TOPIC DISCUSSION: Asymptomatic Hyponatremia

A nice editorial in my favorite journal Nephrology Nature Reviews talks about the " asymptomatic hyponatremia" syndrome.  When we see a calcium > 11 and no symptoms, we admit and treat. When we see a K of >6.0, we treat, so when we see an asymptomatic hyponatremia say of 130, why don't we treat? is what is asked in this editorial. The editorial brings in the points of 30% of elderly population in nursing homes having low Na levels and increase risk of falls and fractures.  The cirrhotics, CHF patients who run in NA 130-135 but are having no symptoms, should they be treated? and with what. With the new agents out now ( V2 receptor antagonists, FWR or lasix) will be the other question?
This has to be further studied and looked at in my opinion.
At least in part, perhaps culprit agents should be discontinued - such as SSRIs, HCTZ to start with
and prevent worsening perhaps of the hyponatremia.
Check out this nice editorial, a must read