. 2019 Sep;15(4):252–261. doi: 10.2174/1573403X15666190306111812

Table 1.

Summary of causes of hyponatremia in patients with heart failure [8, 11, 12, 18, 25, 26, 29-32].

Causes of Hyponatremia in Patients with Heart Failure
1. Continued release AVP despite a reduction in osmolality due to the following reasons: • Low cardiac output • Decreased renal blood flow • Reduced baroreceptor stimulation mediated by low blood pressure 2. Low cardiac output leads to activation of RAAS and increase in angiotensin II levels, potent stimuli to thirst, resulting in enhanced water intake 3. Medications used to treat heart failure, hypertension, or cardiac-related conditions • Diuretics (especially thiazides, less commonly aldosterone antagonists, amiloride, loop diuretics) 4. Hyponatremia in the setting of advanced CKD/ESRD due to Cardiorenal syndromes • Hypotonic hyponatremia due to increased free water intake in the setting of low GFR

Causes of Hyponatremia in Patients with Heart Failure

     1. Continued release AVP despite a reduction in osmolality due to the following reasons:
          • Low cardiac output
          • Decreased renal blood flow
          • Reduced baroreceptor stimulation mediated by low blood pressure
     2. Low cardiac output leads to activation of RAAS and increase in angiotensin II levels, potent stimuli to thirst, resulting in enhanced water intake
     3. Medications used to treat heart failure, hypertension, or cardiac-related conditions
          • Diuretics (especially thiazides, less commonly aldosterone antagonists, amiloride, loop diuretics)
     4. Hyponatremia in the setting of advanced CKD/ESRD due to Cardiorenal syndromes
          • Hypotonic hyponatremia due to increased free water intake in the setting of low GFR

Abbreviations: ACEIs, Angiotensin-Converting Enzyme Inhibitors; AVP, Arginine Vasopressin; CKD, Chronic Kidney Disease; ESRD, End-Stage Renal Disease; GFR, Glomerular Filtration Rate; RAAS, Renin-Angiotensin-Aldosterone System.