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Wootton E, Grossmann M, Warren AM. Dysnatremia in a changing climate: A global systematic review of the association between serum sodium and ambient temperature. Clin Endocrinol (Oxf) 2024; 100:527-541. [PMID: 38634410 DOI: 10.1111/cen.15052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/26/2024] [Accepted: 03/11/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Both hyponatremia and hypernatremia have been reported to occur more frequently with higher ambient temperatures, although the underlying mechanisms are not well understood. Global temperatures are rising due to climate change, which may impact the incidence of dysnatremia worldwide. We aimed to identify, collate and critically appraise studies analyzing the relationship between climate measures (outdoor temperature, humidity) and serum sodium concentrations. DESIGN Systematic review, reported in accordance with PRISMA guidelines. METHODS MEDLINE and Embase were searched with relevant key terms. Studies assessing the effect on serum sodium measurement of elevated temperature or humidity versus a comparator were included. RESULTS Of 1466 potentially relevant studies, 34 met inclusion criteria, originating from 23 countries spanning all inhabited continents. The majority (30 of 34, 88%) reported a significant association between outdoor temperature and dysnatremia, predominantly lower serum sodium with increased ambient temperature. Humidity had a less consistent effect. Individuals aged above 65 years, children, those taking diuretics and antidepressants, those with chronic renal impairment or those undertaking physical exertion had increased vulnerability to heat-associated dysnatremia. The risk of bias was assessed to be high in all but four studies. CONCLUSIONS Higher ambient temperature is consistently associated with an increased incidence of hyponatremia. We infer that hyponatremia presentations are likely to rise with increasing global temperatures and the frequency of extreme heat events secondary to climate change. Evidence-based public health messages, clinician education and reduction in fossil fuel consumption are necessary to reduce the expected burden on healthcare services worldwide.
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Affiliation(s)
| | - Mathis Grossmann
- Department of Endocrinology, Austin Health, Melbourne, Australia
- Department of Medicine, the University of Melbourne, Melbourne, Australia
| | - Annabelle M Warren
- Department of Endocrinology, Austin Health, Melbourne, Australia
- Department of Medicine, the University of Melbourne, Melbourne, Australia
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Ternero-Vega JE, Jiménez-de-Juan C, Castilla-Yelamo J, Cantón-Habas V, Sánchez-Ruiz-Granados E, Barón-Ramos MÁ, Ropero-Luis G, Gómez-Salgado J, Bernabeu-Wittel M. Impact of hyponatremia in patients hospitalized in Internal Medicine units: Hyponatremia in Internal Medicine units. Medicine (Baltimore) 2024; 103:e38312. [PMID: 38787975 PMCID: PMC11124689 DOI: 10.1097/md.0000000000038312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
The aim of this study was to analyze the impact and the clinical and evolutionary characteristics of hypotonic hyponatremia in patients hospitalized in Internal Medicine units. Prospective multicenter observational study of patients with hypotonic hyponatremia (<135 mmol/L) in 5 hospitals in southern Spain. Patients were included according to point prevalence studies carried out every 2 weeks between March 2015 and October 2017, by assessing demographic, clinical, analytical, and management data; each patient was subsequently followed up for 12 months, during which time mortality and readmissions were assessed. A total of 501 patients were included (51.9% women, mean age = 71.3 ± 14.24 years), resulting in an overall prevalence of hyponatremia of 8.3%. The mean comorbidities rate was 4.50 ± 2.41, the most frequent diagnoses being heart failure (115) (23%), respiratory infections (65) (13%), and oncological pathologies (42) (6.4%). Of the total number of hyponatremia cases, 180 (35.9%) were hypervolemic, 164 (32.7%) hypovolemic, and 157 (31.3%) were euvolemic. A total of 87.4% did not receive additional diagnostic tests to establish the origin of the condition and 30% did not receive any treatment. Hospital mortality was 15.6% and the mean length of stay was 14.7 days. Euvolemic and admission hyponatremia versus hyponatremia developed during admission were significantly associated with lower mortality rates (P = .037). Mortality at 1 year and readmissions were high (31% and 53% of patients, respectively). Hyponatremia was common in Internal Medicine areas, with hypervolemic hyponatremia being the most frequent type. The mortality rate was high during admission and at follow-up; yet there is a margin for improvement in the clinical management of this condition.
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Affiliation(s)
| | | | - Javier Castilla-Yelamo
- Department of Internal Medicine, San Juan de Dios Hospital, Seville, Spain
- Department of Internal Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Vanesa Cantón-Habas
- Department of Nursing, Pharmacology, and Physiotherapy, University of Cordoba, Córdoba, Spain
| | | | | | - Guillermo Ropero-Luis
- Department of Internal Medicine, Serranía de Ronda Hospital, Málaga, Spain
- Department of Internal Medicine, Regional University Hospital of Malaga, Málaga, Spain
| | - Juan Gómez-Salgado
- Faculty of Labour Sciences, Department of Sociology, Social Work and Public Health, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
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Mannheimer B, Sterea-Grossu A, Falhammar H, Calissendorff J, Skov J, Lindh JD. Current and Future Burdens of Heat-Related Hyponatremia: A Nationwide Register-Based Study. J Clin Endocrinol Metab 2022; 107:e2388-e2393. [PMID: 35192707 PMCID: PMC9113787 DOI: 10.1210/clinem/dgac103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT A seasonal variation in hyponatremia, with higher incidence rates during hot summer days, has been demonstrated. Whether this applies to cool temperate regions is currently unknown. OBJECTIVE The aim of this study was to investigate the influence of ambient temperature on hyponatremia in the Swedish population under current and future climate scenarios. METHODS This nationwide cohort study identified all patients hospitalized with a first-ever principal diagnosis of hyponatremia between October 2005 and December 2014. Incidence rates for hyponatremia were calculated as number of hospitalizations divided by person-days at risk in the adult Swedish population at a given temperature, in increments of 1 °C. RESULTS The incidence of hyponatremia was stable at 0.3 per million person-days from -10 to 10 °C, but increased rapidly at 24-hour mean temperatures above 15 °C, with 2.26 hospitalizations per million days at the highest recorded temperature of 25 °C. Women and elderly carried the greatest risk, with an incidence of 35 hospitalizations per million days in individuals ≥ 80 years of age on the hottest days, corresponding to a 15-fold increase in incidence compared with cool days. A future 1 or 2 °C increase in mean temperature is expected to increase the incidence of hyponatremia by 6.3% and 13.9%, respectively. CONCLUSION The risk of hospitalization due to hyponatremia increases rapidly at temperatures above 15 °C, indicating a threshold effect. Over the next decades, rising global temperatures are expected to increase the inpatient burden of hyponatremia by approximately 10%. Strategies for protecting vulnerable groups are necessary to reduce this risk.
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Affiliation(s)
- Buster Mannheimer
- Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Alin Sterea-Grossu
- Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Calissendorff
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Jakob Skov
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Karlstad Central Hospital, Karlstad, Sweden
- Correspondence: Dr. Jakob Skov, ME Endokrinologi, QB85, Karolinska Universitetssjukhuset – Solna, SE-17176 Stockholm, Sweden. ;
| | - Jonatan D Lindh
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska University Hospital Huddinge, Karolinska Institutet, Huddinge, Sweden
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Yonai Y, Ben Natan M, Steinfeld Y, Berkovich Y. Combined Effect of Seasonality and Hyponatremia on the Occurrence of Hip Fractures Among Older Adults. Indian J Orthop 2022; 56:856-861. [PMID: 35547345 PMCID: PMC9043052 DOI: 10.1007/s43465-021-00557-5] [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: 08/09/2021] [Accepted: 10/24/2021] [Indexed: 02/06/2023]
Abstract
Background It is unclear whether climate may play a role in the association between hyponatremia on admission and increased mortality risk among hip fracture patients following a hip fracture repair surgery. We aimed (1) to explore if there is any combined effect of seasonality and hyponatremia on the occurrence of hip fractures among older adults and (2) to explore the effect of hyponatremia on admission on mortality rate at latest follow-up among hip fracture patients following a hip fracture repair surgery in the context of the subtropical climate of Israel. Methods We conducted a retrospective cohort study of older patients who underwent a surgery for hip fracture repair in a major 495-bed hospital located in northern-central Israel in 2017-2020. Patients were divided into two groups: hyponatremic (n = 107) and normonatremic (n = 757) patients. Characteristics of the two groups were compared, as well as their survival probability. Results Hyponatremic patients were most frequently hospitalized during winter season. Such seasonal variation was observed only among hyponatremic patients. Moreover, patients who were hospitalized during winter season were more likely to be hyponatremic on admission. Hyponatremia on admission was found as a significant independent predictor of mortality rate at latest follow-up (adjusted hazard ratio = 0.377 [0.26-0.52]), when compared to normonatremia. Conclusion There is a combined effect of seasonality and hyponatremia on the occurrence of hip fractures among older adults, with hyponatremic patients being at a higher risk of sustaining a hip fracture during winter season than during other seasons. In addition, the association between hyponatremia on admission and mortality rate at latest follow-up among hip fracture patients has been confirmed.
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Affiliation(s)
- Yaniv Yonai
- grid.414084.d0000 0004 0470 6828The Orthopedics B Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Merav Ben Natan
- grid.414084.d0000 0004 0470 6828Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, P.O.B. 169, 38100 Hadera, Israel
| | - Yaniv Steinfeld
- grid.414084.d0000 0004 0470 6828The Orthopedics B Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yaron Berkovich
- grid.414084.d0000 0004 0470 6828The Orthopedics B Department, Hillel Yaffe Medical Center, Hadera, Israel ,grid.6451.60000000121102151The Technion, Haifa, Israel
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Zeng QL, He WT, Yuan G. Higher plasma NT-proBNP levels correlate with syndrome of inappropriate antidiuretic hormone and poor prognosis in neurological patients. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:28. [PMID: 33553321 PMCID: PMC7859746 DOI: 10.21037/atm-20-3413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Hyponatremia induced by syndrome of inappropriate antidiuretic hormone secretion (SIADH) was common electrolyte disturbance encountered in critically ill neurological diseases, which has normal or increased fluid volume. Brain natriuretic peptide (BNP), which is released in equal proportion to N-terminal pro-brain natriuretic peptide (NT-proBNP), plays vital roles in regulation of volume status. The relationship between SIADH and NT-proBNP levels in neurological diseases has rarely been reported. Methods A retrospective cross-sectional study was conducted to analyze plasma NT-proBNP levels in 33 patients with SIADH and 23 controlled eunatremic patients with neurological diseases. Results Baseline NT-proBNP levels were compared between two groups [SIADH group: median 311 pg/mL, interquartile range (IQR) 110–768 pg/mL] vs. eunatremic group: median 46 pg/mL, IQR, 12–96 pg/mL) (P<0.05). Plasma NT-proBNP levels were markedly increased in hyponatremic patients who had two or more complications than those who had less complication (P<0.05). In SIADH patients, NT-proBNP levels in remission phase were lower to levels at baseline. Furthermore, no death was seen in eunatremic patients, while five SIADH patients died from complications. Conclusions SIADH had higher plasma NT-proBNP levels and poorer prognosis compared to eunatremic neurological patients. NT-proBNP serves as a biomarker of disease severity while not extracellular volume (ECV) status in critically ill neurological patients.
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Affiliation(s)
- Qing-Ling Zeng
- Merck Serono (China) Co. Ltd., Chengdu, China.,Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-Tao He
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Yuan
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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