[Hyponatremia: from guidelines to clinical practice]

The publication, within a short time interval, of a consensus statement on the pathophysiology, diagnosis and treatment of hyponatremia by a panel of experts mainly from the US and of the European Guidelines on the same topic has marked an important step towards reducing the differences in the treatment of this frequent, and potentially fatal, electrolyte disorder. Within this framework, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE), and the European Dialysis and Transplantation Association-European Renal Association, represented by the European Renal Best Practice (ERBP), have developed these Guidelines for clinical practice, that are focused mainly on the diagnosis and the treatment of hyponatremia. In fact, they are the result of a tight collaboration between the three scientific societies involving those specialists with an elective interest for this electrolyte disorder. In addition to a rigorous methodological approach, a choice was made to provide a document focused on clinically relevant outcomes and useful for everyday practice. With respect to the original paper, this version of the Guidelines has been shortened and translated with a special view to the recommendations concerning the diagnosis and treatment of hyponatremia. It is preceded by an introduction underscoring the main targets of non-pharmacological treatment in acute severely symptomatic cases, specifically as regards the rate of correction of hyponatremia; subsequently, potential explanations for the discrepancies between the European Guidelines and the consensus statement by US experts concerning the use of vaptans are briefly discussed; the rationale and practical limitations in the clinical use of urea are analyzed in more detail.