Water, electrolytes, and acid-base alterations in human immunodeficiency virus infected patients

Table 1 Causes of hypotonic hyponatremia in human immunodeficiency virus infected patients

Hyponatremia with normal ECF

SIADH: Lungs or central nervous system infection or neoplasm

Hypothyroidism: Low T3 syndrome, pituitary infections, thyroiditis and miconazole

Glucocorticoid deficiency: Glucocorticoid axis damaged

Hyponatremia with low ECF (volume depletion)

Digestive losses: vomiting, diarrhea

Renal losses: CSW, interstitial nephritis, cortisol resistance and adrenal insufficiency

Hyponatremia with high ECF (edematous states)

Non-renal causes: cirrhosis, heart failure

Renal causes: acute tubular necrosis, intra-tubular obstruction, interstitial nephritis, nephrocalcinosis, hemolytic-uremic syndrome, collapsing focal and segmental glomerulosclerosis

Hyponatremia secondary to drugs

Renal insufficiency

Interstitial nephritis

Impair maximal urinary dilution capability by direct tubular effect

Cortisol deficiency

SIADH effect

ECF: Extracellular fluid; SIADH: Syndrome of inappropriate antidiuretic hormone release; CSW: Cerebral salt wasting.

Table 2 Causes of hypernatremia in human immunodeficiency virus infected patients

Hypernatremia
Increased insensible water losses: Fever and tachypnea
Increased digestive water losses: Vomiting, diarrhea
Increased urinary water losses: Central diabetes insipidus, nephrogenic diabetes insipidus secondary to nephrocalcinosis or tubule-interstitial damage caused by infection, tumors, drugs
Reduced water intake: Unconsciousness, adipsia: Thirst´s center destruction by a vascular, neoplastic or infectious cause

Table 3 Causes of dyskalemia in human immunodeficiency virus infected patients

Hypokalemia

Increased gastrointestinal K+ losses: Diarrhea: Infection, tumor or AIDS-associated enteropathy

Increased urinary K+ losses: Vomits, tubule toxicity, interstitial nephritis

Low K+ body content: Low potassium intake, sarcopenia and myopathy

Hyperkalemia

Reduced urinary K+ excretion: Drugs, adrenal insufficiency, hyporeninemic hypoaldosteronism

Increased K+ shift to EC: Rhabdomyolysis, tumor lysis syndrome, hyperglucemia

K⁺: Potassium; EC: Extracellular compartment; AIDS: Acquired immune deficiency syndrome.

Table 4 Causes of acid-Base disorders in human immunodeficiency virus infected patients

Acidosis

Hyperchloremic metabolic acidosis: Diarrhea, tubular damage secondary to drugs, hypergammaglobulinaemia, acute tubular necrosis, interstitial nephritis, HIV

High anion gap metabolic acidosis: Uremia, diabetic ketoacidosis, lactic acidosis (type A or B)

Alkalosis

Metabolic alkalosis (volume contraction): Gastro-intestinal losses, urinary losses

Respiratory alkalosis (hyperventilation): Central nervous system alteration, altered liver function, lung opportunistic infections and malignancies

HIV: Human immunodeficiency virus.