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Berend K, Heldeweg MLA. The role of the clinical laboratory in diagnosing hyponatremia disorders. Crit Rev Clin Lab Sci 2025; 62:240-265. [PMID: 40022565 DOI: 10.1080/10408363.2025.2462814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/28/2024] [Accepted: 01/31/2025] [Indexed: 03/03/2025]
Abstract
In clinical medicine, hyponatremia is highly prevalent and frequently misdiagnosed, leading to substantial mismanagement and iatrogenic morbidity. Its differential diagnosis includes numerous diseases with diverse etiologies, making accurate assessment challenging. Despite extensive literature and guidelines on hyponatremia, most patients do not receive adequate evaluation due to the limitations of diagnostic algorithms, which rely on low-value clinical signs and are unable to identify concurrent conditions. In this review, we examine the range of laboratory tests available for hyponatremia assessment. Understanding renal mechanisms of solute and water exchange (e.g., fractional excretion) is essential for selecting appropriate tests and interpreting their diagnostic value. Additionally, detailed electrolyte and acid-base assessments remain critical for establishing a definitive diagnosis. We comprehensively discuss the selection of laboratory tests for specific differential diagnoses of hyponatremia. Importantly, in cases of acute hyponatremia, rapid correction should take precedence over a complete diagnostic workup. Ultimately, a thorough understanding of laboratory evaluation is crucial for accurately diagnosing hyponatremia. This paper critically reviews the available literature and explores relevant diseases in the context of associated laboratory parameters.
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Affiliation(s)
- Kenrick Berend
- Curacao Medical Centre, Department of nephrology, Curacao Medical Center, Curacao, Netherlands
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2
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Rosner MH, Rondon-Berrios H, Sterns RH. Syndrome of Inappropriate Antidiuresis. J Am Soc Nephrol 2025; 36:713-722. [PMID: 39621420 PMCID: PMC11975258 DOI: 10.1681/asn.0000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2024] Open
Abstract
Syndrome of inappropriate antidiuresis (SIAD)-the most frequent cause of hypotonic hyponatremia-is mediated by nonosmotic release of arginine vasopressin, which promotes water retention by activating renal vasopressin type 2 (V2) receptors. There are numerous causes of SIAD, including malignancy, pulmonary and central nervous system diseases, and medications. Rare activating mutations of the V2 receptor can also cause SIAD. Determination of the etiology of SIAD is important because removal of the stimulus for inappropriate arginine vasopressin secretion offers the most effective therapy. Treatment of SIAD is guided by symptoms and their severity, as well as the level of plasma sodium. In the absence of severe symptoms, which require urgent intervention, many clinicians focus on fluid restriction as a first-line treatment. Second-line therapeutic options include loop diuretics and salt tablets, urea, and V2 receptor antagonists.
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Affiliation(s)
- Mitchell H. Rosner
- Department of Medicine, University of Virginia Health, Charlottesville, Virginia
| | - Helbert Rondon-Berrios
- Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Richard H. Sterns
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Sahu UP, Farooquee MR, Hasan O, Ehtesham S, Hasan R. A Cross-Sectional Study on the Observation of Clinical Profiles and Associated Electrolyte Disturbances in Patients Admitted to the Pediatric Intensive Care Unit (PICU) at a Tertiary Care Center. Cureus 2025; 17:e77698. [PMID: 39974216 PMCID: PMC11836910 DOI: 10.7759/cureus.77698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2025] [Indexed: 02/21/2025] Open
Abstract
OBJECTIVE This study aims to determine the prevalence of electrolyte disturbances in children hospitalized in the pediatric intensive care unit (PICU) of Rajendra Institute of Medical Sciences (RIMS), a tertiary care center in Ranchi, India, and to evaluate related factors like pneumonia, heart disease, meningitis/encephalitis, and others. METHODS Serum electrolyte levels (sodium, potassium, calcium, magnesium) were obtained from 110 patients admitted to the PICU at RIMS. Statistical analyses were conducted to identify the prevalence and association of disturbances with specific diseases. RESULTS Sodium disturbances was most common (32 cases, 29%), with 28 (25.45%) patients exhibiting hyponatremia and four exhibiting hypernatremia (3.63%). Hypokalemia (10 cases, 9.09%) was associated predominantly with central nervous system (CNS) disorders. Hypocalcemia (26 cases, 23.63%) was most frequently linked to respiratory disorders. Hypomagnesemia cases (18, 16.36%) were also prevalent. CONCLUSION Electrolyte disturbances are common in critically ill pediatric patients and are associated with various systemic disorders, emphasizing the need for regular monitoring in the PICU.
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Affiliation(s)
- Upendra Prasad Sahu
- Department of Pediatrics, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Md Rizwan Farooquee
- Department of Pediatrics, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Omar Hasan
- Department of Pediatrics, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Sameen Ehtesham
- Department of Pediatrics, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Riaz Hasan
- Department of Chemistry, Dr Shyama Prasad Mukherjee University, Ranchi, IND
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Adin DB, Levinzon I, Harris AN. Long-term Outcome of a Chihuahua With Idiopathic Syndrome of Inappropriate Antidiuretic Hormone Secretion. J Am Anim Hosp Assoc 2024; 60:265-269. [PMID: 39480739 DOI: 10.5326/jaaha-ms-7453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2024] [Indexed: 11/02/2024]
Abstract
An approximately 3 yr old female Chihuahua was presented for evaluation of polyuria and polydipsia noted by the owner after adoption. Serum biochemistry and urinalysis revealed hyponatremia, hypochloremia, hypo-osmolality, and normal fractional excretion of sodium. Serum antidiuretic hormone concentration was 5.54 pg/mL and serum copeptin concentration was 135.40 pg/mL. The antidiuretic hormone value was above the reported range for healthy dogs and was considered inappropriate in light of serum osmolality. Idiopathic syndrome of inappropriate antidiuretic hormone secretion was considered the most likely diagnosis after excluding other potential causes, such as diuretic use, renal disease, adrenal disease, and thyroid dysfunction. The dog remains clinically well 2 yr after diagnosis without specific treatment other than minimal dietary salt supplementation. This case is unique because of the absence of systemic or neurologic signs, good long-term outcome without treatment, and use of novel diagnostic testing.
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Affiliation(s)
- Darcy B Adin
- From the Department of Small Animal Clinical Sciences (D.B.A., A.H.), University of Florida, Gainesville, Florida
| | - Ilana Levinzon
- College of Veterinary Medicine, University of Florida, Gainesville, Florida (I.L.)
| | - Autumn N Harris
- From the Department of Small Animal Clinical Sciences (D.B.A., A.H.), University of Florida, Gainesville, Florida
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Wernicke C, Bachmann U, Mai K. Hyponatremia in the emergency department: an overview of diagnostic and therapeutic approach. Biomarkers 2024; 29:244-254. [PMID: 38853611 DOI: 10.1080/1354750x.2024.2361074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/16/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Hyponatremia, defined as a serum sodium concentration <135 mmol/l, is a frequent electrolyte disorder in patients presenting to an emergency department (ED). In this context, appropriate diagnostic and therapeutic management is rarely performed and challenging due to complex pathophysiologic mechanisms and a variety of underlying diseases. OBJECTIVE To implement a feasible pathway of central diagnostic and therapeutic steps in the setting of an ED. METHODS We conducted a narrative review of the literature, considering current practice guidelines on diagnosis and treatment of hyponatremia. Underlying pathophysiologic mechanisms and management of adverse treatment effects are outlined. We also report four cases observed in our ED. RESULTS Symptoms associated with hyponatremia may appear unspecific and range from mild cognitive deficits to seizures and coma. The severity of hyponatremia-induced neurological manifestation and the risk of poor outcome is mainly driven by the rapidity of serum sodium decrease. Therefore, emergency treatment of hyponatremia should be guided by symptom severity and the assumed onset of hyponatremia development, distinguishing acute (<48 hours) versus chronic hyponatremia (>48 hours). CONCLUSIONS Especially in moderately or severely symptomatic patients presenting to an ED, the application of a standard management approach appears to be critical to improve overall outcome. Furthermore, an adequate work-up in the ED enables further diagnostic and therapeutic evaluation during hospitalization.
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Affiliation(s)
- Charlotte Wernicke
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ulrike Bachmann
- Department of Emergency and Acute Medicine, Charité-Universitätsmedizin Berlin Campus Mitte and Virchow, Berlin, Germany
| | - Knut Mai
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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6
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Andreeva AM, Lamash N, Martemyanov VI, Vasiliev AS, Toropygin IY, Garina DV. High-density lipoprotein remodeling affects the osmotic properties of plasma in goldfish under critical salinity. JOURNAL OF FISH BIOLOGY 2024; 104:564-575. [PMID: 37927095 DOI: 10.1111/jfb.15607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/19/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023]
Abstract
To investigate the stress response and physiological adaptations of goldfish (Carassius auratus) to critical salinity (CS) waters, we analyzed high-density lipoprotein (HDL) stoichiometry, stress markers (cortisol, glucose), and plasma osmotic properties (Na+ , osmolality, water content) using ichthyology, biochemistry, and proteomics approaches. After 21 days of exposure to CS, plasma concentrations of cortisol, glucose, and Na+ increased, indicating stress. Total plasma osmolality (Osmtotal ) and osmolality generated by inorganic (Osminorg ) and organic osmolytes (Osmorg ) also increased, the latter by ~2%. We associated the increase of Osmorg with (1) increased metabolite concentration (glucose), (2) dissociation of HDL particles resulting in increased HDL number per unit plasma volume (~1.5-2-fold) and (3) increased HDL osmotic activity. HDL remodeling may be the reason for the redistribution of bound and free water in plasma, which may contribute to water retention in plasma and, at the same time, to hemodynamic disturbances under CS conditions. The study's findings suggest that HDL remodeling is an important mechanism for maintaining osmotic homeostasis in fish, which is consistent with current capillary exchange models in vertebrates.
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Affiliation(s)
- Alla M Andreeva
- Papanin Institute for Biology of Inland Waters, Russian Academy of Sciences, Borok, Russia
| | - Nina Lamash
- Papanin Institute for Biology of Inland Waters, Russian Academy of Sciences, Borok, Russia
- A.V. Zhirmunsky National Scientifc Center of Marine Biology, Far Eastern Branch, Russian Academy of Sciences, Vladivostok, Russia
| | - V I Martemyanov
- Papanin Institute for Biology of Inland Waters, Russian Academy of Sciences, Borok, Russia
| | - A S Vasiliev
- Papanin Institute for Biology of Inland Waters, Russian Academy of Sciences, Borok, Russia
| | - I Yu Toropygin
- Papanin Institute for Biology of Inland Waters, Russian Academy of Sciences, Borok, Russia
- Institute of Biomedical Chemistry, Russian Academy of Sciences, Moscow, Russia
| | - D V Garina
- Papanin Institute for Biology of Inland Waters, Russian Academy of Sciences, Borok, Russia
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Farah R, Asha N, Mezher F, Maaitah S, Abu Al-Samen F, Abu Abboud F, Ajarmeh S. Prevalence, Risk Factors, and Mortality of Patients Presenting with Moderate and Severe Hyponatremia in Emergency Departments. Emerg Med Int 2023; 2023:9946578. [PMID: 38187818 PMCID: PMC10771923 DOI: 10.1155/2023/9946578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/11/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024] Open
Abstract
Background Hyponatremia is among the most common electrolyte disturbances encountered in clinical practice and is associated with a high rate of morbidity and mortality. However, there are very limited data on adult cases presenting to emergency departments with hyponatremia. Objectives This study aimed to evaluate the frequency, clinical characteristics, and outcomes in hyponatremic patients presenting to emergency departments. Methods This retrospective study analyzed all patients older than 18 years who visited our institution's emergency department between October 2018 and October 2019 and has a serum sodium (Na) level <130 mmol/L. Results Among 24,982 patients who visited the emergency department and had a documented serum sodium level, 284 were included. Patients' median age was 67.13 ± 14.8 years. Younger patients are less likely to develop severe hyponatremia compared to older patients (adjusted odds ratio (AOR): 0.415; 95% confidence interval (CI): 0.231-0.743; p=0.003). Asymptomatic hyponatremia and gastrointestinal manifestations were the most common presenting hyponatremia symptoms (33.7% and 24.2%, respectively). Proton pump inhibitor (PPI) use, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACE/ARB) use, and spironolactone use (OR = 2.6 and 3.9, 2.3 with a p=0.02, 0.03, and 0.05, respectively) were associated with increased odds of severe hyponatremia. There is no difference in the overall mortality rate within 6 months of presentation between severe and moderate hyponatremia groups (11.1% versus 16.2%, p=0.163). Conclusion Moderate and severe hyponatremia are not uncommon among patients presenting to emergency departments. Moderate hyponatremia can be asymptomatic with clinical significance. Older patients, use of PPI, use of ACEi/ARBs, and spironolactone use were associated with an increased risk of severe hyponatremia compared to moderate. Further prospective analysis of a larger population is needed to confirm our findings.
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Affiliation(s)
- Randa Farah
- Nephrology Division, Internal Medicine Department, School of Medicine, The University of Jordan, Queen Rania Street, Amman 11942, Jordan
| | - Nisreen Asha
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Farah Mezher
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Saja Maaitah
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | | | - Salma Ajarmeh
- Paediatric Departments, School of Medicine, Mutah University, Karak, Jordan
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Warren AM, Grossmann M, Christ-Crain M, Russell N. Syndrome of Inappropriate Antidiuresis: From Pathophysiology to Management. Endocr Rev 2023; 44:819-861. [PMID: 36974717 PMCID: PMC10502587 DOI: 10.1210/endrev/bnad010] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 02/19/2023] [Accepted: 03/27/2023] [Indexed: 03/29/2023]
Abstract
Hyponatremia is the most common electrolyte disorder, affecting more than 15% of patients in the hospital. Syndrome of inappropriate antidiuresis (SIAD) is the most frequent cause of hypotonic hyponatremia, mediated by nonosmotic release of arginine vasopressin (AVP, previously known as antidiuretic hormone), which acts on the renal V2 receptors to promote water retention. There are a variety of underlying causes of SIAD, including malignancy, pulmonary pathology, and central nervous system pathology. In clinical practice, the etiology of hyponatremia is frequently multifactorial and the management approach may need to evolve during treatment of a single episode. It is therefore important to regularly reassess clinical status and biochemistry, while remaining alert to potential underlying etiological factors that may become more apparent during the course of treatment. In the absence of severe symptoms requiring urgent intervention, fluid restriction (FR) is widely endorsed as the first-line treatment for SIAD in current guidelines, but there is considerable controversy regarding second-line therapy in instances where FR is unsuccessful, which occurs in around half of cases. We review the epidemiology, pathophysiology, and differential diagnosis of SIAD, and summarize recent evidence for therapeutic options beyond FR, with a focus on tolvaptan, urea, and sodium-glucose cotransporter 2 inhibitors.
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Affiliation(s)
- Annabelle M Warren
- Department of Medicine, University of Melbourne, Victoria 3010, Australia
- Department of Endocrinology, The Austin Hospital, Victoria 3084, Australia
| | - Mathis Grossmann
- Department of Medicine, University of Melbourne, Victoria 3010, Australia
- Department of Endocrinology, The Austin Hospital, Victoria 3084, Australia
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel 4031, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel 4031, Switzerland
| | - Nicholas Russell
- Department of Medicine, University of Melbourne, Victoria 3010, Australia
- Department of Endocrinology, The Austin Hospital, Victoria 3084, Australia
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Ghosal A, Qadeer HA, Nekkanti SK, Pradhan P, Okoye C, Waqar D. A Conspectus of Euvolemic Hyponatremia, Its Various Etiologies, and Treatment Modalities: A Comprehensive Review of the Literature. Cureus 2023; 15:e43390. [PMID: 37700952 PMCID: PMC10495223 DOI: 10.7759/cureus.43390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/14/2023] Open
Abstract
Hyponatremia is the most prevalent electrolyte imbalance encountered among hospitalized patients, athletes, the elderly, patients with chronic ailments, postoperative patients, and a few asymptomatic individuals. Clinical manifestations of hyponatremia can be diverse, with characteristic neurological symptoms. Depending on in-depth medical history, physical examination (including volume status assessment), laboratory investigation, and drug history, patients can be classified broadly as undergoing hypervolemic, euvolemic, or hypovolemic hyponatremia. However, patients with hypervolemic hyponatremia often present with distinctive signs such as edema or ascites, and the clinical presentation of hypovolemic and euvolemic hyponatremia poses significant challenges for clinicians. The convolution in clinical manifestations of patients is due to the varied etiologies of euvolemic hyponatremia, such as syndrome of inappropriate antidiuretic hormone secretion (SIADH), adrenocortical insufficiency, hypothyroidism, psychogenic polydipsia, different classes of drugs (chemotherapeutics, antipsychotics, antidepressants), endurance exercise events, and reset osmostat syndrome (ROS). The management of hyponatremia depends on the rate of hyponatremia onset, duration, severity of symptoms, levels of serum sodium, and underlying comorbidities. Over the last decade, the clinical understanding of hyponatremia has been scattered due to the introduction of innovative laboratory markers and new drugs. This article will be a conspectus of all the recent advancements in the field of diagnosis, investigations, management, and associations of hyponatremia, along with traditional clinical practices. Subsequently, a holistic overview has been laid out for the clinicians to better understand and identify knowledge deficiencies on this topic.
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Affiliation(s)
- Anit Ghosal
- Internal Medicine, Kolkata Medical College and Hospital, Kolkata, IND
| | - Hafiza Amna Qadeer
- Internal Medicine, Foundation University Medical College, Islamabad, PAK
| | | | | | - Chiugo Okoye
- Internal Medicine, Igbinedion University, Okada, NGA
| | - Danish Waqar
- Internal Medicine/Nephrology, Loyola University Medical Center, Chicago, USA
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Paraskevaidis I, Xanthopoulos A, Karamichalakis N, Triposkiadis F, Tsougos E. Medical Treatment in Heart Failure with Reduced Ejection Fraction: A Proposed Algorithm Based on the Patient's Electrolytes and Congestion Status. Med Sci (Basel) 2023; 11:38. [PMID: 37367737 PMCID: PMC10302950 DOI: 10.3390/medsci11020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
In heart failure (HF) with reduced ejection fraction (HFrEF), four classes of drugs (β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor neprilysin inhibitors, mineralocorticoid receptor antagonists, and the most recent Sodium-Glucose Co-Transporters 2 Inhibitors) have demonstrated positive results in randomized controlled trials (RCTs). Nevertheless, the latest RCTs are not proper for comparison since they were carried out at various times with dissimilar background therapies and the patients enrolled did not have the same characteristics. The difficulty of extrapolating from these trials and proposing a common framework appropriate for all cases is thus obvious. Despite the fact that these four agents are now the fundamental pillars of HFrEF treatment, the built-up algorithm of initiation and titration is a matter of debate. Electrolyte disturbances are common in HFrEF patients and can be attributed to several factors, such as the use of diuretics, renal impairment, and neurohormonal activation. We have identified several HFrEF phenotypes according to their sodium (Na+) and potassium (K+) status in a "real world" setting and suggest an algorithm on how to introduce the most appropriate drug and set up therapy based on the patients' electrolytes and the existence of congestion.
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Affiliation(s)
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
| | | | | | - Elias Tsougos
- 6th Department of Cardiology, Hygeia Hospital, 15123 Athens, Greece
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Culhane JT, Velury D, Okeke RI, Freeman C. Fluid and Solute Intakes Show Minimal Association With Serum Sodium Levels in a Mixed ICU Population. Cureus 2023; 15:e37730. [PMID: 37213940 PMCID: PMC10198586 DOI: 10.7759/cureus.37730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Hyponatremia is common among hospital inpatients. It is generally due to excess free body water resulting from increased water intake and decreased water elimination due to underlying pathology and hormonal influence. However, supporting evidence is lacking for treating mild hyponatremia with fluid restriction. Our study examines the association between hyponatremia and fluid intake in acutely ill inpatients. We hypothesize that fluid intake is not closely associated with serum sodium (SNa). METHODS We conducted a retrospective study of hyponatremia using the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC) III dataset, a public ICU registry. We analyzed fluid, sodium, and potassium intake with a mixed model linear regression with SNa as the outcome for hyponatremic and non-hyponatremic patients and cumulative total input from one to seven days. In addition, we compared a group of patients receiving less than one liter of fluid per day to a group receiving more than one liter. RESULTS The association of SNa with fluid intake was negative and statistically significant for most cumulative days of intake from one to seven for the total population and those with sporadic hyponatremia. For those with uniform hyponatremia, the negative association was significant for three and four days of cumulative input. The change in SNa was almost always less than 1 mmol/L of additional fluid intake across all groups. SNa for hyponatremic patients who received less than one liter of fluid per day were within one mmol/L of those who received more (p<0.001 for one, two, and seven cumulative intake days). CONCLUSIONS SNa is associated with a change of less than 1 mmol/L across a wide range of fluid and sodium intake in adult ICU patients. Patients who received less than one liter per day had SNa almost identical to those who received more. This suggests that SNa is not tightly coupled with fluid intake in the acutely ill population and that hormonal control of water elimination is the predominant mechanism. This might explain why the correction of hyponatremia by fluid restriction is often difficult.
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Affiliation(s)
- John T Culhane
- Surgery, Saint Louis University School of Medicine, Saint Louis, USA
| | - Divya Velury
- General Surgery, Saint Louis University School of Medicine, Saint Louis, USA
| | - Raymond I Okeke
- General Surgery, SSM Health Saint Louis University Hospital, Saint Louis, USA
| | - Carl Freeman
- Trauma, Saint Louis University School of Medicine, Saint Louis, USA
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12
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Zhao Y, Dong HS. Hyponatremic encephalopathy due to polyethylene glycol-based bowel preparation for colonoscopy: A case report. World J Clin Cases 2023; 11:187-192. [PMID: 36687188 PMCID: PMC9846991 DOI: 10.12998/wjcc.v11.i1.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/11/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Adequate bowel preparation is critical for colonoscopy screening. At present, the most widely used intestinal cleaner recommended at home and abroad is Polyethylene glycol (PEG). Intestinal cleansers can cause electrolyte disturbances and hyponatremia. However, hyponatremic encephalopathy due to hyponatremia induced by PEG solution, although rare, can lead to serious irreversible sequelae and even death.
CASE SUMMARY In this report, we discuss a case of neurological dysfunction due to hyponatremia, also known as hyponatremic encephalopathy, observed in a 63-year-old woman who underwent PEG-based bowel preparation for colonoscopy. She was eventually transferred to our intensive care unit for treatment due to her Glasgow Coma Scale score of 9/15 (Eye opening 2; Verbal response 1; Motor response 6) and abnormal laboratory tests.
CONCLUSION Physicians should be thoroughly familiarized with the patient's history before prescribing PEG for bowel preparation, and timely identification of patients with hyponatremic encephalopathy is essential as delayed treatment is associated with poor neurological outcomes. An intravenous infusion of 3% sodium chloride is recommended at the onset of early symptoms. The goal of treatment is to adequately treat cerebral edema while avoiding serum sodium correction beyond 15 to 20 mEq/L within 48 h of treatment to prevent osmotic demyelination syndrome.
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Affiliation(s)
- Yuan Zhao
- Department of Critical Care Medicine, Shanghai TCM-integrated Hospital, Shanghai 200082, China
| | - Hai-Sheng Dong
- Department of Critical Care Medicine, Shanghai TCM-integrated Hospital, Shanghai 200082, China
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13
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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, on behalf of the Hyponatremia Guideline Development Group. 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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Cordova Sanchez A, Bhuta K, Shmorgon G, Angeloni N, Murphy R, Chaudhuri D. The association of hyponatremia and clinical outcomes in patients with acute myocardial infarction: a cross-sectional study. BMC Cardiovasc Disord 2022; 22:276. [PMID: 35717160 PMCID: PMC9206366 DOI: 10.1186/s12872-022-02700-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Hyponatremia is a common electrolyte abnormality that has been associated with poor outcomes in several conditions including acute myocardial infarction (AMI). However, those studies were performed in the era before percutaneous coronary intervention (PCI), focused mostly on ST-elevation myocardial infarction (STEMI), and sodium levels up to 72 h of admission. The purpose of this study was to identify the association between hyponatremia and clinical outcomes in patients with acute myocardial infarction. METHODS We performed a retrospective analysis of patients with a diagnosis of non-ST-elevation myocardial infarction (NSTEMI) and STEMI presenting at our institution from March 2021 to September 2021. Our independent variables were sodium levels on the day of admission and up to 7 days later. Dependent variables were in-hospital mortality, 30-day mortality, length of hospital stay, intensive care admission, new heart failure diagnosis, and ejection fraction. RESULTS 50.2% of patients had hyponatremia up to 7 days of admission. Intensive care admission was higher in patients with hyponatremia up to7 days (69.7% vs 54.3%, P 0.019, OR 1.9), they had worse 30-day mortality (12.7% vs to 2.2%, P 0.004, OR 6.5), in hospital mortality (9.9% vs 1.1%, P 0.006, OR 9.9), and new heart failure diagnosis (31.5% vs 17.9%, P < 0.043, OR 2.1). Hyponatremia on admission was associated with in-hopital mortality (16.3% vs 3.8%, P 0.004, OR 4.9), 30-day mortality (18.4% vs 5.9%, P 0.017, OR 3.5). CONCLUSIONS This study suggests that hyponatremia on admission and at any point during the first seven days of hospitalization are associated with in-hospital and 30-day mortality.
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Affiliation(s)
- Andres Cordova Sanchez
- Department of Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA.
| | - Kunal Bhuta
- Department of Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Gary Shmorgon
- College of Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Nicholas Angeloni
- College of Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Ryan Murphy
- College of Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Debanik Chaudhuri
- Division of Cardiology, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
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15
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Aleksandrowicz M, Kozniewska E. Hyponatremia as a risk factor for microvascular spasm following subarachnoid hemorrhage. Exp Neurol 2022; 355:114126. [DOI: 10.1016/j.expneurol.2022.114126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/04/2022]
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Review of Hematological and Oncological Emergencies. Adv Emerg Nurs J 2022; 44:84-102. [PMID: 35476684 DOI: 10.1097/tme.0000000000000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with hematological malignancies, both treated and untreated, or solid tumors undergoing treatment are at risk of life-threatening complications, which may present in the emergency department (ED). Such emergencies are diverse in etiology and often require prompt treatment. Traditional complications, such as febrile neutropenia, have had recent guideline updates, which incorporate new evidence and a new validated risk stratification tool. In addition, newer approaches to treatment, such as chimeric antigen receptor (CAR) T-cell therapy, are becoming more widely available and have unique associated toxicities. This review discusses the management of the following hematological and oncological emergencies likely to be encountered in the ED: febrile neutropenia, CAR T-cell toxicities, differentiation syndrome, tumor lysis syndrome, hypercalcemia of malignancy, and hyponatremia.
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Ortolá Buigues A, Gómez-Hoyos E, Ballesteros Pomar MD, Vidal Casariego A, García Delgado Y, Ocón Bretón MJ, Abad González ÁL, Luengo Pérez LM, Matía Martín P, Tapia Guerrero MJ, Del Olmo García MD, Herrero Ruiz A, Álvarez Hernández J, Tejera Pérez C, Herranz Antolín S, Tenorio Jiménez C, García Zafra MV, Botella Romero F, Argente Pla M, Martínez Olmos MÁ, Bretón Lemes I, Runkle De la Vega I, De Luis Román D. Aetiological diagnosis of hyponatraemia in non-critical patients on total parenteral nutrition: A prospective multicentre study. ENDOCRINOL DIAB NUTR 2022; 69:160-167. [PMID: 35396114 DOI: 10.1016/j.endien.2022.02.013] [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: 11/23/2020] [Accepted: 02/15/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND In patients receiving total parenteral nutrition (TPN), the frequency of hyponatraemia is high. However, the causes of hyponatraemia in TPN have not been elucidated, although diagnosis is required for appropriate therapy. The aim of this study is to describe the aetiology of hyponatraemia in non-critical hospitalised patients receiving TPN. METHODS Prospective multicentre study in 19 Spanish hospitals. Non-critically hyponatraemic patients receiving TPN and presenting hyponatraemia over a 9-month period were studied. Data collected included sex, age, previous comorbidities, and serum sodium levels (SNa) before and following TPN initiation. Parameters for study of hyponatraemia were also included: clinical volaemia, the presence of pain, nausea, gastrointestinal losses, diuretic use, oedema, renal function, plasma and urine osmolality, urinary electrolytes, cortisolaemia, and thyroid stimulating hormone. RESULTS 162 patients were included, 53.7% males, age 66.4 (SD13.8) years. Volume status was evaluated in 142 (88%): 21 (14.8%) were hypovolaemic, 96 (67.6%) euvolaemic and 25 (17.6%) hypervolaemic. In 111/142 patients the analytical assessment of hyponatraemia was completed. Hypovolaemic hyponatraemia was secondary to GI losses in 10/111 (9%), and to diuretics in 3/111 (2.7%). Euvolaemic hyponatraemia was due to Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) in 47/111 (42.4%), and to physiological stimuli of Arginine Vasopressin (AVP) secretion in 28/111 (25.2%). Hypervolaemic hyponatraemia was induced by heart failure in 19/111 (17.1%), cirrhosis of the liver in 4/111 (3.6%). CONCLUSIONS SIADH was the most frequent cause of hyponatraemia in patients receiving TPN. The second most frequent cause was physiological stimuli of AVP secretion induced by pain/nausea.
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Affiliation(s)
- Ana Ortolá Buigues
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain.
| | - Emilia Gómez-Hoyos
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain
| | | | - Alfonso Vidal Casariego
- Endocrinology and Nutrition Department, Complejo Asistencial Universitario de León, León, Spain
| | - Yaiza García Delgado
- Endocrinology and Nutrition Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| | - María Julia Ocón Bretón
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Ángel Luis Abad González
- Endocrinology and Nutrition Department, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Pilar Matía Martín
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria San Carlos (IDISSC), Madrid, Spain
| | | | | | - Ana Herrero Ruiz
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Julia Álvarez Hernández
- Endocrinology and Nutrition Department, Hospital Universitario Príncipe de Asturias, Getafe, Spain
| | - Cristina Tejera Pérez
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Sandra Herranz Antolín
- Endocrinology and Nutrition Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | | | - Francisco Botella Romero
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - María Argente Pla
- Endocrinology and Nutrition Department, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | - Miguel Ángel Martínez Olmos
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Irene Bretón Lemes
- Endocrinology and Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Isabelle Runkle De la Vega
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria San Carlos (IDISSC), Madrid, Spain
| | - Daniel De Luis Román
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain
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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: 3] [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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Kilci F, Yetimakman AF, Jones JH, Çizmecioğlu FM. A case of adrenal insufficiency during multisystem inflammatory syndrome in children. Clin Pediatr Endocrinol 2022; 31:163-167. [PMID: 35928381 PMCID: PMC9297178 DOI: 10.1297/cpe.2022-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/11/2022] [Indexed: 11/24/2022] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a disease related to coronavirus
disease 2019 (COVID-19). Although the effects of COVID-19 on many systems are known, there
is limited data regarding its effects on the endocrine system. This study aimed to discuss
the effect of COVID-19 on cortisol dynamics in a patient who developed adrenal
insufficiency after COVID-19 infection. An 11-yr-old boy with polymerase chain
reaction-proven COVID-19 one month previously was referred with a five-day history of
fever, vomiting, and rash. On admission, he had hypotension, tachycardia, and severe
hyponatremia. After the evaluation, he was diagnosed with MIS-C and glucocorticoid therapy
was initiated. During follow-up, the patient experienced adrenal insufficiency, and
hydrocortisone treatment was initiated at a crisis dose. Four months later, the adrenal
axis function had not recovered. The adrenocortical response in COVID-19 patients may be
significantly impaired, resulting in increased mortality or morbidity.
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Affiliation(s)
- Fatih Kilci
- Department of Pediatrics, Division of Pediatric Endocrinology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Ayşe Filiz Yetimakman
- Department of Pediatrics, Division of Pediatric İntensive Care Unit, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Jeremy Huw Jones
- Department of Academic Writing, Kocaeli University, Kocaeli, Turkey
| | - Filiz Mine Çizmecioğlu
- Department of Pediatrics, Division of Pediatric Endocrinology, Kocaeli University School of Medicine, Kocaeli, Turkey
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Lehtiranta S, Honkila M, Kallio M, Halt K, Paalanne N, Pokka T, Tapiainen T. Severe hospital-acquired hyponatremia in acutely ill children receiving moderately hypotonic fluids. Pediatr Nephrol 2022; 37:443-448. [PMID: 34398305 PMCID: PMC8816776 DOI: 10.1007/s00467-021-05227-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hypotonic fluids have been associated with hospital-acquired hyponatremia. The incidence of life-threatening severe hyponatremia associated with hypotonic fluids has not been evaluated. METHODS This was a population-based cohort study of 46,518 acutely ill children 15 years of age or under who visited the pediatric emergency department (ED) at Oulu University Hospital, Finland, between 2007 and 2017. We retrieved all electrolyte measurements from the comprehensive electronic laboratory system and reviewed medical records for all patients with severe hyponatremia. RESULTS The overall occurrence of severe hyponatremia (serum sodium < 125 mmol/L) was found in 27 out of 46,518 acutely ill children (0.06%, 95% confidence interval 0.04-0.08%). After admission, severe hyponatremia developed in seven of 6,984 children receiving moderately hypotonic fluid therapy (0.1%, 95% confidence interval 0.04-0.2%), usually within 8 h of admission. All children who developed severe hyponatremia during hospitalization were severely ill. CONCLUSION In this register-based cohort study of children presenting to the ED, severe hyponatremia developed in one of 998 acutely ill children receiving moderately hypotonic fluid therapy. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Saara Lehtiranta
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, PO Box 23, N90029, OYS, Oulu, Finland. .,PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit and Medical Research Centre Oulu, University of Oulu, Oulu, Finland.
| | - Minna Honkila
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, PO Box 23, N90029 OYS, Oulu, Finland ,PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit and Medical Research Centre Oulu, University of Oulu, Oulu, Finland
| | - Merja Kallio
- PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit and Medical Research Centre Oulu, University of Oulu, Oulu, Finland ,Department of Pediatric Cardiology, New Children’s Hospital, University Hospital of Helsinki, Helsinki, Finland
| | - Kimmo Halt
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, PO Box 23, N90029 OYS, Oulu, Finland ,PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit and Medical Research Centre Oulu, University of Oulu, Oulu, Finland
| | - Niko Paalanne
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, PO Box 23, N90029 OYS, Oulu, Finland ,PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit and Medical Research Centre Oulu, University of Oulu, Oulu, Finland
| | - Tytti Pokka
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, PO Box 23, N90029 OYS, Oulu, Finland ,PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit and Medical Research Centre Oulu, University of Oulu, Oulu, Finland
| | - Terhi Tapiainen
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, PO Box 23, N90029 OYS, Oulu, Finland ,PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit and Medical Research Centre Oulu, University of Oulu, Oulu, Finland ,Biocenter Oulu, University of Oulu, Oulu, Finland
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Estilo A, McCormick L, Rahman M. Using Tolvaptan to Treat Hyponatremia: Results from a Post-authorization Pharmacovigilance Study. Adv Ther 2021; 38:5721-5736. [PMID: 34693505 PMCID: PMC8572184 DOI: 10.1007/s12325-021-01947-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/06/2021] [Indexed: 01/15/2023]
Abstract
Introduction Hyponatremia is a common condition of varying etiology among hospitalized patients and is associated with adverse outcomes. Treatment to normalize serum sodium is advisable. Tolvaptan received European Union marketing authorization for hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Post-marketing pharmacovigilance activities were required to characterize the safety profile of tolvaptan more fully in this population, which is often elderly with a high burden of comorbid illness. Methods This was a prospective, observational, multinational, post-authorization pharmacovigilance study (NCT01228682) in seven European countries. Hospitalized patients were enrolled who received tolvaptan for hyponatremia associated with SIADH and consented to data collection. Tolvaptan was initiated and assessments performed at physician discretion per local standards of care. To reflect actual clinical practice, no assessments or procedures were required outside the standard of care. Patients who continued to receive long-term tolvaptan following hospital discharge and provided consent received follow-up from their community physicians. Results A total of 252 patients (mean age 70.6 years) enrolled. Mean tolvaptan treatment duration was 139.4 days, median 18.5 (range 1–1130) days; most frequent dose was 15 mg/day (used in 75% of patients). Serum sodium increased from baseline (mean 123.2 mmol/l) during treatment week 1 and remained stable during follow-up, with little difference across doses of 7.5, 15, and 30 mg/day. Hyponatremia symptoms (e.g., confusion, unsteady gait, lethargy) were present in 122/252 (48.4%) patients at pre-treatment baseline, decreasing to 46/252 (18.3%) during treatment. Sixty-two patients (24.6%; mean baseline serum sodium 120 mmol/l) experienced rapid correction of hyponatremia within 72 h. No osmotic demyelination syndrome occurred. Conclusion In clinical practice, tolvaptan improved serum sodium and decreased hyponatremia symptoms in hyponatremia secondary to SIADH. Serum sodium should be monitored during treatment to minimize risk of rapid correction. Trial Registration Clinicaltrials.gov identifier NCT01228682. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01947-9. Hospitalized patients often experience abnormally low blood sodium levels (hyponatremia), which can cause significant symptoms and poses a serious health risk (Wald et al. in Arch Intern Med 170:294–302, 2010). Yet, increasing sodium levels too rapidly in these patients can unintentionally cause osmotic demyelination syndrome, resulting in long-term neurologic damage or death. Tolvaptan was approved in the European Union to treat one type of hyponatremia caused by a hormonal imbalance known as the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Tolvaptan effectively increased patient sodium levels in clinical trials, but real-world data are needed to understand tolvaptan treatment more fully in everyday clinical practice. We evaluated patterns of use, efficacy, and safety of tolvaptan in patients treated in hospitals and after discharge for hyponatremia due to SIADH. Tolvaptan was correctly used to treat only hyponatremia caused by SIADH in nearly all of the 252 patients studied. Patient sodium levels increased in the first week of tolvaptan treatment and then stabilized. Hyponatremia symptoms, such as confusion, nausea, tiredness, and dizziness, were present in 48.4% of patients before treatment and in 18.3% after starting tolvaptan. Consistent with earlier studies, some patients (24.6%) experienced excessively rapid correction of hyponatremia. However, no subsequent neurologic problems or deaths were attributed to the rapid correction, which suggests that medical providers were carefully monitoring and managing sodium levels to prevent serious consequences. Our study indicates that tolvaptan is being used safely and effectively to treat hyponatremia due to SIADH in a patient population with complex medical needs.
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Wang KY, Suresh KV, Mo K, Harris AB, Marrache M, Kebaish KM. Preoperative Hyponatremia is an Independent Risk Factor for Prolonged Hospital Stay Following Anterior Cervical Discectomy and Fusion. World Neurosurg 2021; 161:e18-e24. [PMID: 34688933 DOI: 10.1016/j.wneu.2021.10.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the effects of preoperative hyponatremia on short-term postoperative complications and healthcare utilization (length of stay, readmissions) following anterior cervical fusion and discectomy (ACDF). METHODS Patients who underwent ACDF were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Patients who had revision surgery, trauma, vertebral malignancy, or infection were excluded. Eunatremia was defined as sodium (Na) level between 135 and 145 mEq/L, whereas hyponatremia was defined as Na < 135 mEq/L. Preoperatively hyponatremic patients were matched 1:1 with eunatremic patients using propensity-score matching based upon age, gender, American Society of Anesthesiology (ASA) score, and baseline comorbidities. Minor adverse events included superficial infection, dehiscence, urinary tract infection, pneumonia, and renal insufficiency or failure. Serious adverse events included deep wound infection, reintubation, pulmonary embolism, cerebrovascular accident, cardiac arrest, deep vein thrombosis, sepsis, return to operating room, and death within 30 days. Complications were analyzed using bivariate and logistic analysis with significance set at p<0.05. RESULTS Of the 9,094 patients undergoing ACDF, 3.64% (331 patients) were preoperatively hyponatremic. Preoperative hyponatremia was an independent risk factor for postoperative pneumonia following ACDF (OR=4.47; p=0.020) as well as extended length of hospital stay greater than one standard deviation above the mean (OR=1.71; p=0.042). Preoperative hyponatremia was an independent risk factor for having a serious adverse event (OR=2.40; p=0.005), as well as any adverse event (OR=2.44; p=0.009). CONCLUSION Preoperative hyponatremia is an independent risk factor for pneumonia and prolonged length of stay following ACDF.
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Affiliation(s)
- Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Krishna V Suresh
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Kevin Mo
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Andrew B Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Majd Marrache
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.
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Marroquin MV, Sy J, Kleine CE, Oveyssi J, Hsiung JT, Park C, Soohoo M, Kovesdy CP, Rhee CM, Streja E, Kalantar-Zadeh K, Tantisattamo E. Association of Pre-ESKD Hyponatremia with Post-ESKD Outcomes among Incident ESKD Patients. Nephrol Dial Transplant 2021; 37:358-365. [PMID: 34390572 DOI: 10.1093/ndt/gfab203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hyponatremia is one of the most common electrolyte disturbances in advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) patients and has been shown to be associated with higher mortality risk. However, the relationship between hyponatremia during late-stage CKD and the risk of poor outcomes after ESKD transition is unknown. METHODS We conducted a retrospective cohort study including 32,257 US veterans transitioning to ESKD from October 1, 2007 to March 30, 2015. We evaluated adjusted associations between the 3-month averaged pre-transition to ESKD serum sodium and all-cause mortality. Secondary outcomes included cardiovascular (CV) mortality, infection-related mortalities, and hospitalization rate. RESULTS Cohort mean±SD serum sodium was 139 ± 3 mEq/L, mean age was 67 ± 11 years, 98% were male, and 32% were African American. Over a median follow-up of 702 days (296, 1301) there were 17,162 deaths. Compared to the reference of 135-<144 mEq/L, the lowest serum sodium group (<130 mEq/L) had a 54% higher all-cause mortality risk (hazard ratio [HR]: 1.54, 95% confidence interval [CI]: 1.34, 1.76) in the fully adjusted model. Associations were similar for CV and infection-related mortality, and hospitalization outcomes. CONCLUSIONS Hyponatremia prior to ESKD transition is associated with higher risk of all-cause, CV, and infection-related mortalities and hospitalization rates after ESKD transition. Future studies evaluating management of pre-ESKD hyponatremia may be indicated to improve patient outcomes for those transitioning to ESKD.
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Affiliation(s)
- Maria V Marroquin
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA.,Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - John Sy
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA.,Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Carola-Ellen Kleine
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Justin Oveyssi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Jui-Ting Hsiung
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA.,Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Christina Park
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA.,Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA.,Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.,Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA.,Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA.,Tibor Rubin VA Medical Center, Long Beach, CA, USA.,Fielding School of Public Health at UCLA, Los Angeles, CA, USA
| | - Ekamol Tantisattamo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA
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24
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Ortolá Buigues A, Gómez-Hoyos E, Ballesteros Pomar MD, Vidal Casariego A, García Delgado Y, Ocón Bretón MJ, Abad González ÁL, Luengo Pérez LM, Matía Martín P, Tapia Guerrero MJ, Del Olmo García MD, Herrero Ruiz A, Álvarez Hernández J, Tejera Pérez C, Herranz Antolín A, Tenorio Jiménez C, García Zafra MV, Botella Romero F, Argente Pla M, Martínez Olmos MÁ, Bretón Lemes I, Runkle De la Vega I, De Luis Román D. Aetiological diagnosis of hyponatraemia in non-critical patients on total parenteral nutrition: A prospective multicentre study. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00123-3. [PMID: 34244097 DOI: 10.1016/j.endinu.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND In patients receiving total parenteral nutrition (TPN), the frequency of hyponatraemia is high. However, the causes of hyponatraemia in TPN have not been elucidated, although diagnosis is required for appropriate therapy. The aim of this study is to describe the aetiology of hyponatraemia in non-critical hospitalised patients receiving TPN. METHODS Prospective multicentre study in 19 Spanish hospitals. Non-critically hyponatraemic patients receiving TPN and presenting hyponatraemia over a 9-month period were studied. Data collected included sex, age, previous comorbidities, and serum sodium levels (SNa) before and following TPN initiation. Parameters for study of hyponatraemia were also included: clinical volaemia, the presence of pain, nausea, gastrointestinal losses, diuretic use, oedema, renal function, plasma and urine osmolality, urinary electrolytes, cortisolaemia, and thyroid stimulating hormone. RESULTS 162 patients were included, 53.7% males, age 66.4 (SD13.8) years. Volume status was evaluated in 142 (88%): 21 (14.8%) were hypovolaemic, 96 (67.6%) euvolaemic and 25 (17.6%) hypervolaemic. In 111/142 patients the analytical assessment of hyponatraemia was completed. Hypovolaemic hyponatraemia was secondary to GI losses in 10/111 (9%), and to diuretics in 3/111 (2.7%). Euvolaemic hyponatraemia was due to Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) in 47/111 (42.4%), and to physiological stimuli of Arginine Vasopressin (AVP) secretion in 28/111 (25.2%). Hypervolaemic hyponatraemia was induced by heart failure in 19/111 (17.1%), cirrhosis of the liver in 4/111 (3.6%). CONCLUSIONS SIADH was the most frequent cause of hyponatraemia in patients receiving TPN. The second most frequent cause was physiological stimuli of AVP secretion induced by pain/nausea.
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Affiliation(s)
- Ana Ortolá Buigues
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain.
| | - Emilia Gómez-Hoyos
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain
| | | | - Alfonso Vidal Casariego
- Endocrinology and Nutrition Department, Complejo Asistencial Universitario de León, León, Spain
| | - Yaiza García Delgado
- Endocrinology and Nutrition Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| | - María Julia Ocón Bretón
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Ángel Luis Abad González
- Endocrinology and Nutrition Department, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Pilar Matía Martín
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria San Carlos (IDISSC), Madrid, Spain
| | | | | | - Ana Herrero Ruiz
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Julia Álvarez Hernández
- Endocrinology and Nutrition Department, Hospital Universitario Príncipe de Asturias, Getafe, Spain
| | - Cristina Tejera Pérez
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | | | | | | | - Francisco Botella Romero
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - María Argente Pla
- Endocrinology and Nutrition Department, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | - Miguel Ángel Martínez Olmos
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Irene Bretón Lemes
- Endocrinology and Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Isabelle Runkle De la Vega
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria San Carlos (IDISSC), Madrid, Spain
| | - Daniel De Luis Román
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain
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25
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Elkattawy S, Shankar T, Younes I, Alyacoub R, Fichadiya H, Reddy A. A rare report of obstructive nephropathy induced hyponatremia. J Community Hosp Intern Med Perspect 2021; 11:507-509. [PMID: 34211658 PMCID: PMC8221147 DOI: 10.1080/20009666.2021.1915535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Hyponatremia is a common finding in patients admitted to hospitals in the USA. There is a plethora of causes ranging from excessive diuretic use to volume overload from underlying heart failure or liver cirrhosis. The consequences of missing or mistreating the aforementioned diagnosis can lead to catastrophic outcomes. Here, we focus on a rare yet overlooked cause of hyponatremia: obstructive nephropathy. The causes of obstructive nephropathy in elderly patients are broad with neurogenic bladder being one of the common ones. Our patient is an elderly male who presented with hyponatremia in setting of urine retention post an orthopedic surgery.
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Affiliation(s)
- Sherif Elkattawy
- Internal Medicine Residentm, Department of Internal Medicine, Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Tanya Shankar
- Internal Medicine Residentm, Department of Internal Medicine, Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Islam Younes
- Internal Medicine Residentm, Department of Internal Medicine, Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Ramez Alyacoub
- Internal Medicine Residentm, Department of Internal Medicine, Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Hardik Fichadiya
- Internal Medicine Residentm, Department of Internal Medicine, Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Aravinda Reddy
- Internal Medicine, Department of Internal Medicine, Trinitas Regional Medical Center, Elizabeth, NJ, USA
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26
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Brender R, Mulsant BH, Blumberger DM. An update on antidepressant pharmacotherapy in late-life depression. Expert Opin Pharmacother 2021; 22:1909-1917. [PMID: 33910422 DOI: 10.1080/14656566.2021.1921736] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction: Clinically important depressive symptoms that occur in adults over age 60 are often termed late-life depression (LLD). LLD poses challenges for treating clinicians in both detection and treatment. Antidepressants are the most common first-line treatment approach. Older adults are at an increased risk of adverse effects because of polypharmacy.Areas covered: This article summarizes the challenges and approaches when using pharmacotherapy in LLD with a focus on newer data that have become available during the last five years. While no new antidepressants have become available during this period, a review of the literature summarizes advances in the knowledge of the adverse effects associated with various antidepressants and on the potential contribution of pharmacogenetic tools when prescribing antidepressants to older patients.Expert opinion: During the past 5 years, most of the literature relevant to the pharmacotherapy of MDD in older patients has focused on adverse effects. In particular, the effects of antidepressants on cognition and bone are emerging as important areas for clinical attention and further investigation. There is also an emerging literature on the potential role of pharmacogenetic testing in patients with MDD, though recommendations for use in older adults await larger studies that demonstrate its efficacy and cost-effectiveness.
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Affiliation(s)
- Ram Brender
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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27
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Kawakami T, Fujisawa H, Nakayama S, Yoshino Y, Hattori S, Seino Y, Takayanagi T, Miyakawa T, Suzuki A, Sugimura Y. Vasopressin escape and memory impairment in a model of chronic syndrome of inappropriate secretion of antidiuretic hormone in mice. Endocr J 2021; 68:31-43. [PMID: 32879162 DOI: 10.1507/endocrj.ej20-0289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Recently, chronic hyponatremia, even mild, has shown to be associated with poor quality of life and high mortality. The mechanism by which hyponatremia contributes to those symptoms, however, remains to be elucidated. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a primary cause of hyponatremia. Appropriate animal models are crucial for investigating the pathophysiology of SIADH. A rat model of SIADH has been generally used and mouse models have been rarely used. In this study, we developed a mouse model of chronic SIADH in which stable and sustained hyponatremia occurred after 3-week continuous infusion of the vasopressin V2 receptor agonist 1-desamino-8-D-arginine vasopressin (dDAVP) and liquid diet feeding to produce chronic water loading. Weight gain in chronic SIADH mice at week 2 and 3 after starting dDAVP injection was similar to that of control mice, suggesting that the animals adapted to chronic hyponatremia and grew up normally. AQP2 expression in the kidney, which reflects the renal action of vasopressin, was decreased in dDAVP-infused water-loaded mice as compared with control mice that received the same dDAVP infusion but were fed pelleted chow. These results suggest that "vasopressin escape" occurred, which is an important process for limiting potentially fatal severe hyponatremia. Behavioral analyses using the contextual and cued fear conditioning test and T-maze test demonstrated cognitive impairment, especially working memory impairment, in chronic SIADH mice, which was partially restored after correcting hyponatremia. Our results suggest that vasopressin escape occurred in chronic SIADH mice and that chronic hyponatremia contributed to their memory impairment.
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Affiliation(s)
- Tsukasa Kawakami
- Department of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Haruki Fujisawa
- Department of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Shogo Nakayama
- Department of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Yasumasa Yoshino
- Department of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Satoko Hattori
- Division of Systems Medical Science, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Yusuke Seino
- Department of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Takeshi Takayanagi
- Department of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Tsuyoshi Miyakawa
- Division of Systems Medical Science, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Atsushi Suzuki
- Department of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Yoshihisa Sugimura
- Department of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi 470-1192, Japan
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28
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Castle-Kirszbaum M, Kyi M, Wright C, Goldschlager T, Danks RA, Parkin WG. Hyponatraemia and hypernatraemia: Disorders of Water Balance in Neurosurgery. Neurosurg Rev 2021; 44:2433-2458. [PMID: 33389341 DOI: 10.1007/s10143-020-01450-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/26/2020] [Accepted: 11/25/2020] [Indexed: 12/23/2022]
Abstract
Disorders of tonicity, hyponatraemia and hypernatraemia, are common in neurosurgical patients. Tonicity is sensed by the circumventricular organs while the volume state is sensed by the kidney and peripheral baroreceptors; these two signals are integrated in the hypothalamus. Volume is maintained through the renin-angiotensin-aldosterone axis, while tonicity is defended by arginine vasopressin (antidiuretic hormone) and the thirst response. Edelman found that plasma sodium is dependent on the exchangeable sodium, potassium and free-water in the body. Thus, changes in tonicity must be due to disproportionate flux of these species in and out of the body. Sodium concentration may be measured by flame photometry and indirect, or direct, ion-sensitive electrodes. Only the latter method is not affected by changes in plasma composition. Classification of hyponatraemia by the volume state is imprecise. We compare the tonicity of the urine, given by the sodium potassium sum, to that of the plasma to determine the renal response to the dysnatraemia. We may then assess the activity of the renin-angiotensin-aldosterone axis using urinary sodium and fractional excretion of sodium, urate or urea. Together, with clinical context, these help us determine the aetiology of the dysnatraemia. Symptomatic individuals and those with intracranial catastrophes require prompt treatment and vigilant monitoring. Otherwise, in the absence of hypovolaemia, free-water restriction and correction of any reversible causes should be the mainstay of treatment for hyponatraemia. Hypernatraemia should be corrected with free-water, and concurrent disorders of volume should be addressed. Monitoring for overcorrection of hyponatraemia is necessary to avoid osmotic demyelination.
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Affiliation(s)
| | - Mervyn Kyi
- Department of Endocrinology, Melbourne Health, Melbourne, Australia
| | - Christopher Wright
- Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, Australia.,Department of Surgery, Monash University, Melbourne, Australia
| | - R Andrew Danks
- Department of Neurosurgery, Monash Health, Melbourne, Australia.,Department of Surgery, Monash University, Melbourne, Australia
| | - W Geoffrey Parkin
- Department of Surgery, Monash University, Melbourne, Australia.,Department of Intensive Care, Monash Health, Melbourne, Australia
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29
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Lenci I, Milana M, Grassi G, Signorello A, Aglitti A, Baiocchi L. Natremia and liver transplantation: The right amount of salt for a good recipe. World J Hepatol 2020; 12:919-930. [PMID: 33312419 PMCID: PMC7701977 DOI: 10.4254/wjh.v12.i11.919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/19/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023] Open
Abstract
An adequate balance between electrolytes and clear water is of paramount importance to maintaining physiologic homeostasis. Natremia imbalance and, in particular, hyponatremia is the most frequent electrolyte abnormality observed in hospitalized subjects, involving approximately one-fourth of them. Pathological changes occurring during liver cirrhosis predispose patients to an increased risk of sodium imbalance, and hypervolemic hyponatremia has been reported in nearly 50% of subjects with severe liver disease and ascites. Splanchnic vasodilatation, portal-systemic collaterals' opening and increased excretion of vasoactive modulators are all factors impairing clear water handling during liver cirrhosis. Of concern, sodium imbalance has been consistently reported to be associated with increased risk of complications and reduced survival in liver disease patients. In the last decades clinical interest in sodium levels has been also extended in the field of liver transplantation. Evidence that [Na+] in blood is an independent risk factor for in-list mortality led to the incorporation of sodium value in prognostic scores employed for transplant priority, such as model for end-stage liver disease-Na and UKELD. On the other hand, severe hyponatremic cirrhotic patients are frequently delisted by transplant centers due to the elevated risk of mortality after grafting. In this review, we describe in detail the relationship between sodium imbalance and liver cirrhosis, focusing on its impact on peritransplant phases. The possible therapeutic approaches, in order to improve transplant outcome, are also discussed.
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Affiliation(s)
- Ilaria Lenci
- Department of Internal Medicine, Hepatology Unit, Tor Vergata University, Rome 00133, Italy
| | - Martina Milana
- Department of Internal Medicine, Hepatology Unit, Tor Vergata University, Rome 00133, Italy
| | - Giuseppe Grassi
- Department of Internal Medicine, Hepatology Unit, Tor Vergata University, Rome 00133, Italy
| | - Alessandro Signorello
- Department of Internal Medicine, Hepatology Unit, Tor Vergata University, Rome 00133, Italy
| | - Andrea Aglitti
- Department of Internal Medicine, Hepatology Unit, Tor Vergata University, Rome 00133, Italy
| | - Leonardo Baiocchi
- Department of Internal Medicine, Hepatology Unit, Tor Vergata University, Rome 00133, Italy.
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30
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Umbrello M, Formenti P, Chiumello D. Urine Electrolytes in the Intensive Care Unit: From Pathophysiology to Clinical Practice. Anesth Analg 2020; 131:1456-1470. [PMID: 33079869 DOI: 10.1213/ane.0000000000004994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Assessment of urine concentrations of sodium, chloride, and potassium is a widely available, rapid, and low-cost diagnostic option for the management of critically ill patients. Urine electrolytes have long been suggested in the diagnostic workup of hypovolemia, kidney injury, and acid-base and electrolyte disturbances. However, due to the wide range of normal reference values and challenges in interpretation, their use is controversial. To clarify their potential role in managing critical patients, we reviewed existing evidence on the use of urine electrolytes for diagnostic and therapeutic evaluation and assessment in critical illness. This review will describe the normal physiology of water and electrolyte excretion, summarize the use of urine electrolytes in hypovolemia, acute kidney injury, acid-base, and electrolyte disorders, and suggest some practical flowcharts for the potential use of urine electrolytes in daily critical care practice.
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Affiliation(s)
- Michele Umbrello
- From the Struttura Complessa (SC) Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, Azienda Socio Sanitaria Territoriale (ASST) Santi Paolo e Carlo, Milan, Italy
| | - Paolo Formenti
- From the Struttura Complessa (SC) Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, Azienda Socio Sanitaria Territoriale (ASST) Santi Paolo e Carlo, Milan, Italy
| | - Davide Chiumello
- From the Struttura Complessa (SC) Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, Azienda Socio Sanitaria Territoriale (ASST) Santi Paolo e Carlo, Milan, Italy
- Dipartimento di Scienze della Salute
- Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy
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31
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Kutz A, Ebrahimi F, Aghlmandi S, Wagner U, Bromley M, Illigens B, Siepmann T, Schuetz P, Mueller B, Christ-Crain M. Risk of Adverse Clinical Outcomes in Hyponatremic Adult Patients Hospitalized for Acute Medical Conditions: A Population-Based Cohort Study. J Clin Endocrinol Metab 2020; 105:5894963. [PMID: 32818232 PMCID: PMC7500475 DOI: 10.1210/clinem/dgaa547] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Hyponatremia has been associated with excess long-term morbidity and mortality. However, effects during hospitalization are poorly studied. OBJECTIVE The objective of this work is to examine the association of hyponatremia with the risk of in-hospital mortality, 30-day readmission, and other short-term adverse events among medical inpatients. DESIGN AND SETTING A population-based cohort study was conducted using a Swiss claims database of medical inpatients from January 2012 to December 2017. PATIENTS Hyponatremic patients were 1:1 propensity-score matched with normonatremic medical inpatients. MAIN OUTCOME MEASURE The primary outcome was a composite of all-cause in-hospital mortality and 30-day hospital readmission. Secondary outcomes were intensive care unit (ICU) admission, intubation rate, length-of-hospital stay (LOS), and patient disposition after discharge. RESULTS After matching, 94 352 patients were included in the cohort. Among 47 176 patients with hyponatremia, 8383 (17.8%) reached the primary outcome compared with 7994 (17.0%) in the matched control group (odds ratio [OR] 1.06 [95% CI, 1.02-1.10], P = .001). Hyponatremic patients were more likely to be admitted to the ICU (OR 1.43 [95% CI, 1.37-1.50], P < .001), faced a 56% increase in prolonged LOS (95% CI, 1.52-1.60, P < .001), and were admitted more often to a postacute care facility (OR 1.38 [95% CI 1.34-1.42, P < .001). Of note, patients with the syndrome of inappropriate antidiuresis (SIAD) had lower in-hospital mortality (OR 0.67 [95% CI, 0.56-0.80], P < .001) as compared with matched normonatremic controls. CONCLUSION In this study, hyponatremia was associated with increased risk of short-term adverse events, primarily driven by higher readmission rates, which was consistent among all outcomes except for decreased in-hospital mortality in SIAD patients.
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Affiliation(s)
- Alexander Kutz
- Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Correspondence and Reprint Requests:Alexander Kutz, MD, MSc, Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland. E-mail:
| | - Fahim Ebrahimi
- Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ulrich Wagner
- Foundation National Institute for Cancer Epidemiology and Registration (NICER) University of Zurich, Zurich, Switzerland
| | - Miluska Bromley
- Center for Clinical Research and Management, Division of Health Care Sciences, Education Dresden, Dresden International University, Dresden, Germany
| | - Ben Illigens
- Center for Clinical Research and Management, Division of Health Care Sciences, Education Dresden, Dresden International University, Dresden, Germany
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Timo Siepmann
- Center for Clinical Research and Management, Division of Health Care Sciences, Education Dresden, Dresden International University, Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Philipp Schuetz
- Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Beat Mueller
- Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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32
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Lerner DP, Shepherd SA, Batra A. Hyponatremia in the Neurologically Ill Patient: A Review. Neurohospitalist 2020; 10:208-216. [PMID: 32549945 PMCID: PMC7271621 DOI: 10.1177/1941874419895124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Hyponatremia is a well-known disorder commonly faced by clinicians managing neurologically ill patients. Neurological disorders are often associated with hyponatremia during their acute presentation and can be associated with specific neurologic etiologies and symptoms. Patients may present with hyponatremia with traumatic brain injury, develop hyponatremia subacutely following aneurysmal subarachnoid hemorrhage, or may manifest with seizures due to hyponatremia itself. Clinicians caring for the neurologically ill patient should be well versed in identifying these early signs, symptoms, and etiologies of hyponatremia. Early diagnosis and treatment can potentially avoid neurologic and systemic complications in these patients and improve outcomes. This review focuses on the causes and findings of hyponatremia in the neurologically ill patient and discusses the pathophysiology, diagnoses, and treatment strategies for commonly encountered etiologies.
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Affiliation(s)
- David P. Lerner
- Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | | | - Ayush Batra
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Kleindienst A, Georgiev S, Schlaffer SM, Buchfelder M. Tolvaptan Versus Fluid Restriction in the Treatment of Hyponatremia Resulting from SIADH Following Pituitary Surgery. J Endocr Soc 2020; 4:bvaa068. [PMID: 32666012 PMCID: PMC7326480 DOI: 10.1210/jendso/bvaa068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/08/2020] [Indexed: 12/21/2022] Open
Abstract
Context The relevance of hyponatremia has been acknowledged by guidelines from the United States (2013) and Europe (2014). However, treatment recommendations differ due to limited evidence. Objective In hyponatremia following pituitary surgery-caused by the syndrome of inappropriate antidiuretic hormone (SIADH) secretion-we compared fluid restriction with the pharmacological increase of water excretion by blocking the vasopressin 2 receptors with tolvaptan at a low and a moderate dose. Design Prospective observational study. Setting Neurosurgical Department of a University hospital with more than 200 surgical pituitary procedures per year. Patients Patients undergoing pituitary surgery and developing serum sodium below 136 mmol/L. The diagnosis of SIADH was established by euvolemia (daily measurement of body weight and fluid balance), inappropriately concentrated urine (specific gravity), and exclusion of adrenocorticotropic and thyroid-stimulating hormone deficiency. Intervention Patients were treated with fluid restriction (n = 40) or tolvaptan at 3.75 (n = 38) or 7.5 mg (n = 48). Main Outcome Measures Treatment efficacy was assessed by the duration of hyponatremia, sodium nadir, and length of hospitalization. Safety was established by a sodium increment below 10 mmol/L per day and exclusion of side effects. Results Treatment with 7.5 mg of tolvaptan resulted in a significant attenuation of hyponatremia and in a significant overcorrection of serum sodium in 30% of patients. The duration of hospitalization did not differ between treatment groups. Conclusions Tolvaptan at a moderate dose is more effective than fluid restriction in the treatment of SIADH. Overcorrection of serum sodium may be a side effect of tolvaptan even at low doses.
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Affiliation(s)
- Andrea Kleindienst
- Department of Neurosurgery, Friedrich-Alexander-University Nürnberg-Erlangen, Erlangen, Germany
| | - Simeon Georgiev
- Department of Neurosurgery, Friedrich-Alexander-University Nürnberg-Erlangen, Erlangen, Germany
| | - Sven Martin Schlaffer
- Department of Neurosurgery, Friedrich-Alexander-University Nürnberg-Erlangen, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander-University Nürnberg-Erlangen, Erlangen, Germany
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Cherney DZ, Zevallos G, Oreopoulos D, Halperin ML. A Physiological Analysis of Hyponatremia: Implications for Patients on Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080102100103] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The basis for hyponatremia is a negative balance for sodium (Na+) plus potassium (K+) and/or a positive balance for water. In patients with normal renal function, vasopressin is needed to prevent the excretion of electrolyte-free water. Vasopressin is not important when there is little residual renal function. If hyponatremia is accompanied by a quantitatively appropriate gain in weight, this implies that a gain of electrolyte-free water was the basis for hyponatremia. In the absence of this weight gain, a loss of salts is to be suspected. If the extracellular fluid (ECF) volume is obviously low, hyponatremia is due to a deficit of NaCl, unless there is a deficit of K+. With a KCl deficit and a contracted ECF volume, there should also be a large shift of Na+ into cells, so metabolic alkalosis would not be an expected finding. In contrast, those patients with no change in weight who have a normal or expanded ECF volume are subdivided into those with a gain of solutes restricted to the ECF compartment (glucose, mannitol), or those with a deficit of solutes of intracellular fluid origin, which implies that a catabolic state (malnutrition) may be present.
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Affiliation(s)
- David Z. Cherney
- Renal Division St Michaels Hospital University of Toronto Toronto, Canada
| | - Gonzalo Zevallos
- The University Health Network University of Toronto Toronto, Canada
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Seetharam S, Thankamony P, Gopakumar KG, Krishna KMJ. Higher incidence of syndrome of inappropriate antidiuretic hormone secretion during induction chemotherapy of acute lymphoblastic leukemia in indian children. Indian J Cancer 2020; 56:320-324. [PMID: 31607700 DOI: 10.4103/ijc.ijc_737_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a well-known adverse effect of vincristine (VCR). Literature suggests that Asians are predisposed to develop SIADH following VCR administration. However, data regarding the occurrence of SIADH in children with malignancy are limited. This study aims to analyze the incidence, clinical picture, risk factors, management, and outcome of SIADH during induction chemotherapy for pediatric acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS A prospective study was conducted among the 166 newly diagnosed pediatric ALL patients who were treated at a tertiary cancer center in India between January 2015 and December 2015. Patients who developed hyponatremia during induction chemotherapy were further investigated for SIADH. RESULTS The incidence of SIADH was 10.8% (n = 18) with a mean sodium level of 125 mEq/L (114-129 mEq/L). In the preceding 2 weeks, 72% of episodes were associated with the administration of two (n = 6) or three (n = 7) doses of VCR. One child presented with seizures. All the patients were managed with fluid restriction and only two patients required sodium correction with 3% saline. Girls older than 10 years of age showed a marginally significant correlation to develop SIADH (P-value = 0.059). CONCLUSION We report a higher incidence of SIADH (10.8%) in Indian children, compared to that described in the literature, during induction chemotherapy for ALL. Regular monitoring of sodium levels during this period of chemotherapy is hence essential for the timely diagnosis and appropriate management of SIADH, which in turn will avert complications, including neurological symptoms secondary to SIADH.
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Affiliation(s)
- Shwetha Seetharam
- Division of Paediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Priyakumari Thankamony
- Division of Paediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | | | - K M Jagathnath Krishna
- Department of Cancer Epidemiology and Biostatistics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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Mannheimer B, Skov J, Falhammar H, Calissendorff J, Lindh JD, Nathanson D. Sex-specific risks of death in patients hospitalized for hyponatremia: a population-based study. Endocrine 2019; 66:660-665. [PMID: 31478161 PMCID: PMC6887836 DOI: 10.1007/s12020-019-02073-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/21/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Several studies have reported an association between hyponatremia and lethality. However, it remains elusive whether hyponatremia independently contributes to lethality. The aim of the study was to investigate associations between hyponatremia and lethality and differences in lethality between men and women hospitalized due to hyponatremia. METHODS Four registries were utilized in this population-based retrospective study: The National Patient Registry, the Cause of Death Register, the Swedish Prescribed Drug Register and the Total Population Register (NPR) from which the controls were sampled. All hospitalized patients with a first-ever principal ICD10 diagnosis of hyponatremia or syndrome of inappropriate ADH secretion in the NPR between 1 October 2005 and 31 December 2014 were defined as cases. Cox regression with adjustment for potential confounders was used. RESULTS 14,359 individuals with a principal diagnosis of hyponatremia, and 57,382 matched controls were identified. Median age was 76 years and the majority were women (72%). Median age for women and men was 79 and 68 years, respectively. Adjusted hazard ratios (and 95% CI) for lethality in those with hyponatremia compared with controls were for the entire population 5.5 (4.4-7.0) and in the subgroup free from previously known underlying disease 6.7 (3.3-13.3). Lethality in women with hyponatremia was lower compared with men: HR: 0.56 (0.49-0.64). In the healthier group the lethality remained lower for women: HR: 0.49 (0.34-0.71). CONCLUSIONS Patients hospitalized due to hyponatremia faced an increased subsequent lethality that was independent of concomitant disease. This increase was nearly twice as large among men compared with women.
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Affiliation(s)
- Buster Mannheimer
- Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Jakob Skov
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Calissendorff
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Jonatan D Lindh
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - David Nathanson
- Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
- Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden.
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Kilaru SC, Prasad S, Kilaru H, Anneela RR, Hasan A, Nandury EC. Active pulmonary tuberculosis presenting with acute respiratory failure. Respirol Case Rep 2019; 7:e00460. [PMID: 31346468 PMCID: PMC6635142 DOI: 10.1002/rcr2.460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/09/2019] [Accepted: 06/19/2019] [Indexed: 01/09/2023] Open
Abstract
Four patients with active pulmonary tuberculosis (PTB) presenting with respiratory failure are reported here. Bronchogenic PTB, simulating an acute febrile illness or diffuse interstitial lung disease with short duration of symptoms, as a cause of acute respiratory failure is less recognized. If diagnosed and treated early, it has good prognosis. Three of the four patients presented here had an acute presentation with fever, dyspnoea, and hypoxemia with diffuse infiltrative lesions on radiography, and the other younger patient presented predominantly with lobar consolidation. These patients presenting with respiratory failure required intensive care management, and a diagnosis was made with bronchoalveolar lavage fluid and transbronchial lung biopsy. All four patients promptly received antitubercular therapy, showed clinicoradiological improvement, and were stable at 1 year follow up.
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Affiliation(s)
- Satish Chandra Kilaru
- Department of Respiratory MedicinePrathima Institute of Medical SciencesKarimnagarIndia
| | - Sudhir Prasad
- Internal Medicine, Pulmonology and Critical Care MedicineGlobal HospitalsHyderabadIndia
| | - Hemanth Kilaru
- Department of Respiratory MedicinePrathima Institute of Medical SciencesKarimnagarIndia
| | | | - Ashfaq Hasan
- Respiratory MedicineDeccan College of Medical SciencesHyderabadIndia
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Burton AG, Hopper K. Hyponatremia in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2019; 29:461-471. [DOI: 10.1111/vec.12881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/04/2017] [Accepted: 09/06/2017] [Indexed: 01/10/2023]
Affiliation(s)
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological SciencesUniversity of California Davis CA
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Management of Cerebral Salt-Wasting Syndrome and Syndrome of Inappropriate Antidiuresis in the Neurocritical Care Unit. Neurocrit Care 2019. [DOI: 10.1017/9781107587908.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Khan MY, Rawala MS, Siddiqui M, Abid W, Aslam A. Tolvaptan-induced Liver Injury: Who is at Risk? A Case Report and Literature Review. Cureus 2019; 11:e4842. [PMID: 31410325 PMCID: PMC6684126 DOI: 10.7759/cureus.4842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Hyponatremia is a common clinical condition encountered in the hospital setting. Syndrome of inappropriate antidiuretic hormone (SIADH) is an important and one of the most common causes of hyponatremia. SIADH accounts for approximately one-third of all cases of hyponatremia. Tolvaptan is a vasopressin receptor antagonist used to treat SIADH. Hepatoxicity is a rare yet dangerous side effect from Tolvaptan use. We present a case of cholestatic liver injury in an elderly female who presented with hyponatremia. She received two doses of tolvaptan 15mg and developed worsening in her total bilirubin (T Bili) and alkaline phosphatase (Alk Phos) levels. Tolvaptan is known to cause elevated transaminase levels and the mechanism of action is thought to be idiosyncratic. Fortunately, the patient responded with an improvement in T Bili and Alk Phos levels after stopping tolvaptan. This case highlights the cautious use of tolvaptan in elderly patients with SIADH as even small doses can potentiate hepatotoxicity.
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Affiliation(s)
| | | | | | - Waqas Abid
- Interventional Radiology, Christiana Hospital, Newark, USA
| | - Aysha Aslam
- Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, USA
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Moritz ML, Ayus JC. Hypotonic maintenance i.v. fluids are not appropriate in acutely ill patients. Conclusions can't be extrapolated from healthy volunteers. Br J Anaesth 2019; 119:1064-1065. [PMID: 29077830 DOI: 10.1093/bja/aex376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sailer CO, Winzeler B, Nigro N, Bernasconi L, Mueller B, Christ-Crain M. Influence of Outdoor Temperature and Relative Humidity on Incidence and Etiology of Hyponatremia. J Clin Endocrinol Metab 2019; 104:1304-1312. [PMID: 30462243 DOI: 10.1210/jc.2018-01507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/14/2018] [Indexed: 12/31/2022]
Abstract
CONTEXT Hyponatremia is the most common electrolyte disturbance in hospitalized patients. Known risk factors are heart or renal failure, excessive drinking, or the use of diuretics. The incidence of hyponatremia may also be influenced by climate. OBJECTIVE Analyzing the influence of outdoor temperature and relative humidity on the incidence and etiology of hyponatremia. DESIGN Cohort A: cross-sectional study from January 2011 to December 2016. Cohort B: prospective observational study from June 2011 to August 2013. SETTING Emergency departments of two tertiary centers. PATIENTS Cohort A: patients with plasma sodium ≤145 mmol/L (n = 222,217). Cohort B: consecutive patients (n = 294) with profound hyponatremia (plasma sodium ≤125 mmol/L). MAIN OUTCOME MEASURE The effects of outdoor temperature and relative humidity on the incidence of mild (sodium 126 to 134 mmol/L) and profound hyponatremia (sodium ≤125 mmol/L) were investigated via logistic regression models. The effects of outdoor temperature and relative humidity on hyponatremia etiology were evaluated. RESULTS In cohort A, 9.9% had mild and 1.08% had profound hyponatremia. Outdoor temperature was significantly associated with the incidence of profound but not mild hyponatremia (P < 0.01, P = 0.3). Relative humidity was not associated with the incidence of hyponatremia. In cohort B, diuretic-induced hyponatremia occurred more frequently with higher outdoor temperatures, whereas other etiologies showed no clear variation with outdoor temperature or relative humidity. CONCLUSIONS Higher outdoor temperature, but not relative humidity, seems to be associated with the incidence of profound hyponatremia. Our data suggest that diuretics should be used with caution during hot weather.
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Affiliation(s)
- Clara O Sailer
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Bettina Winzeler
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Nicole Nigro
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Luca Bernasconi
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Division of Endocrinology, Diabetology and Metabolism, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Ranieri M, Di Mise A, Tamma G, Valenti G. Vasopressin-aquaporin-2 pathway: recent advances in understanding water balance disorders. F1000Res 2019; 8. [PMID: 30800291 PMCID: PMC6364380 DOI: 10.12688/f1000research.16654.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2019] [Indexed: 12/11/2022] Open
Abstract
The alteration of water balance and related disorders has emerged as being strictly linked to the state of activation of the vasopressin–aquaporin-2
(vasopressin–AQP2) pathway. The lack of responsiveness of the kidney to the vasopressin action impairs its ability to concentrate the urine, resulting in polyuria, polydipsia, and risk of severe dehydration for patients. Conversely, non-osmotic release of vasopressin is associated with an increase in water permeability in the renal collecting duct, producing water retention and increasing the circulatory blood volume. This review highlights some of the new insights and recent advances in therapeutic intervention targeting the dysfunctions in the vasopressin–AQP2 pathway causing diseases characterized by water balance disorders such as congenital nephrogenic diabetes insipidus, syndrome of inappropriate antidiuretic hormone secretion, nephrogenic syndrome of inappropriate antidiuresis, and autosomal dominant polycystic kidney disease. The recent clinical data suggest that targeting the vasopressin–AQP2 axis can provide therapeutic benefits in patients with water balance disorders.
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Affiliation(s)
- Marianna Ranieri
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Bari, Italy, 70125, Italy
| | - Annarita Di Mise
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Bari, Italy, 70125, Italy
| | - Grazia Tamma
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Bari, Italy, 70125, Italy.,Istituto Nazionale di Biostrutture e Biosistemi, Rome, Roma, Italy, 00136, Italy
| | - Giovanna Valenti
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Bari, Italy, 70125, Italy.,Istituto Nazionale di Biostrutture e Biosistemi, Rome, Roma, Italy, 00136, Italy.,Center of Excellence in Comparative Genomics (CEGBA), University of Bari, Bari, Italy, 70125, Italy
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Gómez-Hoyos E, Buigues AO, Ballesteros Pomar MD, Casariego AV, Delgado YG, Ocón Bretón MJ, Abad González AL, Luengo Pérez LM, Martín PM, Tapia Guerrero MJ, Del Olmo García MD, Ruiz AH, Hernández JÁ, Guerrero DB, Antolín SH, Tenorio-Jiménez C, García Zafra MV, Romero FB, Pla MA, Martínez Olmos MA, Lemes IB, De la Vega IR, De Luis Román D. Development of hyponatremia in non-critical patients receiving total parenteral nutrition: A prospective, multicenter study. Clin Nutr 2018; 38:2639-2644. [PMID: 30545660 DOI: 10.1016/j.clnu.2018.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 10/06/2018] [Accepted: 11/25/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS Hyponatremia is frequent in hospitalized patients, especially in those receiving total parenteral nutrition (TPN). Furthermore, the presence of hyponatremia is associated with increased morbimortality in both groups. The goal of this study is to describe the prevalence of hyponatremia developing during TPN in non-critical patients, and identify risk factors for its appearance. METHODS This prospective multicenter study involved 19 Spanish hospitals. Noncritically-ill patients prescribed TPN over a 9-month period were studied. Variables analyzed demographic characteristics, prior comorbidities, drug therapy, PN composition, additional iv fluids, and serum sodium levels. RESULTS A total of 543 patients were recruited, 60.2% males. Age: 67 (IR 57-76). Of 466/543 who were eunatremic when starting TPN, 18% developed hyponatremia (serum sodium < 135 mmol/L) during TPN. Independent risk factors identified by logistic regression analysis: female (OR 1.74 [95% CI = 1.04-2.92], p = 0.036); severe malnutrition (OR 2.15 [95% CI = 1.16-4.35], p = 0.033); opiates (OR 1.97 [95% CI = 1.10-3.73], p = 0.036); and nausea/vomiting (OR 1.75 [95% CI = 1.04-2.94], p = 0.036). CONCLUSIONS Previously eunatremic patients frequently develop hyponatremia while receiving TPN. In this group, severe malnutrition is an independent risk factor for hyponatremia, as well as previously described risk factors: opiates, nausea/vomiting, and female gender.
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Affiliation(s)
- Emilia Gómez-Hoyos
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid-IEN, Universidad de Valladolid, Valladolid, Spain.
| | - Ana Ortolá Buigues
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid-IEN, Universidad de Valladolid, Valladolid, Spain
| | | | - Alfonso Vidal Casariego
- Endocrinology and Nutrition Department, Complejo Asistencial Universitario de León, León, Spain
| | - Yaiza García Delgado
- Endocrinology and Nutrition Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - Maria Julia Ocón Bretón
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Angel Luis Abad González
- Endocrinology and Nutrition Department, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Pilar Matía Martín
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IDISSC), Madrid, Spain
| | | | | | - Ana Herrero Ruiz
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Julia Álvarez Hernández
- Endocrinology and Nutrition Department, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Diego Bellido Guerrero
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Ferrol, Coruña, Spain
| | - Sandra Herranz Antolín
- Endocrinology and Nutrition Department, Hospital Universitario de Guadarajara, Guadarajara, Spain
| | | | | | - Francisco Botella Romero
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - María Argente Pla
- Endocrinology and Nutrition Department, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | - Miguel Angel Martínez Olmos
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Irene Bretón Lemes
- Endocrinology and Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Isabelle Runkle De la Vega
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IDISSC), Madrid, Spain
| | - Daniel De Luis Román
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid-IEN, Universidad de Valladolid, Valladolid, Spain
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El Hage L, Reineks E, Nasr C. PSEUDOHYPONATREMIA IN THE SETTING OF HYPERCHOLESTEROLEMIA. AACE Clin Case Rep 2018; 5:e172-e174. [PMID: 31967027 DOI: 10.4158/accr-2018-0309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/22/2018] [Indexed: 11/15/2022] Open
Abstract
Objective To describe a case of pseudohyponatremia in the setting of hypercholesterolemia. Methods A 69-year-old man was admitted to the hospital after asymptomatic hyponatremia was detected on follow-up blood work for acute, drug-induced cholestatic hepatitis. Results Plasma sodium (PNa) was 119 mmol/L and total protein was 4.7 g/dL. Plasma osmolality was 283 mOsm/kg, urine osmolality was 332 mOsm/kg, and random urine sodium was 45 mmol/L. Pseudohyponatremia was suspected and lipid profiling showed triglycerides were 281 mg/dL, cholesterol was 1,340 mg/dL, high-density lipoprotein was 21 mg/dL, and low-density lipoprotein was 1,419 mg/dL. Direct ion-selective electrode (ISE) using a blood gas analyzer revealed a PNa level of 132 mmol/L. PNa concentration can be measured using direct or indirect ISE. With indirect ISE, the sample is diluted before analysis and the PNa is measured with the assumption that plasma is composed of 93% water. When hyperlipidemia is present, the actual plasma water fraction is decreased, and therefore using indirect ISE will result in falsely low PNa levels. Direct ISE analyzes the sample without dilution. Thus, the PNa is measured directly irrespective of plasma water fraction and so is not affected by changes in plasma percentage concentration. Conclusion Around two thirds of laboratories in the United States use indirect ISE. Awareness of pseudohyponatremia is important to prevent inappropriate management.
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Refardt J, Kling B, Krausert K, Fassnacht M, von Felten S, Christ-Crain M, Fenske W. Impact of chronic hyponatremia on neurocognitive and neuromuscular function. Eur J Clin Invest 2018; 48:e13022. [PMID: 30153330 DOI: 10.1111/eci.13022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 07/25/2018] [Accepted: 08/24/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Chronic hyponatremia is common and associated with increased morbidity and mortality. However, whether treatment improves outcome in patients without significant symptoms is unclear. We here assessed the therapeutic outcome on clinical symptoms, neurocognitive and neuromuscular function in patients with chronic non profound hyponatremia. MATERIAL AND METHODS Prospective case-control study in 19 patients from the University Hospital Würzburg with chronic non profound hyponatremia without clinically apparent symptoms. At baseline and after a 14-day treatment period of hyponatremia, patients were assessed by specific clinical symptoms questionnaire, neurocognitive and neuromuscular function was analysed by five attention tests and a gait test consisting of 3 steps "in tandem." The results were compared to a control group of healthy volunteers. RESULTS Compared to healthy volunteers, patients with mild (n = 10, mean serum sodium 132 ± 1.2 mmol/L) and moderate hyponatremia (n = 9, mean 126 ± 3.3 mmol/L) performed significantly worse in the neurocognitive subtests alertness (P = 0.018), divided attention (P = 0.017) and go/no-go (P = 0.026). Performance in the neuromuscular subtests was also lower in the patient group without reaching significance. The extent of hyponatremia had no impact on the specific test and questionnaire results. Fourteen-day treatment of hyponatremia improved clinical symptoms in all patients (P = 0.003) and neurocognitive function in sodium-normalised patients (go/no-go test, P = 0.029). CONCLUSION Chronic hyponatremia is symptomatic and impairs neurocognitive and neuromuscular function. Short-time therapeutic intervention led to improved clinical symptoms and neurocognitive function, but had no effect on neuromuscular function. Larger trials with long-term treatment are needed to specify the therapeutic need in chronic hyponatremia.
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Affiliation(s)
- Julie Refardt
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Bernadette Kling
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Katharina Krausert
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Würzburg, Germany.,Central Laboratory, University Hospital Würzburg, Würzburg, Germany
| | - Stefanie von Felten
- Clinical Trial Unit (CTU), University Basel and University Hospital Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Wiebke Fenske
- Integrated Research and Treatment Center for Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany.,Department of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany
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48
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Gurnurkar S, Villacres S, Warner L, Chegondi M. Successful Use of Fludrocortisone in a Child with Refractory Cerebral Salt Wasting Syndrome: A Case Report and Review of Literature. Cureus 2018; 10:e3505. [PMID: 30648045 PMCID: PMC6318137 DOI: 10.7759/cureus.3505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hyponatremia post-neurosurgical intervention can be dangerous and potentially life-threatening. Two of its most common causes are cerebral salt wasting (CSW) and syndrome of inappropriate anti-diuretic hormone release (SIADH). CSW is proposed to be secondary not only to the elevated levels of circulating atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) but inhibition of steroidogenesis in the zona glomerulosa of the adrenal cortex, thus resulting in mineralocorticoid deficiency. We present a two-year-old male who had developed acute hyponatremia secondary to CSW on post-operative day two after a sub-total resection of a low-grade juvenile pilocytic astrocytoma (WHO grade I). Fludrocortisone was successfully used to manage the refractory hyponatremia and alleviated the need to use very large amounts of oral sodium supplementation.
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Affiliation(s)
| | | | - Lindsey Warner
- Pediatrics, University of Central Florida College of Medicine, Orlando, USA
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49
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Shimada A, Takeuchi H, Fukuda K, Suda K, Nakamura R, Wada N, Kawakubo H, Kitagawa Y. Hyponatremia in patients with esophageal cancer treated with chemotherapy including cisplatin. Esophagus 2018; 15:209-216. [PMID: 30225740 DOI: 10.1007/s10388-018-0615-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/17/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Little is known about hyponatremia in patients with esophageal cancer treated with cisplatin-based chemotherapy. The aim of this study was to analyze the risk factors for hyponatremia and its effect on outcomes in patients with esophageal cancer treated with chemotherapy including cisplatin. METHODS We retrospectively analyzed the records of 137 patients with esophageal cancer who received chemotherapy including cisplatin for the first time between January 2011 and December 2014. RESULTS Hyponatremia (Na < 135 mEq/L) was seen in 77 patients (59%), of whom 29 had Grade 3 (120 ≤ Na < 130 mEq/L) or Grade 4 (Na < 120 mEq/L) hyponatremia. We divided patients into the hyponatremia group (patients with Na < 130 mEq/L) and the control group (patients with Na ≥ 130 mEq/L), and compared the results between the two groups. Three patients (2%) were diagnosed with the syndrome of inappropriate secretion of antidiuretic hormone. The serum sodium level before starting chemotherapy was significantly lower and white blood cell count was significantly higher in the hyponatremia group. Appetite loss was seen significantly more often in the hyponatremia group as the chemotherapy-related adverse effect. There was no significant difference in overall survival between the two groups. CONCLUSIONS Hyponatremia is a common adverse effect induced by cisplatin. Caution should be exercised with patients with a low sodium level before starting chemotherapy. Hyponatremia can be associated with other chemotherapy-related adverse effects, and it should therefore be treated correctly.
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Affiliation(s)
- Ayako Shimada
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Kazumasa Fukuda
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Koichi Suda
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Rieko Nakamura
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Norihito Wada
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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50
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Tominaga N, Fernandez SJ, Mete M, Shara NM, Verbalis JG. Hyponatremia and the risk of kidney stones: A matched case-control study in a large U.S. health system. PLoS One 2018; 13:e0203942. [PMID: 30240426 PMCID: PMC6150503 DOI: 10.1371/journal.pone.0203942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/11/2018] [Indexed: 12/13/2022] Open
Abstract
Kidney stones impose a large and increasing public health burden. Previous studies showed that hyponatremia is associated with an increased risk of osteoporosis and bone fractures, which are also known to be associated with kidney stones. However, the relation between hyponatremia and kidney stones is not known. To assess the relation between hyponatremia and kidney stones, we designed a matched case-control study by using the electronic health records of the MedStar Health system with more than 3.4 million unique patient records as of March 2016. Data were extracted for clinical factors of patients with kidney stones (cases) and those without kidney stones (controls). Cases (n = 20,199) and controls (n = 20,199) were matched at a 1:1 ratio for age, sex, race, and the duration of encounter window. Case and control exposures for each of the hyponatremia variables were defined by serum sodium laboratory measurements reported within the encounter windows, and divided into 3 categories: prior hyponatremia, recent hyponatremia, and persistent hyponatremia. In the final conditional logistic models adjusted for potential confounders, the risk of kidney stones significantly increased in both recent and persistent hyponatremia categories: prior hyponatremia odds ratio (OR) 0.93 (95% confidence interval [CI], 0.86–1.00); recent hyponatremia OR 2.02 (95% CI, 1.76–2.32); persistent hyponatremia OR 6.25 (95% CI, 3.27–11.96). In conclusion, chronic persistent hyponatremia is a significant and clinically important risk factor for kidney stones in patients in the U.S.
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Affiliation(s)
- Naoto Tominaga
- Division of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, DC, United States of America
| | - Stephen J Fernandez
- Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Hyattsville, MD, United States of America
| | - Mihriye Mete
- Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Hyattsville, MD, United States of America
| | - Nawar M Shara
- Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Hyattsville, MD, United States of America
| | - Joseph G Verbalis
- Division of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, DC, United States of America
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