The management of hyponatremia in HIV disease

Hyponatremia is reported to be the most common electrolyte abnormality encountered in clinical practice. Diagnosis and principles of management of hyponatremia are everyday issues in patient care. Interest has also been generated by its association with adverse prognosis from studies in specific disease groups. Patients with human immunodeficiency virus (HIV) disease are living longer and medical diseases similar to the general population are more frequently encountered in them. Hyponatremia has been observed to be widely prevalent in both hospitalized and outpatient HIV patients, although population-based estimates are not known. From case series, these patients appear to be at greater risk for the development of hyponatremia from pathomechanisms encountered in the non-HIV population. In addition, certain HIVspecific mechanisms from infectious etiologies, endocrine causes, and medications are unique to them. Using an illustrative case as an example, in the following review, we discuss the varied etiologies, pathogenetic mechanisms, clinical features, diagnosis, and outline the management of hyponatremia in HIV patients.