The specific causes of hyponatremia are generally divided into those with low tonicity (lower than normal concentration of solutes), without low tonicity, and falsely low sodiums. Those with low tonicity are then grouped by whether the person has high fluid volume, normal fluid volume, or low fluid volume. Too little sodium in the diet alone is very rarely the cause of hyponatremia. High volume Both sodium and water content increase: Increase in sodium content leads to hypervolemia and water content to hyponatremia. * Cirrhosis of the liver * Congestive heart failure * Nephrotic syndrome in the kidneys * Excessive drinking of fluids Normal volume There is volume expansion in the body, no edema, but hyponatremia occurs * SIADH (and its many causes) * Hypothyroidism * Not enough ACTH * Beer potomania * Normal physiologic change of pregnancy * Reset osmostat Low volume Hypovolemia (extracellular volume loss) is due to total body sodium loss. Hyponatremia is caused by a relatively smaller loss in total body water. * Any cause of hypovolemia such as prolonged vomiting, decreased oral intake, severe diarrhea * Diuretic use (due to the diuretic causing a volume depleted state and thence ADH release, and not a direct result of diuretic-induced urine sodium loss) * Addison's disease and congenital adrenal hyperplasia in which the adrenal glands do not produce enough steroid hormones (combined glucocorticoid and mineralocorticoid deficiency) *Pancreatitis * Prolonged exercise and sweating, combined with drinking water without electrolytes is the cause of exercise-associated hyponatremia (EAH). It is common in marathon runners and participants of other endurance events. * The use of MDMA (ecstasy) can result in hyponatremia. Medication Antipsychotics have been reported to cause hyponatremia in a review of medical articles from 1946 to 2016. Available evidence suggests that all classes of psychotropics, i.e., antidepressants, antipsychotics, mood stabilizers, and sedative/hypnotics can lead to hyponatremia. Age is a significant factor for drug induced hyponatremia. Other causes Miscellaneous causes that are not included under the above classification scheme include the following: * False hyponatremia (due to massive increases in blood triglyceride levels or extreme elevation of immunoglobulins as may occur in multiple myeloma) * Hyponatremia with elevated tonicity can occur with high blood sugar.
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