Keywords
Reset osmostat
Diagnosis
Osmolar concentration
Vasopressins
Communicable diseases
How to Cite
Abstract
Introduction: Reset osmostat (RO) is a common syndrome, making up about 30% of patients with hyponatremia.
Objective: Conduct a comprehensive review of osmostat reset, describing its clinical, pathophysiologic, diagnostic, and therapeutic aspects.
Methodology: A narrative review was conducted based on the main articles published in the medical literature.
Results: Reset osmostat has a low plasma osmolality threshold, which consequently leads to an elevation in antidiuretic hormone at a lower plasma osmolarity, along with normal water load excretion and intact urine diluting ability, while maintaining normal sodium balance. Reset osmostat can be observed in pregnancy, older age, quadriplegia, psychosis, cerebral hemorrhage, encephalitis, dementia, alcoholism, malnutrition, malignancy, and particular infectious diseases.
Conclusion: Reset osmostat often resets to normal if it is the consequence of a reversible clinical setting; however, this normalization might not happen if it is secondary to an irreversible condition. In such cases, treatment is required similar to that of any hyponatremia in order to avoid its negative consequences.
References
Esposito P, Piotti G, Bianzina S, Malul Y, Dal-Canton A. The syndrome of inappropriate antidiuresis: Pathophysiology, clinical management and new therapeutic options. Nephron Clin Pract. 2011;119(1):c62–c73. https://doi.org/10.1159/000324653
Robertson GL. Regulation of arginine vasopressin in the syndrome of inappropriate antidiuresis. Am J Prev. 2006;119(7):S36-S42. https://doi.org/10.1016/j.amjmed.2006.05.006
Moritz M. Syndrome of inappropriate antidiuresis and cerebral salt wasting syndrome: Are they different and does it matter? Pediatr Nephrol. 2012;27(5):689-93. https://doi.org/10.1007/s00467-012-2112-1
Maesaka J, Imbriano L. Cerebral salt wasting is a real cause of hyponatremia: PRO. Kidney360. 2022;4(4):e437-e440. https://doi.org/10.34067/KID.0001422022
Sterns R, Rondon-Berrios H. Cerebral salt wasting is a real cause of hyponatremia: CON. Kidney360. 2022;4(4):e441-e444. https://doi.org/10.34067/KID.0001412022
Palmer B, Clegg D. Cerebral salt wasting is a real cause of hyponatremia: COMMENTARY. Kidney360. 2022;4(4):e445-e447. https://doi.org/10.34067/KID.0001452022
Bitew S, Imbriano L, Miyawaki N, Fishbane S, Maesaka JK. More on renal salt wasting without cerebral disease: Response to saline infusion. Clin J Am Soc Nephrol. 2009;4(2):309-315. https://doi.org/10.2215/CJN.02740608
Harris K, Shankar R, Black K, Rochelson B. Reset osmostat in pregnancy: A case report. J Matern Fetal Neonatal Med. 2014;27(5):530?553. https://doi.org/10.3109/14767058.2013.819333
Rohana AG, Norasyikin AW, Suehazlyn Z, Ming W, Norlela S, Norazmi MK. A case of persistent hyponatraemia due to reset osmostat. Med J Malaysia. 2006;61(5):638?640.
Liamis GL, Milionis HJ, Rizos EC, Siamopoulos KC, Elisaf MS. Mechanisms of hyponatraemia in alcohol patients. Alcohol Alcohol. 2000;35(6):612?616. https://doi.org/10.1093/alcalc/35.6.612
Imbriano LJ, Mattana J, Drakakis J, Maesaka JK. Identifying different causes of hyponatremia with fractional excretion of uric acid. Am J Med Sci. 2016;352(4):385?390. https://doi.org/10.1016/j.amjms.2016.05.035
Hoorn EJ, Swart RM, Westerink M, van den Dorpel MA, Berghout A, Bakker JJ. Hyponatremia due to reset osmostat in dementia with lewy bodies. J Am Geriatr Soc. 2008;56(3):567?569. https://doi.org/10.1111/j.1532-5415.2008.01579.x
Vale BM, Morais S, Mesquita J, Mimoso G. Reset osmostat: A rare cause of hyponatraemia. BMJ Case Rep. 2015;2015:bcr2013009111. https://doi.org/10.1136/bcr-2013-009111
Suneja M, Makki N, Kuppachi S. Essential hypernatremia: Evidence of reset osmostat in the absence of demonstrable hypothalamic lesions. Am J Med Sci. 2014;347(4):341?342. https://doi.org/10.1097/MAJ.0000000000000246
Feder J, Gomez JM, Serra-Aguirre F, Musso CG. Reset osmostat: Facts and controversies. Indian J Nephrol. 2019;29(4):232-234. https://doi.org/10.4103/ijn.IJN_307_17
Harris K, Shankar R, Black K, Rochelson B. Reset osmostat in pregnancy: A case report. J Matern Fetal Neonatal Med. 2014;27(5):530?533. https://doi.org/10.3109/14767058.2013.819333
Musso CG, Jauregui JR. Hyponatremia secondary to reset osmostat in a very old individual: A case report and pathophysiologic proposal. Electron J Biomed. 2016;3: 49?51.
Rigueto LG, Santiago HM, Hadad DJ, Seguro AS, Girardi ACC, Luchi WM. The “new normal” osmotic threshold: Osmostat reset. Clin Nephrol Case Studies. 2022; 10(1):11-15. https://doi.org/10.5414/CNCS110740
Imbriano LJ, Ilamathi E, Ali NM, Miyawaki N, Maesaka JK. Normal fractional urate excretion identifies hyponatremic patients with reset osmostat. J Nephrol. 2012;25(5):833-838. https://doi.org/10.5301/jn.5000074
Maesaka JK, Imbriano LJ, Miyawaki N. High prevalence of renal salt wasting without cerebral disease as cause of hyponatremia in general medical ward. Am J Med Sci. 2018;356(1):15-22. https://doi.org/10.1016/j.amjms.2018.03.020
Hoorn EJ, Zietse R. Diagnosis and treatment of hyponatremia: Compilation of the guidelines. J Am Soc Nephrol. 2017;28(5):1340?1349. https://doi.org/10.1681/ASN.2016101139
Musso CG, Vilas M. Water, electrolyte, and acid-base disorders in the elderly. In: Macias-Nunez JF, Jauregui J, Covic A, Musso CG, editors. Clinical Nephrogeriatrics. Springer Cham. 2019. p.43-62. https://doi.org/10.1007/978-3-030-18711-8_4
Assadi F and Mazaheri M. Differentiating syndrome of inappropriate ADH, reset osmostat, cerebral/renal salt wasting using fractional urate excretion. J Pediatr Endocrinol Metab. 2021;34(1):137–140. https://doi.org/10.1515/jpem-2020-0379
Kuthiah N, Er C. Reset osmostat: A challenging case of hyponatremia. Case Rep Med. 2018;2018:5670671. https://doi.org/10.1155/2018/5670671
Berl T, Schrier R. Water homeostasis alterations. In: Schrier R (Editor). Renal and Electrolytes Alterations. Philadelphia. Lippincott Williams & Wilkins. 2011. p.1?85.
Decaux G. Is asymptomatic hyponatremia really asymptomatic? Am J Med. 2006;119(7):S79?82. https://doi.org/10.1016/j.amjmed.2006.05.013
Lee JJ, Kilonzo K, Nistico A, Yeates K. Management of hyponatremia. CMAJ. 2014;186(8):E281?E286. https://doi.org/10.1503/cmaj.120887
Renneboog B, Musch W, Vandemergel X, Manto M, Decaux G. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med 2006;119(1):711-718. https://doi.org/10.1016/j.amjmed.2005.09.026
Gankam Kengne F, Andres C, Sattar L, Melot C, Decaux G. Mild hyponatremia and risk of fracture in the ambulatory elderly. QJM-INT J Med J. 2008;101(7):583–8. https://doi.org/10.1093/qjmed/hcn061
Decaux G. Morbidity associated with chronic hyponatremia. J Clin Med. 2023;12(3):978. https://doi.org/10.3390/jcm12030978
Verbalis JG, Barsony J, Sugimura Y, Tian Y, Adams DJ, Carter EA, et al. Hyponatremia-induced osteoporosis. JBMR. 2010;25(3):554-563. https://doi.org/10.1359/jbmr.090827
Ayus JC, Tejedor A, Caramelo C. Agua, electrolitos y equilibrio ácido-base. Buenos Aires (Argentina): Panamericana;2007.
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