Approach to hyponatremia according to the clinical setting: Consensus statement from the Italian Society of Endocrinology (SIE), Italian Society of Nephrology (SIN), and Italian Association of Medical Oncology (AIOM)

Despite being the most common electrolyte disorder encountered in clinical practice, hypoNa is frequently underdiagnosed and/or not appropriately treated. This may be due to a lack of awareness of the implications of this condition on patient outcomes, particularly when hospital-acquired and mildly or moderately symptomatic. Appropriate workup and treatment in the various clinical settings associated with hypoNa require a multidisciplinary approach. In such a need, this task force has provided the above-outlined suggestions and warnings. Ineffective management of hypoNa may negatively affect patient prognosis. New therapeutic options for the correction of hypoNa, particularly vaptans, the vasopressin receptor antagonists, represent an effective tool to safely treat this disorder and improve outcomes among a wide range of patients with hypoNa secondary to SIAD. However, the different clinical scenarios in which hypoNa may occur suggest that a thoughtful and personalized management should be individuated. This scenario is even more complex when we consider that not all the hospitals are properly equipped to perform an accurate differential diagnosis of hypoNa. As an example, the infrequent availability of osmometers in the medium/small hospital facilities is a limiting factor for the diagnosis of SIAD. Thus, we propose that clinicians may refer to calculated serum and/or urinary osmolality according to recently reviewed formulae [118]. A rapid recognition and optimal treatment of hypoNa can reduce the risk of death, also reducing the length of hospitalization and associated costs, and improving the quality of life.