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Teo CB, Gan MY, Tay RYK, Loh WJ, Loh NHW. Association of preoperative hyponatremia with surgical outcomes: a systematic review and meta-analysis of 32 observational studies. J Clin Endocrinol Metab 2022; 108:1254-1271. [PMID: 36472931 PMCID: PMC10099166 DOI: 10.1210/clinem/dgac685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/08/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preoperative hyponatremia is prevalent in patients undergoing surgical procedures, but it is uncertain if hyponatremia will lead to increased risk of surgical mortality and morbidity. METHODS A systematic search of Medline (PubMed), Embase and Cochrane Library from inception till 2 July 2021 was performed. Full length articles that reported on the association between surgical outcomes among adults ≥18 years with documented preoperative hyponatremia were included. FINDINGS We identified 32 observational studies comprising 1,301,346 participants. All studies had low risk of bias. When adjusted for covariates, patients with hyponatremia had significantly higher odds of developing major complications (defined as a composite measure of 9 major complications) compared to patients with normal sodium concentrations (aOR = 1.37, 95%CI = 1.23-1.53, I2 = 78%. N = 10). Additionally, patients with preoperative hyponatremia also significantly higher hazards of early mortality (<90 days) compared to patients with normonatremia (aHR = 1.27, 95%CI = 1.13-1.43, I2 = 97%. N = 10) after adjustment for covariates. Preoperative hyponatremia also had significant associations with respiratory, renal and septic complications. In terms of prognostic performance, preoperative hyponatremia performed adequately in predicting major complications in surgical patients (AUC = 0.70, LR- 0.90) with a specificity of 88% and a sensitivity of 25%. INTERPRETATION Our meta-analysis suggests that preoperative hyponatremia is associated with poorer early mortality and major morbidity outcomes in surgical patients. Hyponatremia is also a specific prognosticator for major complications in surgical patients, reiterating its potential use as a clinical indicator of poor outcomes.
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Affiliation(s)
- Chong Boon Teo
- Ministry of Health Holdings, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Ryan Yong Kiat Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wann Jia Loh
- Department of Endocrinology, Changi General Hospital, Singapore
| | - Ne-Hooi Will Loh
- Department of Anaesthesia, National University Hospital, Singapore
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2
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Lee Y, Yoo KD, Baek SH, Kim YG, Kim HJ, Ryu JY, Paek JH, Suh SH, Oh SW, Lee J, Jhee JH, Suh JS, Yang EM, Park YH, Kim YL, Choi M, Oh KH, Kim S. Korean Society of Nephrology 2022 Recommendations on controversial issues in diagnosis and management of hyponatremia. Kidney Res Clin Pract 2022. [PMCID: PMC9351400 DOI: 10.23876/j.krcp.33.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Yeonhee Lee
- Division of Nephrology, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Republic of Korea
| | - Kyung Don Yoo
- Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Seon Ha Baek
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Yang Gyun Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyo Jin Kim
- Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Ji Young Ryu
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Jin Hyuk Paek
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Sang Heon Suh
- Division of Nephrology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jeonghwan Lee
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Soon Suh
- Division of Pediatric Nephrology, Department of Pediatrics, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Mi Yang
- Division of Pediatric Nephrology, Department of Pediatrics, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Young Ho Park
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yae Lim Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sejoong Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Correspondence: Sejoong Kim Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173beon-gil, Bundang-gu, Seongnam 13620, Republic of Korea. E-mail:
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Incidence of and factors associated with hyponatremia in traumatic cervical spinal cord injury patients. Spinal Cord Ser Cases 2022; 8:15. [PMID: 35091531 PMCID: PMC8799646 DOI: 10.1038/s41394-022-00475-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 01/30/2023] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To investigate the incidence of and factors associated with hyponatremia among traumatic cervical spinal cord injury (SCI) patients. SETTING Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. METHODS This retrospective study included traumatic cervical SCI patients that were admitted to the Siriraj Spinal Unit during January 2002 to May 2013. Patient demographic and clinical data were collected. RESULTS One hundred and twenty-three patients (98 males, 25 females) were enrolled. The mean age of patients was 47.2 ± 16.9 years (range: 11-84). There were 38 complete and 85 incomplete cord injuries. Seventy-six patients were treated surgically, and all others received conservative treatment. Hyponatremia developed in 54 patients (43.9%), and 74.1% of all cases of hyponatremia presented within 9 days after SCI. Hyponatremia occurred on the first day in 10 patients (18.5%), on the fifth day in 6 patients (11.1%), and on the eighth day in 5 patients (9.26%). Hyponatremia occurred in 6/10 patients (60.0%) with upper cervical spine injury (C1-2), and in 48/113 patients (42.5%) with lower cervical spine injury (C3-7) (odds ratio [OR]: 2.031, 95% confidence interval [CI]: 0.543-7.596; p = 0.292). The incidence of hyponatremia was 65.8% in complete SCI patients, and 34.1% in incomplete SCI patients. Logistic regression analysis revealed complete SCI to be the only factor significantly associated with hyponatremia (OR: 3.714, 95% CI: 1.658-8.317; p < 0.001). CONCLUSION Hyponatremia was found to be common in post-traumatic cervical SCI patients. Complete SCI was identified as the only factor significantly associated with hyponatremia in traumatic cervical SCI patients.
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Gregoriano C, Molitor A, Haag E, Kutz A, Koch D, Haubitz S, Conen A, Bernasconi L, Hammerer-Lercher A, Fux CA, Mueller B, Schuetz P. Activation of Vasopressin System During COVID-19 is Associated With Adverse Clinical Outcomes: An Observational Study. J Endocr Soc 2021; 5:bvab045. [PMID: 34056499 PMCID: PMC7989362 DOI: 10.1210/jendso/bvab045] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Indexed: 12/26/2022] Open
Abstract
Background Activation of the vasopressin system plays a key role for the maintenance of osmotic, cardiovascular, and stress hormone homeostasis during disease. We investigated levels of copeptin, the C-terminal segment of the vasopressin prohormone, that mirrors the production rate of vasopressin in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods We measured levels of copeptin on admission and after days 3/4, 5/6, and 7/8 in 74 consecutive hospitalized adult COVID-19 patients and compared its prognostic accuracy to that of patients with community-acquired pneumonia (n = 876) and acute or chronic bronchitis (n = 371) from a previous study by means of logistic regression analysis. The primary endpoint was all-cause 30-day mortality. Results Median admission copeptin levels in COVID-19 patients were almost 4-fold higher in nonsurvivors compared with survivors (49.4 pmol/L [iterquartile range (IQR) 24.9–68.9 pmol/L] vs 13.5 pmol/L [IQR 7.0–26.7 pmol/L]), resulting in an age- and gender-adjusted odds ratio of 7.0 (95% confidence interval [CI] 1.2–40.3), p < 0.03 for mortality. Higher copeptin levels in nonsurvivors persisted during the short-term follow-up. Compared with the control group patients with acute/chronic bronchitis and pneumonia, COVID-19 patients did not have higher admission copeptin levels. Conclusions A pronounced activation of the vasopressin system in COVID-19 patients is associated with an adverse clinical course in COVID-19 patients. This finding, however, is not unique to COVID-19 but similar to other types of respiratory infections.
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Affiliation(s)
- Claudia Gregoriano
- Medical University Department of Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Alexandra Molitor
- Medical University Department of Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Ellen Haag
- Medical University Department of Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Alexander Kutz
- Medical University Department of Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Daniel Koch
- Medical University Department of Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Sebastian Haubitz
- Medical University Department of Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland.,Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Anna Conen
- Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, 5001 Aarau, Switzerland.,Medical Faculty, University of Basel, 4056 Basel, Switzerland
| | - Luca Bernasconi
- Institute of Laboratory Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | | | - Christoph A Fux
- Medical University Department of Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland.,Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Beat Mueller
- Medical University Department of Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland.,Medical Faculty, University of Basel, 4056 Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department of Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland.,Medical Faculty, University of Basel, 4056 Basel, Switzerland
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Naaraayan A, Pant S, Jesmajian S. Severe Hyponatremic Encephalopathy in a Patient With COVID-19. Mayo Clin Proc 2020; 95:2285-2286. [PMID: 33012359 PMCID: PMC7368888 DOI: 10.1016/j.mayocp.2020.06.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/02/2020] [Accepted: 06/23/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Ashutossh Naaraayan
- Department of Medicine, Montefiore New Rochelle Hospital, New Rochelle, New York
| | - Sushil Pant
- Department of Medicine, Montefiore New Rochelle Hospital, New Rochelle, New York
| | - Stephen Jesmajian
- Department of Medicine, Montefiore New Rochelle Hospital, New Rochelle, New York
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Yousaf Z, Al-Shokri SD, Al-Soub H, Mohamed MFH. COVID-19-associated SIADH: a clue in the times of pandemic! Am J Physiol Endocrinol Metab 2020; 318:E882-E885. [PMID: 32396497 PMCID: PMC7276977 DOI: 10.1152/ajpendo.00178.2020] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Zohaib Yousaf
- Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Shaikha D Al-Shokri
- Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hussam Al-Soub
- Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mouhand F H Mohamed
- Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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7
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Gemcioglu E, Karabuga B, Ercan A, Erden A. A case of Inappropriate Antidiuretic Hormone Secretion Syndrome Associated with COVID-19 Pneumonia. ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 16:110-111. [PMID: 32685049 DOI: 10.4183/aeb.2020.110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
At the end of 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia in China and it spread quickly to other countries. Although Covid-19 causes severe pneumonia, it is known that it can be associated with different diseases and prognosis of disease can be due to many of disorders such as hyponatremia. A 65-year-old female patient with sarcoidosis, cronic obstructive lung disease, hypertension and congestive heart failure presented to the emergency department with shortness of breath and fever. Oropharyngeal swab for Covid-19 PCR test was positive. After the initiation of treatment, the patient developed hyponatremia. This case is remarkable because there is no reported case of Covid-19 and inappropriate ADH syndrome coexistence and it demonstrates that there may be a correlation between Covid-19 infection prognosis and hyponatremia.
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Affiliation(s)
- E Gemcioglu
- Ankara City Hospital, Ministry of Health, Department of Internal Medicine, Ankara, Turkey
| | - B Karabuga
- Ankara City Hospital, Ministry of Health, "Yildirim Beyazit" University, Faculty of Medicine - Internal Medicine, Ankara, Turkey
| | - A Ercan
- Ankara City Hospital, Ministry of Health, Department of Internal Medicine, Ankara, Turkey
| | - A Erden
- Ankara City Hospital, Ministry of Health, Division of Rheumatology, Ankara, Turkey
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8
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Gaglani B, Gupta S, Chavez O, Libardo R. Influenza as a Cause of SIADH Related Hyponatremia: A Case Report. J Clin Diagn Res 2017; 11:OD10-OD11. [PMID: 28658832 DOI: 10.7860/jcdr/2017/25785.9797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/14/2017] [Indexed: 01/10/2023]
Abstract
Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH) is one of the most common causes of hyponatremia in hospitalized patients. The distinct aetiologies and co-morbidities associated with hyponatremia pose substantial challenges in identifying and managing this disorder. Several infectious causes of SIADH are reported but hyponatremia associated with SIADH and influenza virus infection is less commonly seen. We present a case of hyponatremia associated with influenza, which was subsequently diagnosed as SIADH.
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Affiliation(s)
- Bhavita Gaglani
- PGY3 (R3) Resident, Department of Internal Medicine, St. Barnabas Hospital, Bronx, New York, USA
| | - Sorab Gupta
- PGY3 (R3) Resident, Department of Internal Medicine, St. Barnabas Hospital, Bronx, New york, USA
| | - Octavio Chavez
- PGY2 (R2) Resident, Department of Internal Medicine, St. Barnabas Hospital, Bronx, New york, USA
| | - Rueda Libardo
- PGY2 (R2) Resident, Department of Internal medicine, St. Barnabas Hospital, Bronx, New york, USA
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9
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Dumont AS, Nemergut EC, Jane JA, Laws ER. Postoperative Care Following Pituitary Surgery. J Intensive Care Med 2016; 20:127-40. [PMID: 15888900 DOI: 10.1177/0885066605275247] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients undergoing surgery for pituitary tumors represent a heterogeneous population each with unique clinical, biochemical, radiologic, pathologic, neurologic, and/or ophthalmologic considerations. The postoperative management of patients following pituitary surgery often occurs in the context of a dynamic state of the hypothalamic-pituitary-end organ axis. Consequently, a significant component of the postoperative care of these patients focuses on vigilant screening and observation for neuroendocrinologic perturbations such as varying degrees of hypopituitarism and disorders of water balance (diabetes insipidus and the syndrome of inappropriate antidiuretic hormone). Additionally, one must be cognizant of other potential complications specific to the transsphenoidal approach for tumor removal including cerebrospinal fluid leakage and meningitis. This review addresses the postoperative management of patients undergoing pituitary surgery with an emphasis on careful screening and recognition of complications.
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Affiliation(s)
- Aaron S Dumont
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, 22908, USA
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Balling L, Gustafsson F, Goetze JP, Dalsgaard M, Nielsen H, Boesgaard S, Bay M, Kirk V, Nielsen OW, Køber L, Iversen K. Hyponatraemia at hospital admission is a predictor of overall mortality. Intern Med J 2015; 45:195-202. [PMID: 25370908 DOI: 10.1111/imj.12623] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 10/22/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hyponatraemia is a prognostic marker of increased mortality and morbidity in selected groups of hospitalised patients. The aim of the present study was to examine the prevalence and prognostic significance of hyponatraemia at hospital admission in an unselected population with a broad spectrum of medical and surgical diagnoses. METHODS Consecutive patients >40 years of age admitted to a general district hospital in Greater Copenhagen between 1 April 1998 and 31 March 1999. Median follow-up time was 5.16 years (range 0-4372 days). Plasma sodium measurements were available in 2960 patients, and hyponatraemia defined as P-Na(+) <137 mmol/L at hospital admission was present in 1105 (37.3 %) patients. RESULTS One-year mortality was higher for hyponatraemic patients than for normonatraemic patients: 27.5% versus 17.7%. Moreover, hyponatraemia was an independent predictor of short and long-term all-cause mortality after 1 year and after the entire observation period respectively: hazard ratio (HR) 1.6 (95 % confidence interval (CI) 1.4-1.9, P < 0.0001) and HR 1.4 (95 % CI 1.3-1.6, P < 0.0001). Patients with hyponatraemia had longer hospitalisations than patients with normonatraemia: 7.6 (±0.38) days vs 5.6 (±0.21) days, P < 0.001. There was no interaction between hyponatraemia at admission and any admission diagnoses (P > 0.05 for all interaction analyses). CONCLUSION Hyponatraemia is associated with increased all-cause mortality and longer admission length independently of diagnosis and clinical variables.
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Affiliation(s)
- L Balling
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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Lunøe M, Overgaard-Steensen C. Prevention of hospital-acquired hyponatraemia: individualised fluid therapy. Acta Anaesthesiol Scand 2015; 59:975-85. [PMID: 25960126 DOI: 10.1111/aas.12522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/01/2015] [Accepted: 03/02/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Large amounts of fluids are daily prescribed to hospitalised patients across different medical specialities. Unfortunately, inappropriate fluid administration commonly causes iatrogenic hyponatraemia with associated increase in morbidity and mortality. METHODS/RESULTS Fundamental for prevention of hospital-acquired hyponatraemia is an understanding of what determines plasma sodium concentration (P-[Na(+) ]) in the individual patient. P-[Na(+) ] is determined by balances of water and cations according to Edelman. This paper discusses the mechanisms influencing water and cation balances. In the hospitalised patient, non-osmotic antidiuretic hormone secretion is frequent and results in a reduced renal electrolyte-free water clearance (EFWC). This condition puts the patient at risk of hyponatraemia upon infusion of fluids that are hypotonic such as 5% glucose, Darrow-glucose, NaKglucose and 0.45% NaCl in 5% glucose. It is suggested that individualised fluid therapy includes the following: Firstly, bolus therapy with Ringer-acetate/Ringer-lactate/0.9% NaCl in the hypovolaemic patient to minimise the risk of fluid under-/overload. Secondly, P-[Na(+) ] should be monitored together with the balances influencing P-[Na(+) ]. This may include EFWC in patients at additional risk of hyponatraemia. In patients with potentially reduced intracranial compliance (e.g. meningitis, intracranial bleeding, cerebral contusion and brain oedema), even a small decrease in P-[Na(+) ] induced by slightly hypotonic fluids like Ringer-acetate/Ringer-lactate can increase the intracranial pressure dramatically. Consequently, 0.9 % NaCl is recommended as first-line fluid for such patients. CONCLUSIONS The occurrence of hospital-acquired hyponatraemia may be reduced by prescribing fluids, type and amount, with the same dedication as shown for other drugs.
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Affiliation(s)
- M. Lunøe
- Department of Anaesthesiology; Bispebjerg Hospital; Copenhagen Denmark
| | - C. Overgaard-Steensen
- Department of Anaesthesiology; Bispebjerg Hospital; Copenhagen Denmark
- Department of Neuroanaesthesiology; Rigshospitalet; Copenhagen Denmark
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12
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Pathak R, Khanal A, Poudel DR, Karmacharya P. Down with the Flu: Hyponatremia in a patient with influenza. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 7:227-8. [PMID: 26110135 PMCID: PMC4462819 DOI: 10.4103/1947-2714.157488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Context: Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a common cause of hyponatremia. Although it has been associated with different pulmonary infections, there have been only few case reports describing the association of SIADH with influenza. Case Report: We report a case of SIADH in a patient with influenza who was successfully treated with fluid restriction. Conclusion: It is essential for clinicians to be aware of the association between influenza and SIADH.
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Affiliation(s)
- Ranjan Pathak
- Department of Internal Medicine, Reading Health System, 6th Avenue and Spruce Street, West Reading, PA, USA
| | - Ashish Khanal
- Department of Internal Medicine, Nepal Medical College Teaching Hospital, Attarkhel, Jorpati-7, Nepal
| | - Dilli Ram Poudel
- Department of Internal Medicine, Reading Health System, 6th Avenue and Spruce Street, West Reading, PA, USA
| | - Paras Karmacharya
- Department of Internal Medicine, Reading Health System, 6th Avenue and Spruce Street, West Reading, PA, USA
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Urso C, Brucculeri S, Caimi G. Employment of vasopressin receptor antagonists in management of hyponatraemia and volume overload in some clinical conditions. J Clin Pharm Ther 2015; 40:376-85. [PMID: 25924179 DOI: 10.1111/jcpt.12279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/07/2015] [Indexed: 12/21/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Hyponatraemia, the most common electrolyte imbalance occurring in hospitalized subjects, is usually classified as hypovolaemic, euvolaemic or hypervolaemic. Hyponatraemia is a predictor of death among subjects with chronic heart failure and cirrhosis. The inappropriate secretion of the antidiuretic hormone (AVP) seems to be of pivotal importance in the decline of serum sodium concentration in these clinical conditions. The objective of this review was to summarize recent progress in management of hyponatraemia in SIADH, cirrhosis and heart failure. METHODS Literature searches were conducted on the topics of hyponatraemia and vasopressin receptor antagonists, using PubMed, pharmaceutical company websites and news reports. The information was evaluated for relevance and quality, critically assessed and summarized. RESULTS AND DISCUSSION The initial treatment of severe hyponatraemia is directed towards the prevention or management of neurological manifestations and consists of an intravenous infusion of hypertonic saline. Fluid restriction is indicated in oedematous states. Diuretics alone or in combination with other specific drugs remain the main strategy in the management of volume overload in heart failure. In resistant cases, ultrafiltration can lead to effective removal of isotonic fluid preventing new episodes of decompensation; however, aquapheresis is associated with increased costs and other limits. In several trials, the efficacy of vasopressin receptor antagonists in euvolaemic patients (inappropriate antidiuretic hormone secretion) or in hypervolaemic hyponatraemia (chronic heart failure, cirrhosis) has been evaluated. It was found that vaptans, which promote aquaresis, were superior to a placebo in raising and maintaining serum sodium concentrations in these subjects. WHAT IS NEW AND CONCLUSIONS Combined with conventional therapy, vasopressin receptor antagonists (AVP-R antagonists) are able to increase the excretion of electrolyte-free water and the sodium concentration. Further studies are needed to assess efficacious outcomes of aquaresis compared with aquapheresis and with conventional therapy.
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Affiliation(s)
- C Urso
- Dipartimento Biomedico di Medicina Interna e Specialistica, Universitá di Palermo, Palermo, Italy
| | - S Brucculeri
- Dipartimento Biomedico di Medicina Interna e Specialistica, Universitá di Palermo, Palermo, Italy
| | - G Caimi
- Dipartimento Biomedico di Medicina Interna e Specialistica, Universitá di Palermo, Palermo, Italy
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Vitorino H, Castanheira A, Veiga MZ, Silva AM. Tuberculous lymphadenitis and syndrome of inappropriate antidiuresis, improbable partners. CASE REPORTS 2015; 2015:bcr-2014-208795. [DOI: 10.1136/bcr-2014-208795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Safety and efficacy of isotonic (0.9%) vs. hypotonic (0.18%) saline as maintenance intravenous fluids in children: A randomized controlled trial. Indian Pediatr 2015; 51:969-74. [DOI: 10.1007/s13312-014-0542-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND hyponatraemia in orthopaedic patients is common but has been poorly investigated following surgery for traumatic hip fracture. The aims of this study were to define the incidence of new-onset post-operative hyponatraemia and to investigate associations between hyponatraemia and patient demographics, medication use and duration of hospital stay. METHODS all patients admitted to the Orthopaedic Unit for hip surgery following trauma in 2012 were retrospectively reviewed. Patients who developed post-operative hyponatraemia within 10 days of surgery were compared with patients who remained normonatraemic pre- and post-operatively. RESULTS a total of 254 patients were included. Overall, this study identified a significant (P =< 0.001) mean post-operative drop in serum sodium of 1.8 mmol/l (95% CI: 1.3-2.3%) compared with pre-operative levels. The incidence of moderate (<135 mmol/l) and severe (<130 mmol/l) post-operative hyponatraemia was 27% (95% CI: 21.7-32.5%) and 9% (95% CI: 5.7-12.8%), respectively. Statistical analysis revealed significant associations between the development of post-operative hyponatraemia and: (i) proton pump inhibitor use, (ii) selective serotonin re-uptake inhibitor use and (iii) increasing number of medications. Length of hospital stay was significantly increased in patients with moderate post-operative hyponatraemia compared with normonatraemic patients (30 versus 21 days; P =< 0.001). The incidence of new-onset post-operative hyponatraemia was not significantly increased by ethnicity, gender, fracture type, functional status or operative procedure. CONCLUSION hyponatraemia after surgery for hip fracture is common and results in longer hospital stay. This study provides evidence that an average post-operative drop in serum sodium concentration should be expected in this patient group. Moreover, patients taking SSRI or PPI medications may be at increased risk of post-operative hyponatraemia.
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Affiliation(s)
- James Edward Rudge
- City Hospital, Sandwell and West Birmingham Hospitals NHS Trust - Postgraduate Centre, Birmingham, UK
| | - Daniel Kim
- City Hospital, Sandwell and West Birmingham Hospitals NHS Trust - Postgraduate Centre, Birmingham, UK
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Salahudeen AK, Ali N, George M, Lahoti A, Palla S. Tolvaptan in hospitalized cancer patients with hyponatremia: a double-blind, randomized, placebo-controlled clinical trial on efficacy and safety. Cancer 2014; 120:744-51. [PMID: 24895288 DOI: 10.1002/cncr.28468] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/01/2013] [Accepted: 10/02/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND The rate of hyponatremia is higher in hospitalized cancer patients than in hospitalized patients without cancer and is associated with poor clinical outcomes. The availability of V2 receptor antagonists has been a major breakthrough in the management of hyponatremia, but its efficacy and safety in treating hyponatremia in patients with cancer is not known. METHODS Adult patients with cancer who were admitted to The University of Texas MD Anderson Cancer Center with nonhypovolemic hyponatremia (125-130 mmol/L) were randomized to receive either tolvaptan or placebo in a double-blind, placebo-controlled, adaptive, randomized trial. Both groups received the standard of care for hyponatremia, except that patients were allowed to drink to thirst. RESULTS A preplanned Data Safety Monitoring Board analysis of 30 of 48 randomized patients who completed the study revealed that the primary endpoint of hyponatremia correction was met by 16 of 17 patients who received tolvaptan and by 1 of 13 patients who received placebo (94% vs 8%; P < .001), which met the study stopping rule for superiority. The secondary endpoints between the tolvaptan and placebo groups (mean ± standard deviation) for length of stay (21 ± 15 days vs 26 ± 15 days, respectively) and change in the Mini-Mental State Examination score (-0.35 ± 1.66 vs 0.31 ± 2.42, respectively) were not significantly different. No overcorrection of serum sodium (>12 mmol/L per day) was noted in the tolvaptan group, and the main adverse events noted were dry mouth, polydipsia, and polyuria, leading to 13% study withdrawal. CONCLUSIONS Although tolvaptan was effective for correcting hyponatremia in patients with cancer, studies with a larger sample size will be required to confirm the current findings, including the outcomes of secondary endpoints.
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Affiliation(s)
- Abdulla K Salahudeen
- Nephrology Section, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Abu Zeinah GF, Al-Kindi SG, Hassan AA, Allam A. Hyponatraemia in cancer: association with type of cancer and mortality. Eur J Cancer Care (Engl) 2014; 24:224-31. [PMID: 24661476 DOI: 10.1111/ecc.12187] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 11/28/2022]
Abstract
Hyponatraemia is common in patients with cancer. The objectives of this study are to investigate the severity distribution of hyponatraemia and its association with mortality. We retrospectively reviewed medical records for patients admitted to a national centre for cancer care and research in Qatar between 2008 and 2012. A model was built through multivariate analyses to investigate the role of hyponatraemia in mortality. Patients were grouped into those who had moderate-severe hyponatraemia (Na < 130) and those who only had normal-mild hyponatraemia (Na ≥ 130). A total of 2048 patients were included in this study. Prostate (57.1%), pancreatic (50%), liver (49%) and lung (40.2%) cancers showed the highest frequency of moderate-severe hyponatraemia, while breast cancer showed the lowest frequency at 23.5%. In the multivariate analyses, patients with moderate-severe hyponatraemia (Na < 130 mmol/L) were 4.28 times more likely to die than those with normal-mild hyponatraemia (Na ≥ 130) (P < 0.05). The present study shows that hyponatraemia is a common electrolyte disturbance among hospitalised patients with cancer diagnoses. The severity of hyponatraemia was a statistically significant independent factor associated with higher in-hospital mortality. This is in accordance with the reported literature and emphasises the importance of early diagnosis and correction of hyponatraemia.
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Affiliation(s)
- G F Abu Zeinah
- Department of Internal Medicine, New York Presbyterian Hospital, New York, NY
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Abstract
Vasopressin antagonists have been studied in a variety of clinical settings, including patients with acute and chronic heart failure. The clinical trials published to date have sought to describe the clinical and physiologic effects of these agents in an effort to prove clinical efficacy and safety. A variety of agents with varying effects on V2 and V1a vasopressin receptor subtype have been studied. They have been shown to reduce bodyweight and improve serum sodium without worsening renal function. They may also decrease the need for loop diuretic use and may be particularly useful in patients with hyponatremia in the setting of volume overload. Further studies are underway that are powered to assess for morbidity and mortality benefits. The beneficial effects have been well documented but, until outcomes are understood more fully, the use of these agents should be limited to currently approved indications. In the USA, this includes only the treatment of euvolemic hyponatremia.
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Affiliation(s)
- Joseph Rossi
- Northwestern University, Feinberg School of Medicine, 251 E. Huron Galter 10-240, Chicago IL 60611, USA.
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20
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O'Connor KA, Cotter PE, Kingston M, Twomey C, O'Mahony D. The pattern of plasma sodium abnormalities in an acute elderly care ward: A cross-sectional study. Ir J Med Sci 2013; 175:28-31. [PMID: 17073244 DOI: 10.1007/bf03169169] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The combination of ageing, illness, and medications can lead to hyponatraemia or hypernatraemia. AIMS To describe the distribution of plasma sodium levels in older patients admitted to hospital. METHODS We carried out a hospital based cross-sectional study examining 1,511 serum sodium concentrations ([Na+]) among 336 elderly patients and attempted to elucidate the cause(s) of the abnormal serum [Na+]. RESULTS The study population had a mean age of 81.4. Ninety-two (27.4%) patients had hyponatraemia and seven patients (2.1%) had hypernatraemia during their hospitalisation. The distribution of [Na+] results was towards the lower end of the normal range. The mortality rate of patients with hyponatraemia was 14.1% and that of patients with normal serum [Na+] was 8.9%. Six patients with hypernatraemia died in hospital. Lower respiratory tract infection and medication accounted for the majority of cases. CONCLUSIONS Deranged [Na+] is common among elderly patients admitted to hospital.
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Affiliation(s)
- K A O'Connor
- South Munster Geriatric Training Scheme, Dept of Geriatric Medicine, Cork University Hospital, Wilton, Cork
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21
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Abstract
Intravenous maintenance fluid therapy aims to replace daily urinary and insensible losses for ill children in whom adequate enteric administration of fluids is contraindicated or infeasible. The traditional determination of fluid volumes and composition dates back to Holliday and Segar's seminal article from 1957, which describes the relationship between weight, energy expenditure, and physiologic losses in healthy children. Combined with estimates of daily electrolyte requirements, this information supports the use of the hypotonic maintenance fluids that were widely used in pediatric medicine. However, using hypotonic intravenous fluids in a contemporary hospitalized patient who may have complex physiologic derangements, less caloric expenditure, decreased urinary output, and elevated antidiuretic hormone levels is often not optimal; evidence over the last 2 decades shows that it may lead to an increased incidence of hyponatremia. In this review, we present the evidence for using isotonic rather than hypotonic fluids as intravenous maintenance fluid.
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The frequency, cost, and clinical outcomes of hypernatremia in patients hospitalized to a comprehensive cancer center. Support Care Cancer 2013; 21:1871-8. [PMID: 23404230 DOI: 10.1007/s00520-013-1734-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 01/28/2013] [Indexed: 12/26/2022]
Abstract
PURPOSE To study the frequency of hypernatremia in hospitalized cancer patients and its impact on clinical outcomes and healthcare cost. METHODS Cross-sectional analysis of data obtained from patients admitted to the University of Texas M. D. Anderson Cancer Center over a 3-month period in 2006. The clinical outcomes and hospital costs were compared among hypernatremics, eunatremics, and hyponatremics (serum sodium values include >147, 135-147, and <135 mEq/L, respectively). RESULTS Of 3,446 patients with at least one serum sodium value, 51.4 % were eunatremic, 46.0 % hyponatremic, and 2.6 % hypernatremic with most of the hypernatremia (90 %) acquired during hospital stay. The multivariate hazard ratio (HR) for mortality in hypernatremic was 5-fold higher than eunatremic (HR for 90 days-5.09 (95 % CI, 3.32-7.81); p < 0·01) and over 2-fold higher than hyponatremic (HR for 90 days-2.79 (95 % CI, 1.91-4.11), p < 0.01). The length of hospital stay in hypernatremic was 2-fold higher than in hyponatremic and 4-fold higher than in eunatremic (e.g., 27 ± 22 days in hypernatremic vs. 6 ± 5 days in eunatremic; mean ± SD, p < 0.01). The hospital bill was higher for hypernatremic compared with the rest of the groups (46 % over eunatremic and 37 % over hyponatremic, p < 0.01 for both). CONCLUSIONS Although hypernatremia was far less frequent than hyponatremia in the hospitalized cancer patients, most hypernatremia were acquired in the hospital and had substantially higher mortality, hospital stay, and hospital bills than eunatremic or even hyponatremic patients. Studies are warranted to determine whether avoidance of hypernatremia or its prompt and sustained correction improves clinical outcomes.
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Abstract
Although traditionally regarded as a disease confined to the lungs, acute pneumonia has important effects on the cardiovascular system at all severities of infection. Pneumonia tends to affect individuals who are also at high cardiovascular risk. Results of recent studies show that about a quarter of adults admitted to hospital with pneumonia develop a major acute cardiac complication during their hospital stay, which is associated with a 60% increase in short-term mortality. These findings suggest that outcomes of patients with pneumonia can be improved by prevention of the development and progression of associated cardiac complications. Before this hypothesis can be tested, however, an adequate mechanistic understanding of the cardiovascular changes that occur during pneumonia, and their role in the trigger of various cardiac complications, is needed. In this Review, we summarise knowledge about the burden of cardiac complications in adults with acute pneumonia, the cardiovascular response to this infection, the potential effects of commonly used cardiovascular and anti-infective drugs on these associations, and possible directions for future research.
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24
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Oral lixivaptan effectively increases serum sodium concentrations in outpatients with euvolemic hyponatremia. Kidney Int 2012; 82:1215-22. [PMID: 22932122 DOI: 10.1038/ki.2012.274] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hyponatremia is the most common electrolyte disorder in clinical practice. Its incidence increases with age and it is associated with increased morbidity and mortality. Recently, the vaptans, antagonists of the arginine vasopressin pathway, have shown promise for safe treatment of hyponatremia. Here we evaluated the efficacy, safety, and tolerability of oral lixivaptan, a selective vasopressin V2-receptor antagonist, for treatment of nonhospitalized individuals with euvolemic hyponatremia (sodium less than 135 mmol/l) in a multicenter, randomized, double-blind, placebo-controlled, phase III study. About half of the 206 patients were elderly in a chronic care setting. Of these patients, 52 were given a placebo and 154 were given 25-100 mg per day lixivaptan, titrated based on the daily serum sodium measurements. Compared with placebo (0.8 mmol/l), the serum sodium concentration significantly increased by 3.2 mmol/l from baseline to day 7 (primary efficacy endpoint) with lixivaptan treatment. A significantly greater proportion of patients that received lixivaptan achieved normal serum sodium (39.4%) by day 7 relative to placebo (12.2%). Overall, lixivaptan was considered safe and well-tolerated. Thus, oral lixivaptan can be safely initiated in the outpatient setting and effectively increases serum sodium concentrations in outpatients with euvolemic hyponatremia.
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26
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Abstract
Kinnier Wilson coined the term metabolic encephalopathy to describe a clinical state of global cerebral dysfunction induced by systemic stress that can vary in clinical presentation from mild executive dysfunction to deep coma with decerebrate posturing; the causes are numerous. Some mechanisms by which cerebral dysfunction occurs in metabolic encephalopathies include focal or global cerebral edema, alterations in transmitter function, the accumulation of uncleared toxic metabolites, postcapillary venule vasogenic edema, and energy failure. This article focuses on common causes of metabolic encephalopathy, and reviews common causes, clinical presentations and, where relevant, management.
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Affiliation(s)
- Michael J Angel
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
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27
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Doshi SM, Shah P, Lei X, Lahoti A, Salahudeen AK. Hyponatremia in hospitalized cancer patients and its impact on clinical outcomes. Am J Kidney Dis 2011; 59:222-8. [PMID: 22001181 DOI: 10.1053/j.ajkd.2011.08.029] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 08/10/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hyponatremia is the most common electrolyte abnormality in clinical practice, yet little is known about its frequency in patients with cancer or its impact on their clinical outcomes. STUDY DESIGN Retrospective analysis of prospectively collected data. SETTING & PARTICIPANTS Patients with cancer admitted to the University of Texas M.D. Anderson Cancer Center in 2006 for 3 months. PREDICTOR Serum sodium levels categorized as eunatremia (serum sodium, 135-147 mEq/L) and mild (134-130 mEq/L), moderate (129-120 mEq/L), and severe (<120 mEq/L) hyponatremia. OUTCOMES (1) Length of hospital stay and (2) 90-day mortality. RESULTS In 4,702 admissions in 3,357 patients with cancer, hyponatremia (serum sodium <135 mEq/L) was noted in 47% of admissions. It was mild in 36%, moderate in 10%, and severe in 1%. Hyponatremia was acquired during the hospital stay in 24%. Using the first admission data, mean length of stay was 5.6 ± 5.0 days for patients with eunatremia and 9.9 ± 9.2, 13.0 ± 14.1, and 11.5 ± 12.6 days for those with mild, moderate, and severe hyponatremia, respectively. The respective HRs in the multivariate Cox model for longer hospital stay, using patients with eunatremia as reference, were 1.92 (95% CI, 1.75-2.13; P < 0.01), 2.94 (95% CI, 2.56-3.45; P < 0.01), and 2.32 (95% CI, 1.32-4.00; P = 0.01). 283 (8.4%) deaths occurred during 90 days, and in the multivariate model, the respective HRs for 90-day mortality for mild, moderate, and severe hyponatremia were 2.04 (95% CI, 1.42-2.91; P < 0.01); 4.74 (95% CI, 3.21-7.01; P < 0.01), and 3.46 (95% CI, 1.05-11.44; P = 0.04). These findings were consistent when analyses were repeated with sodium levels in tertiles. LIMITATIONS Observational study, retrospective, inability to adjust for all comorbid conditions. CONCLUSION Hyponatremia in patients with cancer is associated with longer hospital stay and higher mortality. Whether long-term correction of hyponatremia would improve these outcomes remains to be determined.
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Affiliation(s)
- Simit M Doshi
- Division of Internal Medicine, University of Texas M.D. Anderson Cancer Center, Houston, 77030, USA
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28
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Pillai BP, Unnikrishnan AG, Pavithran PV. Syndrome of inappropriate antidiuretic hormone secretion: Revisiting a classical endocrine disorder. Indian J Endocrinol Metab 2011; 15 Suppl 3:S208-S215. [PMID: 22029026 PMCID: PMC3183532 DOI: 10.4103/2230-8210.84870] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Hyponatremia occurs in about 30% of hospitalized patients and syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common cause of hyponatremia. SIADH should be differentiated from other causes of hyponatremia like diuretic therapy, hypothyroidism and hypocortisolism. Where possible, all attempts should be made to identify and rectify the cause of SIADH. The main problem in SIADH is fluid excess, and hyponatremia is dilutional in nature. Fluid restriction is the main stay in the treatment of SIADH; however, cerebral salt wasting should be excluded in the clinical setting of brain surgeries, subarachnoid hemorrhage, etc. Fluid restriction in cerebral salt wasting can be hazardous. Sodium correction in chronic hyponatremia (onset >48 hours) should be done slowly to avoid deleterious effects in brain.
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Affiliation(s)
- Binu P. Pillai
- Department of Endocrinology, Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | | | - Praveen V. Pavithran
- Department of Endocrinology, Amrita Institute of Medical Sciences, Cochin, Kerala, India
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29
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Wang CC, Shiang JC, Chen JT, Lin SH. Syndrome of inappropriate secretion of antidiuretic hormone associated with localized herpes zoster ophthalmicus. J Gen Intern Med 2011; 26:216-20. [PMID: 20878495 PMCID: PMC3019334 DOI: 10.1007/s11606-010-1517-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 03/26/2010] [Accepted: 09/08/2010] [Indexed: 12/18/2022]
Abstract
The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with localized herpes zoster is rarely reported and may be under-appreciated. We describe two diabetic men with herpes zoster ophthalmicus (HZO) who developed hyponatremia (114 and 116 mmol/L) during acute illness. Both were euvolemic and had elevated urine osmolality (435 and 368 mmol/kg.H(2)O) and sodium (Na(+)) concentration (61 and 63 mmol/L) along with normal cardiac, renal, liver, and endocrine function consistent with the diagnosis of SIADH. Thorough investigation for other causes of SIADH, including detailed physical examination, laboratory studies, and computed tomography of the brain, chest, and abdomen, were negative. Despite antiviral therapy (acyclovir) for herpes zoster, ophthalmoplegia, keratitis, and post-herpetic neuralgia (PHN) developed. Even with fluid restriction and high salt diet, SIADH lasted for 3 to 4 months and resolved concomitantly with resolution of PHN, suggesting an association between SIADH and HZO. These two cases raise the potential for herpes zoster infection, especially HZO, to involve the regulatory pathway of ADH secretion, contributing to SIADH. The presence of PHN, which reflects greater neural damage may, at least in part, explain the prolonged ADH secretion and hyponatremia.
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Affiliation(s)
- Chih-Chiang Wang
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
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30
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Nozu T, Yoshida Y, Ohira M, Okumura T. Severe hyponatremia in association with I(131) therapy in a patient with metastatic thyroid cancer. Intern Med 2011; 50:2169-74. [PMID: 21963736 DOI: 10.2169/internalmedicine.50.5740] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hyponatremia is a common clinical problem that results from various causes. Hypothyroidism is known to be one of the causes of this disorder. We report a case of metastatic thyroid cancer presenting with severe hyponatremia in association with hypothyroidism induced by pretreatment of I(131) therapy, such as a low-iodine diet and withdrawal of thyroid hormone. Serum arginine vasopressin (AVP) was elevated and urine osmolality was higher than that of serum. Saline infusion and thyroid hormone replacement normalized serum sodium and AVP. Inappropriate secretion of AVP in hypothyroid state was thought to be one of the causes of this hyponatremia.
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Affiliation(s)
- Tsukasa Nozu
- Department of Regional Medicine and Education, Asahikawa Medical University, Japan.
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Angel MJ, Chen R, Bryan Young G. Metabolic encephalopathies. HANDBOOK OF CLINICAL NEUROLOGY 2010; 90:115-66. [PMID: 18631820 DOI: 10.1016/s0072-9752(07)01707-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Michael J Angel
- University of Toronto, Division of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada.
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Siddique H, Kahal H, Tahrani AA, Chikura B, Shankland R, Anders J, Kaja R, Hardy K, Daggett P. The management of hyponatraemia at two district general hospitals in the UK. J Eval Clin Pract 2010; 16:1353-6. [PMID: 20663000 DOI: 10.1111/j.1365-2753.2009.01252.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Peri A, Pirozzi N, Parenti G, Festuccia F, Menè P. Hyponatremia and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). J Endocrinol Invest 2010; 33:671-82. [PMID: 20935451 DOI: 10.1007/bf03346668] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The syndrome of inappropriate ADH secretion (SIADH), also recently referred to as the "syndrome of inappropriate antidiuresis", is an often underdiagnosed cause of hypotonic hyponatremia, resulting for instance from ectopic release of ADH in lung cancer or as a side-effect of various drugs. In SIADH, hyponatremia results from a pure disorder of water handling by the kidney, whereas external Na+ balance is usually well regulated. Despite increased total body water, only minor changes of urine output and modest edema are usually seen. Renal function and acid-base balance are often preserved, while neurological impairment may range from subclinical to life-threatening. Hypouricemia is a distinguishing feature. The major causes and clinical variants of SIADH are reviewed, with particular emphasis on iatrogenic complications and hospital-acquired hyponatremia. Effective treatment of SIADH with water restriction, aquaretics, or hypertonic saline + loop diuretics, as opposed to worsening of hyponatremia during parenteral isotonic fluid administration, underscores the importance of an early accurate diagnosis and careful follow-up of these patients.
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Affiliation(s)
- A Peri
- Endocrine Unit, Department of Clinical Physiopathology, Center for Research, Transfer and High Education on Chronic, Inflammatory, Degenerative and Neoplastic Disorders (DENOThe), University of Florence, Viale Pieraccini 6, Florence, Italy.
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Lee P, Ho KKY. Hyponatremia in pulmonary TB: evidence of ectopic antidiuretic hormone production. Chest 2010; 137:207-8. [PMID: 20051406 DOI: 10.1378/chest.09-0405] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Hyponatremia is among the most common biochemical abnormalities in hospital inpatients. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is one of several causes of hyponatremia, particularly in patients with pulmonary diseases. The mechanism of SIADH associated with pulmonary infection is, however, poorly understood. We report an unusual case of hyponatremia in a man with pulmonary TB and central diabetes insipidus with biochemical evidence of ectopic antidiuretic hormone production as a possible mechanism causing hyponatremia.
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Affiliation(s)
- Paul Lee
- Department of Endocrinology, St Vincent's ospital and Pituitary Research Unit, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney, New South Wales, Australia.
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Nevéus T, Läckgren G, Tuvemo T, Jerker H, Hjälmås K, Stenberg A. Enuresis - Background and Treatment. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/003655900750169257] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Tryggve Nevéus
- Dept of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Göran Läckgren
- Dept of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Torsten Tuvemo
- Dept of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Hetta Jerker
- Dept of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Kelm Hjälmås
- Dept of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Arne Stenberg
- Dept of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden
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Callahan MA, Do HT, Caplan DW, Yoon-Flannery K. Economic impact of hyponatremia in hospitalized patients: a retrospective cohort study. Postgrad Med 2009; 121:186-91. [PMID: 19332977 DOI: 10.3810/pgm.2009.03.1991] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Hyponatremia is the most common electrolyte abnormality seen in general hospital patients, with an incidence of 1% to 6% in the United States. OBJECTIVE We aimed to evaluate the impact of varying levels of hyponatremia at admission on length of stay (LOS) and cost of care in adult hospitalized patients. METHODS A retrospective cohort study was conducted using an existing clinical database from a large academic-setting hospital. All adult admissions from January 2004 through May 2005 with serum sodium level at admission of < or = 134 mEq/L were separated into 2 cohorts: patients with moderate-to-severe hyponatremia (serum sodium level at admission of < or = 129 mEq/L, n = 547) and patients with mild-to-moderate hyponatremia (serum sodium level of 130-134 mEq/L, n = 1500). ICD-9 diagnosis codes for these 2047 admissions with hyponatremia were used to identify a cohort of 7573 admissions with the same principal admitting diagnoses and a serum sodium level of 135 to 145 mEq/L. Differences in hospital LOS, intensive care unit (ICU) admission rate, and median total costs per admission between cohorts were examined using multiple linear regression, logistic, and quantile regression models. RESULTS Admissions with hyponatremia had significantly longer hospital LOS than those admitted without hyponatremia (median LOS: moderate-to-severe hyponatremia, 8 days; mild-to-moderate hyponatremia, 8 days; normal, 6 days; P < 0.001). Patients with more severe hyponatremia were also more likely to be admitted to the ICU during the hospital stay (moderate-to-severe hyponatremia, 32%; mild-to-moderate hyponatremia, 26%; normal, 22%; P < 0.001). These trends were also reflected in the total costs per admission, with median costs of $16,606 for moderate-to-severe hyponatremia cases, $14,266 for mild-to-moderate hyponatremia cases, and $13,066 for normal admissions (P < 0.001). CONCLUSIONS Hyponatremia at admission was associated with increased LOS and cost of care for hospitalized patients. Interventions or pharmacotherapies for the prompt treatment of hyponatremia could potentially reduce morbidity and LOS, thereby reducing the utilization of health care resources.
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Affiliation(s)
- Mark A Callahan
- Weill Cornell Medical College, Division of Outcomes and Effectiveness Research, Department of Public Health, New York, NY, USA.
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Abstract
Survival of human and animal cells requires avoidance of excessive alterations of cell volume. The osmolarity amassed by cellular accumulation of organic substances must be compensated by lowering cytosolic ion concentrations. The Na+/K+ ATPase extrudes Na+ in exchange for K+, which can permeate the cell membrane through K+ channels. K+ exit generates a cell-negative potential difference across the cell membrane, driving the exit of anions such as Cl-. The low cytosolic Cl- concentrations counterbalance the excess cellular osmolarity by organic substances. Cell volume regulation following cell swelling involves releasing ions through activation of K+ channels and/or anion channels, KCl-cotransport, or parallel activation of K+/H+ exchange and Cl-/HCO3- exchange. Cell volume regulation following cell shrinkage involves accumulation of ions through activation of Na+,K+,2Cl- cotransport, Na+/H+ exchange in parallel to Cl-/HCO3- exchange, or Na+ channels. The Na+ taken up is extruded by the Na+/K+ ATPase in exchange for K+. Shrunken cells further accumulate organic osmolytes such as sorbitol and glycerophosphorylcholine, and monomeric amino acids by altered metabolism and myoinositol (inositol), betaine, taurine, and amino acids by Na+ coupled transport. They release osmolytes during cell swelling. Challenges of cell volume homeostasis include transport, hormones, transmitters, and drugs. Moreover, alterations of cell volume participate in the machinery regulating cell proliferation and apoptotic cell death. Deranged cell volume regulation significantly contributes to the pathophysiology of several disorders such as liver insufficiency, diabetic ketoacidosis, hypercatabolism, fibrosing disease, sickle cell anemia, and infection.
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Affiliation(s)
- Florian Lang
- Department of Physiology I, University of Tübingen, Tübingen, Germany.
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Dawwas MF, Lewsey JD, Neuberger JM, Gimson AE. The impact of serum sodium concentration on mortality after liver transplantation: a cohort multicenter study. Liver Transpl 2007; 13:1115-24. [PMID: 17663412 DOI: 10.1002/lt.21154] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Modification of the current allocation system for donor livers in the United States to incorporate recipient serum sodium concentration ([Na]) has recently been proposed. However, the impact of this parameter on posttransplantation mortality has not been previously examined in a large risk-adjusted analysis. We assessed the effect of recipient [Na] on the survival of all adults with chronic liver disease who received a first single organ liver transplant in the UK and Ireland during the period March 1, 1994 to March 31, 2005 (n=5,152) at 3 years, during the first 90 days, and beyond the first 90 days, adjusting for a wide range of recipient, donor, and graft characteristics. Compared to those with normal [Na] (135-145 meq/L; n=3,066), severely hyponatremic recipients ([Na]<130 meq/L, n=541), had a higher risk-adjusted mortality at 3 years (hazard ratio [HR] 1.28; 95% confidence interval [CI], 1.04-1.59; P<0.02). The excess mortality was, however, confined to the first 90 days (HR 1.55; 95% CI, 1.18-2.04; P<0.002) with no significant difference thereafter. This was also true for hypernatremic recipients ([Na]>45 meq/L, n=81), who had an even greater risk-adjusted mortality compared to normonatremic recipients (overall: HR 1.85; 95% CI, 1.25-2.73; P<0.002; <or=90 days: HR 2.29; 95% CI, 1.42-3.70; P<0.001; >90 days: HR 1.12; 95% CI, 0.55-2.29; P=0.8), whereas mildly hyponatremic recipients ([Na] 130-134 meq/L, n=1,127) had similar risk-adjusted mortality to those with normal [Na] at the same time points. In conclusion, recipient [Na] is an independent predictor of death following liver transplantation. Attempts to correct the [Na] toward the normal reference range are an important aspect of pretransplantation management.
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Affiliation(s)
- Muhammad F Dawwas
- Hepatobiliary and Liver Transplant Unit, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, UK.
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Lee KS, Kang TW, Ma SK, Kim SW, Kim NH, Choi KC. SIADH associated with prostate cancer. Electrolyte Blood Press 2007; 5:47-9. [PMID: 24459500 PMCID: PMC3894506 DOI: 10.5049/ebp.2007.5.1.47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Accepted: 05/10/2007] [Indexed: 11/07/2022] Open
Abstract
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common disease leading to hyponatremia, and it is characterized by an inappropriately elevated serum ADH level relative to serum osmolality. This syndrome may occur in a variety of clinical settings including malignancies. However, it is rarely observed in association with prostate cancer. Moreover, its pathogenesis and clinical characteristics have not been completely understood. We report a case of SIADH associated with prostate cancer in a 64-year-old male patient with a literature review.
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Affiliation(s)
- Kyun Sang Lee
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Taek Won Kang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Nam Ho Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ki Chul Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Beukhof CM, Hoorn EJ, Lindemans J, Zietse R. Novel risk factors for hospital-acquired hyponatraemia: a matched case-control study. Clin Endocrinol (Oxf) 2007; 66:367-72. [PMID: 17302870 DOI: 10.1111/j.1365-2265.2007.02741.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hospital-acquired hyponatraemia is a common and potentially serious condition. Risk factors for hospital-acquired hyponatraemia have not been studied in a controlled fashion. Methods From 1501 patients in whom serum sodium (S(Na)) was determined, 50 cases with hospital-acquired hyponatraemia (in-hospital decrease in S(Na)>or= 7 mmol/l to < 136 mmol/l) were identified. They were matched by age, gender and department to 69 normonatraemic controls. RESULTS In the 50 cases, S(Na) fell from 141 +/- 2 to 130 +/- 4 mmol/l, while controls remained normonatraemic. During the development of hyponatraemia, C-reactive protein (CRP) increased in cases (median from 23 to 146 mg/l), whereas it decreased in controls (median from 31 to 24 mg/l, P = 0.008). Additional factors associated with hospital-acquired hyponatraemia included diabetes mellitus (16/50 vs. 10/69, P = 0.009) and the use of insulin (12/50 vs. 4/69, P = 0.007), antibiotics (41/50 vs. 38/69, P = 0.006) and opioids (32/50 vs. 27/69, P = 0.005). Multivariate conditional logistic regression showed that the use of insulin [odds ratio (OR) 10.5, 95% confidence interval (CI) 1.5-72.4], antibiotics (OR 4.5, 95% CI 1.4-14.6) and opioids (OR 2.9, 95% CI 1.1-7.8) was also independently associated with hospital-acquired hyponatraemia. Mortality (6/50 vs. 1/69, P = 0.04) and intensive care admission (15/50 vs. 7/69, P = 0.008) were higher in cases. CONCLUSIONS An increase in CRP and the use of insulin, antibiotics and opioids are novel risk factors for hospital-acquired hyponatraemia. These factors represent interesting new clues regarding the pathophysiology of hospital-acquired hyponatraemia, suggesting that the acute-phase response, pain and/or direct drug effects could be involved in the release of antidiuretic hormone.
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Affiliation(s)
- Carolien M Beukhof
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
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Munger MA. New agents for managing hyponatremia in hospitalized patients. Am J Health Syst Pharm 2007; 64:253-65. [PMID: 17244874 DOI: 10.2146/060101] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE An overview of hyponatremia is provided, including its pathophysiology, clinical manifestations, signs and symptoms, and treatment, particularly with arginine vasopressin (AVP)-receptor antagonists. SUMMARY Hyponatremia (generally defined as a serum sodium concentration of <135 meq/L) is one of the most common electrolyte disorders in hospitalized and clinic patients. It may be caused by a number of conditions, including infections, heart disease, surgery, malignancy, and medication use. Clinical signs and symptoms such as hallucinations, lethargy, weakness, bradycardia, respiratory depression, seizures, coma, and death have been reported. Conventional treatment consists of fluid restriction and administration of hypertonic saline and pharmacologic agents, such as demeclocycline, lithium carbonate, and urea. These treatment options are often of limited effectiveness or difficult for patients to tolerate. AVP promotes the reabsorption of water in the renal collecting ducts by activation of V(2) receptors, resulting in water retention and dilution of serum solutes. The AVP-receptor antagonists, conivaptan, lixivaptan, and tolvaptan, are being studied for the treatment of hyponatremia. Conivaptan has been shown in clinical trials to increase free-water excretion and safely normalize serum sodium concentrations in patients with hyponatremia and is well tolerated. Also in clinical trials, lixivaptan and tolvaptan have safely improved serum sodium concentrations in patients with hyponatremia. CONCLUSION Hyponatremia is a serious health condition for which treatment should be carefully performed. As new agents for treating hyponatremia, AVP-receptor antagonists have demonstrated efficacy and safety in clinical trials and may serve as significant improvements in the current treatment options for managing this disorder.
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Affiliation(s)
- Mark A Munger
- College of Pharmacy, University of Utah, 30 South 2000 East, Room 201, Salt Lake City, UT 84112-5820, USA.
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Abstract
The syndrome of inappropriate antidiuresis is the most common cause of euvolemic hyponatremia and complicates a wide spectrum of diseases and neurosurgical conditions. The syndrome is characterized by clinical euvolemia, dilute plasma osmolality and inappropriately concentrated urine, with normal renal, adrenal and thyroid function. Hyponatremia in syndrome of inappropriate antidiuresis represents an excess of plasma water, rather than sodium deficiency. The severity of hyponatremia is limited by renal escape from antidiuresis. Treatment varies according to symptoms, severity and speed of onset of hyponatremia. Acute, severe, symptomatic hyponatremia may require rapid treatment with hypertonic saline, with care to avoid central pontine myelinosis. Chronic hyponatremia is managed with fluid restriction and demeclocycline for unresponsive cases. Vasopressin antagonists represent a new option for chronic hyponatremia of syndrome of inappropriate antidiuresis.
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Affiliation(s)
- Rachel K Crowley
- a Department of Academic Endocrinology, Beaumont Hospital, Dublin 9, Ireland.
| | - C J Thompson
- b Department of Academic Endocrinology, Beaumont Hospital, Dublin 9, Ireland.
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Londoño MC, Guevara M, Rimola A, Navasa M, Taurà P, Mas A, García-Valdecasas JC, Arroyo V, Ginès P. Hyponatremia impairs early posttransplantation outcome in patients with cirrhosis undergoing liver transplantation. Gastroenterology 2006; 130:1135-43. [PMID: 16618408 DOI: 10.1053/j.gastro.2006.02.017] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Accepted: 12/21/2005] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Hyponatremia is associated with reduced survival in patients with cirrhosis awaiting liver transplantation. However, it is not known whether hyponatremia also represents a risk factor of poor outcome after transplantation. We aimed to assess the effects of hyponatremia at the time of transplantation on posttransplantation outcome in patients with cirrhosis. METHODS Two-hundred forty-one consecutive patients with cirrhosis submitted to liver transplantation during a 4-year period (January 2000-December 2003) were included in the study. The main end point was survival at 3 months after transplantation. Secondary end points were complications within the first month after transplantation. RESULTS Patients with hyponatremia (serum sodium lower than 130 mEq/L) had a greater incidence of neurologic disorders, renal failure, and infectious complications than patients without hyponatremia (odds ratio; 4.6, 3.4 and 2.7, respectively) within the first month after transplantation. By contrast, hyponatremia was not associated with an increased incidence of severe intra-abdominal bleeding, acute rejection, or vascular and biliary complications. Hyponatremia was an independent predictive factor of early posttransplantation survival. Three-month survival of patients with hyponatremia was 84% compared with 95% of patients without hyponatremia (P < .05). Survival was similar after 3 months. CONCLUSIONS In patients with cirrhosis, the presence of hyponatremia is associated with a high rate of neurologic disorders, infectious complications, and renal failure during the first month after transplantation and reduced 3-month survival. In cirrhosis, hyponatremia should be considered not only a risk factor of death before transplantation but also a risk factor of impaired early posttransplantation outcome.
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Affiliation(s)
- Rebecca M Reynolds
- Endocrinology Unit, Centre for Cardiovascular Sciences, University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ
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Tisdall M, Crocker M, Watkiss J, Smith M. Disturbances of sodium in critically ill adult neurologic patients: a clinical review. J Neurosurg Anesthesiol 2006; 18:57-63. [PMID: 16369141 PMCID: PMC1513666 DOI: 10.1097/01.ana.0000191280.05170.0f] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Disorders of sodium and water balance are common in critically ill adult neurologic patients. Normal aspects of sodium and water regulation are reviewed. The etiology of possible causes of sodium disturbance is discussed in both the general inpatient and the neurologic populations. Areas of importance are highlighted with regard to the differential diagnosis of sodium disturbance in neurologic patients, and management strategies are discussed. Specific discussions of the etiology, diagnosis, and management of cerebral salt wasting syndrome, the syndrome of inappropriate antidiuretic hormone secretion, and central diabetes insipidus are presented, as well as the problems of overtreatment. The importance of diagnosis at an early stage of these diseases is stressed, with a recommendation for conservative management of milder cases.
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Affiliation(s)
| | | | | | - Martin Smith
- Corresponding author: Dr Martin Smith, Consultant in Neuroanaesthesia, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, , Tel: 44 (0)20 7829 8711, Fax: 44 (0)20 7829 8734
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Tran HA. A woman with malaise and hyponatremia. Hyponatremia factitia (Munchausen syndrome) secondary to desmopressin use. Arch Pathol Lab Med 2006; 130:e15-8. [PMID: 16454573 DOI: 10.5858/2006-130-e15-awwmah] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Huy A Tran
- Department of Clinical Chemistry, Hunter Area Pathology Service, New South Wales, Australia.
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Kurtz I, Nguyen MK. Evolving concepts in the quantitative analysis of the determinants of the plasma water sodium concentration and the pathophysiology and treatment of the dysnatremias. Kidney Int 2006; 68:1982-93. [PMID: 16221198 DOI: 10.1111/j.1523-1755.2005.00652.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The physiologic and clinical implications of the empirical formula originally discovered by Edelman et al [J Clin Invest 37:1236-1256, 1958] relating the plasma water sodium concentration ([Na(+)](pw)) to the total exchangeable sodium (Na(e)), total exchangeable potassium (K(e)), and total body water (TBW) have recently been elucidated. It is quite remarkable that the full significance of the Edelman equation discovered almost 50 years ago had remained unrecognized by clinicians and physiologists until recently. Although Edelman and colleagues had shown that the [Na(+)](pw) is proportional to the magnitude of (Na(e)+ K(e))/TBW, the linear equation relating [Na(+)](pw) to (Na(e)+ K(e))/TBW had a slope greater than unity of 1.11, and a non-zero y intercept of -25.6 whose significance was unrecognized and more often than not ignored. It has recently been demonstrated that the slope and y intercept in this equation are quantitatively determined by several additional physiologic parameters, which in addition to (Na(e)+ K(e))/TBW, play a role both in modulating the [Na(+)](pw) and in the generation of the dysnatremias. Even more remarkably, based only on the theoretical principles of Gibbs-Donnan and osmotic equilibrium, all the physiologic parameters that determine the magnitude of the [Na(+)](pw) can be incorporated into a simple conceptual and mathematical framework that sheds light on a broad of range of seemingly unrelated topics that have heretofore been treated separately clinically, including (1) effect of changes in the mass balance of Na(+), K(+), and H(2)O on the [Na(+)](pw); (2) modulation of [Na(+)](pw) in hyperglycemic states; (3) definition of an isonatric solution; (4) current formulas used to quantitate electrolyte-free water excretion; (5) complex role of K(+) in modulating the [Na(+)](pw); and (6) quantitative analysis of the generation and treatment of the dysnatremias. Moreover, this analysis has also proven to be an indispensable tool for deriving new formulas to aid the clinician in both interpreting the pathogenesis and treating the dysnatremias.
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Affiliation(s)
- Ira Kurtz
- Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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De Luca L, Klein L, Udelson JE, Orlandi C, Sardella G, Fedele F, Gheorghiade M. Hyponatremia in patients with heart failure. Am J Cardiol 2005; 96:19L-23L. [PMID: 16399089 DOI: 10.1016/j.amjcard.2005.09.066] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mild hyponatremia is encountered frequently in patients hospitalized for worsening heart failure. Admission plasma sodium concentration appears to be an independent predictor of increased mortality after discharge and rehospitalization. Recent studies have suggested that correction of hyponatremia may be associated with improved survival. This hypothesis is currently being studied in large prospective randomized clinical trials.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiovascular and Respiratory Sciences, La Sapienza University, Rome, Italy
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