Prevention of hospital-acquired hyponatraemia: individualised fluid therapy

Impact of a Treatment Guide on Intravenous Fluids in Minimising the Risk of Hospital-Acquired Hyponatraemia in Denmark

Hypotonic intravenous (IV) fluids are associated with an increased risk of hospital-acquired hyponatraemia, eventually leading to brain injury and death. We evaluated the effectiveness of a treatment guide to improve prescribing practices of IV fluids. We conducted a before-and-after cross-sectional survey among physicians working at Danish emergency departments. The primary outcome was prescribing practices of IV fluids. Participants were asked which IV fluid they would select in four clinical scenarios. We applied multivariate logistic regression models to estimate the odds ratio of selecting hypotonic fluids. Secondary outcomes included knowledge about IV fluids and hyponatraemia, and the receipt, reading, and usefulness of the treatment guide. After the intervention, about a third (47/154) reported that they would use hypotonic fluids in patients with increased intracranial pressure, and a quarter (39/154) would use hypotonic maintenance fluids in children, both of which are against guideline recommendations. A total of 46% selected the correct fluid, a 3% hypertonic saline solution for a patient with hyponatraemia and severe neurological symptoms. None of the knowledge questions met the predefined criteria of success of 80% correct answers. Of the respondents, 22% had received the treatment guide. Since the implementation failed, we recommend improving distribution by applying methods from implementation science.

Sodium, Potassium, Calcium, and Magnesium in the Scalp Hair and Blood Samples Related to the Clinical Stages of the Parkinson's Disease

Neurodegeneration disorders are complex and multifaceted, leading to many chronic diseases, like Parkinson's disease (PD). Electrolytes imbalance has a significant role in the pathophysiology of neurological disorders, which might serve as a bio-indicator of these problems. In the present study, the disturbances of the electrolytes, calcium (Ca), magnesium (Mg), sodium (Na), and potassium (K), concentrations, and their correlation with biochemical parameters of PD patients at three different age groups (15 to 75 years) and stages were studied. The all resulted data of PD patients was compared with non-diseased/referents (PD) of same age groups. The biological samples (scalp hair, serum and plasma) were collected from Parkinson's disease (PD) patients, diagnosed at three stages, early (15 to 30 years), mild (30 to 60 years) and severe (61 to 75 years). The electrolyte concentrations were measured after acid digested biological samples using flame atomic absorption spectrometry. The precision of the digestion method was verified by matrices matched certified reference materials. The resulted data indicated that the contents of Ca and Mg were found to be higher in scalp hair samples of PD patients at early to severe stages as compared with those results obtained from referents. The concentrations of Na and K were found to be lower for all PD patients groups as compared with referents; however, the difference was not significant (p < 0.05). Electrolytes levels in blood serum and plasma were found to be lower in all patients than healthy groups (p < 0.01). These results suggest a disturbance in the electrolytes homeostasis during the different clinical stages of PD, whereas the higher disturbance was observed in patients at severe stage (61 to 75 years).

Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices

BACKGROUND

Hyponatraemia is associated with increased morbidity, increased mortality and is frequently hospital-acquired due to inappropriate administration of hypotonic fluids. Despite several attempts to minimise the risk, knowledge is lacking as to whether inappropriate prescribing practice continues to be a concern.

METHODS

A cross-sectional survey was performed in Danish emergency department physicians in spring 2019. Prescribing practices were assessed by means of four clinical scenarios commonly encountered in the emergency department. Thirteen multiple-choice questions were used to measure knowledge.

RESULTS

201 physicians responded corresponding to 55.4% of the total population of physicians working at emergency departments in Denmark. About a quarter reported that they would use hypotonic fluids in patients with increased intracranial pressure and 29.4% would use hypotonic maintenance fluids in children, both of which are against guideline recommendations. Also, 29.4% selected the correct fluid, a 3% hypertonic saline solution, for a patient with hyponatraemia and severe neurological symptoms, which is a medical emergency. Most physicians were unaware of the impact of hypotonic fluids on plasma sodium in acutely ill patients.

CONCLUSION

Inappropriate prescribing practices and limited knowledge of a large number of physicians calls for further interventions to minimise the risk of hospital-acquired hyponatraemia.

Maintenance Fluid Therapy: Isotonic Versus Hypotonic Solutions

The goal of maintenance fluid therapy in small animals is to replace normal ongoing losses of water and salts when oral intake is withheld. Hospitalized dogs and cats may have multiple stimuli for antidiuretic hormone release that disrupt normal osmoregulation and predispose to water retention. Severe illness promotes retention of both sodium and water as edema. Commercially available fluids have electrolyte concentrations that are very different from dietary maintenance requirements, and potential consequences include development of hypoosmolality, edema, or both when excesses of water or sodium are administered. Suggestions for tailoring fluid administration toward specific goals are provided.