Hyponatremia in hospitalized patients with chronic kidney disease; aetiology, treatment, and outcome, in a tertiary care hospital, Dubai, UAE (original) (raw)
Related papers
National Journal of Physiology, Pharmacy and Pharmacology, 2017
Background: Hyponatremia, defined as a serum sodium concentration 20 mmol/l, Serum uric acid ≤4 mg/dl, normal renal function (serum creatinine and blood urea) and absence of thyroid or pituitary insufficiency were classified as having Syndrome of inappropriate antidiuresis (SIAD). The sodium estimation was done in the randox automated analyser which measures sodium by ion selective electrode technology. Results: A total of 100 patients with hyponatremia (serum Na+≤130 mEq/L) were included in the study. The mean age of presentation was around 51.5 ± 17.5 years with male to female (M:F) ratio 1.8:1. Severe hyponatremia was detected in 56 patients and the mean sodium level was 118.2 ± 8.1 mEq/L. 43 patients had altered level of consciousness in form of drowsiness, confusion, irrelevant talking or coma, 6 patients had seizure, 38 patients had vomiting, 7 patients had hiccups and 38 hyponatremic patients were asymptomatic. The commonest type of hyponatremia noted in our study was euvolem...
Clinical Profile and Outcome of Patients with Hyponatremia at Tertiary Care Teaching Hospital
Journal of Evolution of Medical and Dental Sciences, 2018
BACKGROUND Hyponatremia is defined as a serum sodium concentration less than 135 mmol/L and is the most common electrolyte disorder encountered in clinical practice. MATERIALS AND METHODS This was a retrospective, descriptive and data analysis study conducted over period of 12 month at a tertiary care centre, to study the clinical profile, aetiology, classification and outcome of hyponatremia. A total 115 consecutive cases who had serum sodium levels of <135 mmol/L were enrolled. The mean and standard deviation and percentage for numerical variables were calculated. Chi square test was used to analyse categorical variables. RESULTS Of a total of 115 patients, 73 (63.47%) were male and 42 (36.52%) were females. There was a predominance of Na + levels of 115-134 mmol/L (mild hyponatremia) 59.13% ['p'< 0.001]. The majority of patients (42.61%) had nausea and/or vomiting ('p'<0.001) and confusion, seizures and coma were associated with moderate to profound hyponatremia ('p' <0.01). The SIADH (37.39%) was the commonest pathophysiological process observed in the present study ['p' <0.0001]. Overall mortality was 9.57%. The patients with Sr. Na + <105 mmol/L had (36.84%) significant mortality compared to >105 mmol/L ['p' <0.002196]. The duration of hospital stay was inversely related to Sr. sodium level. CONCLUSION In present cohort of hyponatremia the SIADH was the commonest aetiology. Confusion, seizures and coma were associated with moderate to profound hyponatremia. The duration of hospital stay was inversely related to serum sodium level with overall mortality of 9.57% which was correlated with severity of hyponatremia.
Factors Influencing Hyponatremia in Hospitalized Diabetic Patients-a cross sectional study
Hyponatremia is a very common electrolyte imbalance in admitted diabetic patients which leads to substantial morbidity and mortality. There is no existing record for profiling of hyponatremia in Bangladeshi diabetic subjects. The objective of this study was to find out the factors influencing hyponatremia and associated co-morbidities in admitted diabetic patients of a tertiary care hospital. Samples were selected from all adult nonpregnant diabetic patients with serum sodium level < 135 mmol/L irrespective of their cause of admission. A total number of 115 admitted diabetic patients with hyponatremia were studied. Informations were collected in a semi structured data collection form for analysis. Hyponatremia was found to be more common in the aged (47%) and female populations (63.5%). Vomiting was found to be the most common factor (51.3%) causing hyponatremia in the admitted diabetic patients. Other common factors influencing hyponatremia were diarrhea, sweating, severe hyperglycemia, diabetic ketoacidosis and drugs especially diuretics. The commonest co-morbid condition associated with diabetes was hypertension. Thiazide diuretics should be used with caution in the elderly who are prone to develop hyponatremia.
Journal of Medical Science And clinical Research, 2015
Introduction: Hyponatremia is one of the most common electrolyte disturbances of encountered in medical wards, Dialysis unit, and medical intensive care unit (ICU). It is defi ned as sodium ion concentration <135 mmol. ICU in patients with various comorbid conditions such as congestive heart failure (CHF), chronic kidney disease (CKD), liver cirrhosis, and diarrhea and vomiting. This contributes to substantial morbidity and mortality. However, early recognition and management drastically alters the prognosis. Objective: This study was conducted to explore the clinical profile of hyponatremia in medically ill patients. Materials and Methods: Study was conducted on 100 patients admitted in the medical unit from October 2011 to October 2013.All patients underwent clinical examination, routine hemogram, blood urea, sugar, creatinine, serum electrolytes and necessary investigations. Patients were divided as per their osmolarity. SIADH was diagnosed on the basis of diagnostic criteria by Verbalis. Results: The commonest age group of presentation of hyponatremia was older age group (>56 years). Hyponatremia was more common in males than in females. SIADH was the single most important etiology of hyponatremia. Diuretics and salt wasting nephropathy were also significant causes of hyponatremia in this study. Other causes of hyponatremia were CCF, Cirrhosis of liver, Hypothroidism and gastro-Intestinal loss. Among the various diuretics causing hyponatremia thiazides were the most frequent cause. Drowsiness was the single most important symptom of hyponatremia followed by vomitting, hiccups and seizures were also significant symptoms in this study. However one fifth of patients of hyponatremia had no symptoms of hyponatremia. Majority of the patients had mild hyponatremia. Majority of the patients had euvolemic hyponatremia.Mortality was more in patients with severe hyponatremia. Conclusion: Hyponatremia is fairly common in patients admitted in medical wards, ICU, dialysis unit as patients with CHF, CKD, Liver cirrhosis, and diarrhea and vomiting hence early recognition and prompt treatment are of supreme importance in such patients.
SYMPTOMATIC HYPONATREMIA, ETIOLOGY AND OUTCOME IN A TERTIARY CARE HOSPITAL
ABSTRACT Background: Hyponatremia is one of the common electrolyte abnormalities in hospitalized patients. The spectrum of different etiologies of hyponatremia have both prognostic and therapeutic implications. Aims and Objectives: To evaluate the clinical and etiological profile of hyponatremia, and to study the outcome of hyponatremia. Study Design: A prospective cohort Study. Materials and Methods: A total of 100 consecutive patients clinical history, physical examination, baseline biochemical and metabolic profile followed by serum and urine osmolality and urine sodium was done in all patients. Results: Out of 100 consecutive patients enrolled in this study, thirty-eight were males and sixty-two were females with male to female ratio of 1:1.6, with mean age of 61.2 years. Commonest neurological complaints were confusion (46%), lethargy (20%) and seizures (10%). Diuretic use was the most common cause of hyponatremia 34%, followed by SIADH 29%, gastrointestinal losses 10% and chronic kidney disease in 8% of patients. Chronic liver disease and chronic heart failure contributed 6% each. Other rare causes like hypothyroidism, primary adrenal failure, primary polydipsia and Beer potomania was found in 7% of patients. 46% patients were euvolemic, 37% hypervolemic and 17% hypovolemic. Conclusion: Diuretics are the most common cause of hyponatremia followed by SIADH and gastrointestinal losses. Mortality rate in our study was 12%, with maximum mortality in SIADH group 50%. Key words: Hyponatremia, Euvolemic, Diuretics, SIADH.
Journal of the American Geriatrics Society, 2015
To assess symptoms and characteristics of hyponatremia, the most common electrolyte disturbance in hospitalized individuals and a condition that is associated with substantial morbidity and mortality. Prospective observational multicenter study. Two Swiss academic centers. Individuals with profound hypoosmolar hyponatremia (sodium <125 mmol/L) (N = 298). All symptoms and complete medical history including current medications, therapy management, and in-hospital outcomes were recorded. The median age of all participants was 71 (interquartile range (IQR) 60-80), 195 (65%) were female, and mean serum sodium value on admission was 120 mmol/L (IQR 116-123 mmol/L). Frequent clinical symptoms were nausea (n = 130, 44%), acute vomiting (n = 91, 30%), generalized weakness (n = 205, 69%), fatigue (n = 175, 59%), gait disturbance (n = 92, 31%), recurrent falls (n = 47, 16%), and acute falls (n = 60, 20%). Fractures were reported in 11 participants (4%). More-severe symptoms such as acute ep...
Hyponatremia in Hospitalized Patients
Asian journal of multidisciplinary studies, 2018
Objective: Alleviation of cerebral oedema, not to correct sodium. Therefore, provision is only to severely symptomatic patients. Place and Duration of Study: This study was carried out from Jan 2018 to March 2018 at Mayo Hospital, Lahore, Pakistan. Materials and Methods: Out of 3000 patients, 100(3.3%) patients had hyponatremia defined as having level of serum sodium less than 135mmol/L. Among them male patients were 65(65%) and female patients were 35(35%) with average 55 years of age. Results: In 24(22.2%) patients severe hyponatremia (Na+ < 120 mmol/L) was detected. Euvolemic was the largest group of hyponatraemic patients with 42(42%), then hypervolemic patients with 33(33%) and thirdly hypovolemia patients with 25(25%). 4(4%) patients out of 100 patients qualify the criteria for Syndrome of Inappropriate Anti Diuretic Hormone (SIADH). During stay at hospital, 2(2%) out of 100 hyponatraemic patients died. No death was secondary to hyponatremia. No patient was Tolvaptan (a V2R...
A prospective study on clinical profile of hyponatremia in ICU hospitalized patients
The incidence of hyponatremia is roughly 12% in ICU hospitalized patients. The precise incidence of hyponatremia varies depending on the conditions leading to and the criteria used to define it. 1 Hyponatremia represents excess of body water relative to body sodium content and is frequently referred to as a serum sodium concentration of less than 135 mEq/L. Hyponatremia is the most common electrolyte disorder, 1 reported to occur in up to 6% of hospitalized patients. 3 Mild hyponatremia plasma sodium 130 -135 mmol / l ) is found in as many as 15 -30% of hospitalized patients or in the institutionalized elderly. 4 Clinically hyponatremia is often unrecognized when it is mild or when it develops slowly. But severe hyponatremia (plasma sodium < 120 mmol / l ), particularly of rapid onset, is associated with substantial morbidity and can be life threatening. 5 Also moderate to severe hyponatremia bears a substantial associated morbidity and mortality. Hyponatremia is associated with varying morbidity. Morbidity varies widely in severity; serious complications can arise from the disturbances itself as well as from the underlying causative conditions. Errors in assessment and management play to a significant extent. Hyponatremia is also an important predictor of mortality in heart failure 7 , cirrhosis 8 and acute pancreatitis. Unfortunately, hyponatremia is more often iatrogenic. Traditional therapies have significant limitations. Newer agents especially those that antagonize arginine vasopressin at V 2 receptor or both the V 1A and V 2 receptors show promise for treating hypervolemic and euvolemic hyponatremia, as they induce desired free water diuresis without inducing sodium excretion. Management of hyponatremia depends upon speed of recognition, its onset, magnitude and severity and associated risk factors especially for neurological complications.
Etiology, Clinical Features and Outcomes of Treatment of Hyponatremia -A Prospective Study
https://www.ijrrjournal.com/IJRR\_Vol.9\_Issue.3\_March2022/IJRR-Abstract051.html, 2022
Hyponatremia is a common problem encountered in patients presenting with nonspecific symptoms. Symptomatology depends more on the rate of development of the electrolyte abnormality than on its severity. Data regarding the incidence of hyponatremia in hospitalized patients in our country is limited. This prospective, descriptive study was conducted at Ramakrishna care hospital Raipur from September 2016-November 2017.100 cases were taken by random sampling method to know the common clinical features etiology and treatment outcome of hospitalized patients and study the morbidity and mortality in such patients. hyponatremia presented with various clinical symptoms out of which nausea was most common followed by vomiting ,altered sensorium and seizure. Physician need to be aware about the common occurrence of hyponatremia and early identification to prevent serious complication like seizures. Over all most common cause of hyponatremia in all 3 group was diuretics and salt restriction (53%). most of hyponatremic patients were hypertensive and number of cases increased from mild to severe hyponatremia secondary to diuretic and salt restriction it was statistically highly significant i.e. 54% (p<0.0001).
To Assess the Clinical Features of Hyponatremia in Adult Subjects Admitted in SMS Hospital
Saudi Journal of Medicine
Background: Hyponatremia, which is defined as plasma sodium concentration of less than 135meq/L, occurs primarily due to imbalance in water homeostasis, antidiuretic hormone (ADH) regulation and renal handling of filtered sodium. The two most common causes are effective circulating volume depletion causing non-osmotic release of ADH and the syndrome of inappropriate ADH secretion, disorders in which ADH secretion is not suppressed despite decrease in plasma osmolality. Methods: Observational Study conducted at Medicine wards and, Medicine OPD of SMS hospital, Jaipur. Patients were interviewed for demographic data such as age and sex. History of other comorbid conditions along with presenting complaints was noted. Further these patients were subjected to a physical examination for clinical signs. These findings were recorded on a predesigned and pretested proforma. Results: In our study, lethargy(50.4%), headache(42.3%) and anxiety(31.7%) were most common symptoms. Majority of the cases were admitted and treated in the ward i.e. 249(87.7%), while few patients were treated in ICU i.e.35 (12.3%). Conclusion: Based on the findings of this study it may be concluded that, hyponatremia can present with protean clinical manifestations. The presentation can vary from mild symptoms such as vomiting, lethargy, malaise to severe forms such as confusion, seizure and coma.