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Pakchotanon K, Kanjanasuphak N, Chuasuwan A, Gojaseni P, Chittinandana A. Safety and efficacy of proactive versus reactive administration of desmopressin in severe symptomatic hyponatremia: a randomized controlled trial. Sci Rep 2024; 14:7487. [PMID: 38553491 PMCID: PMC10980789 DOI: 10.1038/s41598-024-57657-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/20/2024] [Indexed: 04/02/2024] Open
Abstract
This randomized controlled trial aimed to evaluate the safety and efficacy of proactive versus reactive desmopressin (DDAVP) strategies in treating severe symptomatic hyponatremia. Conducted from June 20, 2022, to February 20, 2023, it involved 49 patients with serum sodium levels below 125 mmol/L. Patients were assigned to either the proactive group, receiving DDAVP immediately upon diagnosis, or the reactive group, receiving DDAVP only if the serum sodium level tended to be overcorrected. The primary outcome was the incidence of overcorrection. The study revealed no significant difference in the overcorrection incidence between the proactive (16.7%) and reactive (28%) groups (p = 0.54). The change in serum sodium levels at 1, 6, 12, and 24 h were not different, however, at 48 h, the proactive group exhibited a higher but still safe change in serum sodium levels compared to the reactive group (10.3 ± 3.6 mmol/L vs. 7.7 ± 3.6 mmol/L, p = 0.013). Other parameters including time to symptom improvement, total intravenous fluid administered, DDAVP dose, urine volume, hospital stay duration, osmotic demyelination syndrome incidence, and 28-day mortality did not significantly differ between the groups. In conclusion, our findings suggest that there was no significant disparity in overcorrection rates between proactive and reactive DDAVP strategies for treating severe symptomatic hyponatremia. However, further large-scale studies are warranted to validate these results.
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Affiliation(s)
- Kamolwan Pakchotanon
- Division of Nephrology, Department of Internal Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, 10220, Thailand.
| | - Nichanone Kanjanasuphak
- Division of Nephrology, Department of Internal Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, 10220, Thailand
| | - Anan Chuasuwan
- Division of Nephrology, Department of Internal Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, 10220, Thailand
| | - Pongsathorn Gojaseni
- Division of Nephrology, Department of Internal Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, 10220, Thailand
| | - Anutra Chittinandana
- Division of Nephrology, Department of Internal Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, 10220, Thailand
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Been RA, Voets PJGM, van Rhijn-Brouwer FCCC, Vogtländer NPJ. A lesson for the clinical nephrologist: desmopressin and its unforeseen efficacy in clinical post-obstructive diuresis. J Nephrol 2024; 37:515-517. [PMID: 37856066 PMCID: PMC11043196 DOI: 10.1007/s40620-023-01782-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/03/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Riemer Anton Been
- Department of Internal Medicine, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands.
| | - Philip Johannes Gerdiaan Maria Voets
- Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands
- Department of Internal Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
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Nagase K, Watanabe T, Nomura A, Nagase FN, Iwasaki K, Nakamura Y, Ikai H, Yamamoto M, Murai Y, Yokoyama-Kokuryo W, Takizawa N, Shimizu H, Fujita Y. Predictive correction of serum sodium concentration with formulas derived from the Edelman equation in patients with severe hyponatremia. Sci Rep 2023; 13:1783. [PMID: 36720979 PMCID: PMC9889706 DOI: 10.1038/s41598-023-28380-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/17/2023] [Indexed: 02/02/2023] Open
Abstract
Severe hyponatremia can cause life-threatening cerebral edema. Treatment comprises rapid elevation of serum sodium concentration; however, overcorrection can result in osmotic demyelination. This study investigated potential factors, including predictive correction based on the Edelman equation, associated with appropriate correction in 221 patients with a serum sodium concentration ≤ 120 mEq/L who were admitted to a hospital in Nagoya, Japan. Appropriate correction was defined as an elevation in serum sodium concentration in the range of 4-10 mEq/L in the first 24 h and within 18 mEq/L in the first 48 h after the start of the correction. Appropriate corrections were made in 132 (59.7%) of the 221 patients. Multivariate analysis revealed that predictive correction with an infusate and fluid loss formula derived from the Edelman equation was associated with appropriate correction of serum sodium concentration (adjusted odds ratio, 7.84; 95% confidence interval, 2.97-20.64). Relative without its use, the predictive equation results in a lower proportion of undercorrection (14.3% vs. 48.0%, respectively) and overcorrection (1.0% vs. 12.2%, respectively). These results suggest that predictive correction of serum sodium concentrations using the formula derived from the Edelman equation can play an essential role in the appropriate management of patients with severe hyponatremia.
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Affiliation(s)
- Koya Nagase
- Department of Nephrology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Tsuyoshi Watanabe
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan.
| | - Akihiro Nomura
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Fumika N Nagase
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Keita Iwasaki
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Yoshihiro Nakamura
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroki Ikai
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Mari Yamamoto
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Yukari Murai
- Department of Nephrology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Waka Yokoyama-Kokuryo
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Naoho Takizawa
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Hideaki Shimizu
- Department of Nephrology and Renal Replacement, Daido Hospital, 9, Hakusui-cho, Minami-ku, Nagoya, Aichi, 457-8511, Japan
| | - Yoshiro Fujita
- Department of Nephrology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
- Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, Aichi, 455-8530, Japan
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