Hyponatremia: Evolving diagnostics and emerging therapeutics in clinical practice

Hyponatremia remains the most common electrolyte disorder in clinical practice, with a wide range of causes ranging from endocrine dysregulation to iatrogenic causes. Recent developments in point-of-care ultrasonography, vasopressin physiology, and osmoregulation have transformed diagnostics by emphasizing accuracy above purely clinical judgment. Although traditional management based on fluid restriction and hypertonic solutions remain the cornerstone of treatment, a careful and cautious monitoring is required to avoid osmotic demyelination and overcorrection. The Furst equation, a validated predictor of response to fluid restriction, should be integrated into routine practice, together with objective tools such as point-of-care ultrasonography, to improve the accuracy of volume assessment and guide more precise therapeutic decisions. Likewise, different therapeutic options have been studied for non-responders to fluid restriction, including urea, desmopressin, and selective vasopressin receptor antagonists (vaptans), showing promising results. Ongoing developments in artificial intelligence and laboratory-based decision support tools are expected to improve personalized management and predictive accuracy, potentially reconciling the disparity between evidence and clinical practice.