Diagnostic Workup and Outcome in Patients with Profound Hyponatremia

Short-Term Outcomes of Patients With Hyponatremia Presenting to the Emergency Department: An Observational Study

BACKGROUND

Hyponatremia is the predominant electrolyte imbalance disorder in the emergency department. It can manifest with a diverse array of symptoms, ranging from non-specific and moderate to severe and even life-threatening. There is a scarcity of literature addressing the clinical characteristics and prognosis of patients with hyponatremia presenting to the emergency department in the western part of Rajasthan. The objective of this study was to investigate the impact of hyponatremia on the outcomes of patients presenting to the emergency department.

METHODS

In this prospective, cross-sectional, observational study, 200 patients aged more than 18 years who presented to the emergency department with serum sodium < 135 mEq/l were included. The triage of patients was determined by their primary complaints. The primary outcome was to study the clinical profile of patients with hyponatremia presenting to the emergency department. The secondary outcomes were to examine the etiology, i.e., hypovolemic, euvolemic, or hypervolemic, and the outcome of patients on the 7th day (patient admitted to the ward or intensive care unit) and the 28th day (discharged or death) with hyponatremia presenting to the emergency department. The clinical status of the patients was noted by telephonic follow-up in case they were not admitted for this period.

RESULTS

Out of 200 patients, 66 (33%) had hypovolemic, 96 (48%) had euvolemic, and 38 (19%) had hypervolemic hyponatremia. We observed that seizures (84.2%), confusion (56%), and coma (77.7%) were the most common clinical features of patients with severe hyponatremia in the emergency, which was statistically significant than mild and moderate hyponatremia (p = 0.03, 0.023, and 0.029, respectively). On the 7th day of hospitalization, out of 181 (90.5%) admissions in the ward, 116 (64.08%) had severe hyponatremia, and out of 19 (9.5%) ICU admissions, 13 (68.4%) had severe hyponatremia. Death was seen in five (2.5%) patients, one (20%) in moderate and four (80%) in severe hyponatremia cases.

CONCLUSION

Most cases of hyponatremia in this study were euvolemic. Most patients experienced severe hyponatremia, and seizures, confusion, and coma were the most prevalent symptoms. These disorders must be recognized early to properly diagnose and treat hyponatremia and prevent its morbidity and death.

Position paper on perioperative management and surgical risk in the patient with cirrhosis

INTRODUCTION

Management of the patient with cirrhosis of the liver that requires surgical treatment has been relatively unexplored. In Mexico, there is currently no formal stance or expert recommendations to guide clinical decision-making in this context.

AIMS

The present position paper reviews the existing evidence on risks, prognoses, precautions, special care, and specific management or procedures for patients with cirrhosis that require surgical interventions or invasive procedures. Our aim is to provide recommendations by an expert panel, based on the best published evidence, and consequently ensure timely, quality, efficient, and low-risk care for this specific group of patients.

RESULTS

Twenty-seven recommendations were developed that address preoperative considerations, intraoperative settings, and postoperative follow-up and care.

CONCLUSIONS

The assessment and care of patients with cirrhosis that require major surgical or invasive procedures should be overseen by a multidisciplinary team that includes the anesthesiologist, hepatologist, gastroenterologist, and clinical nutritionist. With respect to decompensated patients, a nephrology specialist may be required, given that kidney function is also a parameter involved in the prognosis of these patients.

Hyponatremia and Identification of Seniors at Risk (ISAR) Score in Geriatric Patients: An Analytical Cross-Sectional Study

Aim and objective Hyponatremia is the most common electrolyte abnormality in hospitalized patients. Age is an important, strong independent factor for hyponatremia. Geriatric at-risk groups are identified with six straightforward dichotomous questions. The research aims to determine the incidence of hyponatremia and correlate the identification of seniors at risk (ISAR) score with electrolytes in elderly individuals.  Materials and methods The 334 geriatric population of elderly men and women were recruited based on age cut-off as more than 70 to 75, 76 to 80, and more than 80. Patients were categorized based on serum sodium levels as severe hyponatremia group A (< 125 mEq/L), moderate hyponatremia B (126 to 130 mEq/L), mild hyponatremia C (131 to 135 mEq/L) and normonatremia D (136 to 145 mEq/L). At the time of admission, the ISAR Tool was utilized to identify the participants with hyponatremia at risk. Electrolytes sodium, potassium, and chloride were analyzed in the Beckman Coulter AU480 autoanalyzer by indirect ISE method. The mean of the data was compared with ANOVA, and the ISAR risk score was correlated with electrolytes by Pearson correlation analysis; p < 0.5 is considered significant.  Results and discussion About 16.76 % (56 patients) had severe hyponatremia (Serum sodium 119.14± 4.14 mEq/L) with a high ISAR score (6.0) and were reported as critical alert results by the central laboratory. Based on age-wise category, 70 to 75 yrs had serum sodium levels of 133.82 mEq/L, 76 to 80 yrs had 128.4 mEq/L, and more than 80 years had serum hyponatremia 119.17 mEq/L. Geriatrics with normonatremia had a 1.22 ISAR score, whereas geriatrics with severe hyponatremia had a 6.0 ISAR score. Correlation analysis of the ISAR score revealed a statistically significant negative correlation with sodium (r = - 0.53), potassium (r = - 0.34), and chloride (r = - 0.30) levels. Likewise, the length of hospital stay of the geriatrics with severe hyponatremia was prolonged (19 days), which contributed to the deterioration of health status; thereby, better healthcare follow-up is encouraged.  Conclusion Hyponatremia is a critical alert analyte that is common in hospitalized geriatric patients. The ISAR score system points towards the individuals who are at risk and need immediate correction. Thereby, correction of sodium levels and close monitoring of the elderly patient enables quick recovery, and the consequences of hyponatremia are circumvented.