Hyponatremia is encountered quite frequently in everyday clinical practice. The symptomatology mainly includes neurological manifestations. In addition, it has been noted in recent years that uncertain gait, falls, fractures, and osteoporosis are also associated with hyponatremia. Based on clinical and laboratory analyses, hyponatremia can be classified into three categories: hypovolemic (decreased volume), hypervolemic (with venous edema), and euvolemic. The severity of the neurological symptoms related to hyponatremia should serve to guide the therapeutic approach. Severe cerebral symptoms due to acute cerebral edema require a prompt and closely monitored course of action with administration of hypertonic saline solution. Milder and moderate symptoms as well as the syndrome of inappropriate ADH secretion (SIADH) can now also be managed with controlled use of the ADH antagonist tolvaptan, one of a new class of vaptans. Tolvaptan is a selective antagonist of the antidiuretic effect of vasopressin without primarily affecting blood pressure and depending on the dose leads to increased excretion of free water (aquaresis). Side effects predominantly concern thirst, polyuria, and hypernatremia. Under these conditions, vaptans represent a valuable asset to the therapeutic spectrum in SIADH. Further studies are needed to determine whether falls and fractures can also be beneficially influenced.