Mechanisms of Hyponatremia in Chronic Congestive Heart Failure

Abstract

Recent studies have shown that several factors may contribute to the hyponatremia of congestive heart failure. These include electrolyte shifts between intracellular and extracellular compartments (1), abnormal antidiuretic responses (2-6), glomerulotubular imbalance (7-11), lowered osmoreceptor settings (7, 8, 12, 13), and persistence of water intake despite dilution of body fluids. These diverse factors indicate the complexity of this problem and help explain the erratic responses to a strictly empirical approach to therapy. This study was designed primarily to elucidate the renal mechanisms contributing to the pathogenesis of hyponatremia in congestive heart failure and to devise a diagnostic procedure for classification