara, N.M., and Verbalis, J.G. (2018). Hyponatremia and the risk of kidney stones: A matched case-control study in a large US health system. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0203942"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Decaux, G., and Musch, W. (2023). The urine calcium\/creatinine ratio and uricemia during hyponatremia of different origins: Clinical implications. J. Clin. Med., 12.","DOI":"10.3390\/jcm12020723"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1159\/000493235","article-title":"Morbidity and mortality of hyponatremia","volume":"52","author":"Peri","year":"2019","journal-title":"Front. Horm. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1053\/j.ajkd.2012.09.019","article-title":"Hyponatremia and mortality: Moving beyond associations","volume":"62","author":"Hoorn","year":"2013","journal-title":"Am. J. Kidney Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1038\/ki.2012.459","article-title":"Mild hyponatremia is associated with an increased risk of death in an ambulatory setting","volume":"83","author":"Ayers","year":"2013","journal-title":"Kidney Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/j.amjmed.2009.01.027","article-title":"Mortality after hospitalization with mild, moderate and severe hyponatremia","volume":"122","author":"Waikar","year":"2009","journal-title":"Am. J. Med."},{"key":"ref_41","first-page":"71","article-title":"Hyponatremia and mortality risk: A Danish Cohort Study of 279508 Acutely hospitalized patients","volume":"137","author":"Christiansen","year":"2015","journal-title":"Eur. J. Endocrinol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Corona, G., Giuliani, C., Verbalis, J.G., Forti, G., Maggi, M., and Peri, A. (2015). Hyponatremia improvement is associated with a reduced risk of mortality: Evidence from a meta-analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0124105"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.ejim.2016.07.028","article-title":"Hyponatremia, all-cause mortality and risk of cancer diagnosis in the primary care setting: A large population study","volume":"36","author":"Selmer","year":"2016","journal-title":"Eur. J. Intern. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1007\/s12017-013-8235-0","article-title":"Low extracellular sodium causes neuronal distress independly of reduced osmolality in an experimental model of chronic hyponatremia","volume":"15","author":"Benvenuti","year":"2013","journal-title":"Neuromolecular Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"111419","DOI":"10.1016\/j.mce.2021.111419","article-title":"Low sodium and tolvaptan have opposite effects in human Small Cell Lung Cancer","volume":"537","author":"Marroncini","year":"2021","journal-title":"Mol. Cell. Endocrinol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/978\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:17:09Z","timestamp":1760120229000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/978"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,27]]},"references-count":45,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["jcm12030978"],"URL":"https:\/\/doi.org\/10.3390\/jcm12030978","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,27]]}}}