Diagnosis and Management of Sodium Disorders: Hyponatremia and Hypernatremia (original) (raw)
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Sodium Correction Practice and Clinical Outcomes in Profound Hyponatremia
Mayo Clinic proceedings, 2015
To assess the epidemiology of nonoptimal hyponatremia correction and to identify associated morbidity and in-hospital mortality. An electronic medical record search identified all patients admitted with profound hyponatremia (sodium <120 mmol/L) from January 1, 2008, through December 31, 2012. Patients were classified as having optimally or nonoptimally corrected hyponatremia at 24 hours after admission. Optimal correction was defined as sodium correction in 24 hours of 6 through 10 mmol/L. We investigated the association between sodium correction and demographic and outcome variables, including occurrence of osmotic demyelination syndrome (ODS). Baseline characteristics by correction outcome categories were compared using the Kruskal-Wallis test for continuous variables and the χ(2) test for categorical variables. Odds ratios for in-hospital mortality between groups were assessed using logistic regression. Adjusted differences in hospital length of stay (LOS) and intensive care ...
Hyponatremia in patients with liver diseases: not just a cirrhosis-induced hemodynamic compromise
Hepatology International, 2016
Hyponatremia (Na ? \135 mmol/l) is the most common electrolyte disorder. Cirrhosis represents a rather frequent cause of hyponatremia mainly due to systemic and splanchnic vasodilation resulting in decreased effective arterial blood volume, which leads to excessive non-osmotic secretion of antidiuretic hormone. However, hyponatremia of multifactorial origin may be seen in patients with liver diseases. The review focuses on the factors and pathogenetic mechanisms of decreased sodium levels other than the hemodynamic compromise of cirrhosis in patients with liver diseases. The mechanisms and causal or contributing role of pseudohyponatremia, hyperglycemia, infections, drugs and toxins as well as of endocrine disorders, renal failure and cardiac disease in patients with liver disease are meticulously discussed. Hyponatremia of multifactorial origin is frequently observed in patients with liver diseases, and special efforts should be made to delineate the underlying causative and precipitating factors as well as the risk factors of the osmotic demyelination syndrome in order to properly manage this serious electrolyte disorder and avoid treatment pitfalls. Keywords Hyponatremia Á Liver disease Á Cirrhosis Á Infection Á Terlipressin Á Hepatitis Pathophysiology of hyponatremia Hyponatremia is attributed to either water retention or (less often) to loss of effective solute (sodium plus potassium) in excess of water. The capacity for water excretion is adequate in normal states; hence, retention of water resulting in decreased serum sodium levels is observed only in conditions that impair renal excretion of water. The exception to this rule is primary polydipsia in which the disproportionate water intake (10-15 l/per day) can overwhelm the normal & T. D. Filippatos
Acute and Chronic Hyponatremia
Frontiers in Medicine, 2021
Hyponatremia is the most common electrolyte disorder in clinical practice. Catastrophic complications can occur from severe acute hyponatremia and from inappropriate management of acute and chronic hyponatremia. It is essential to define the hypotonic state associated with hyponatremia in order to plan therapy. Understanding cerebral defense mechanisms to hyponatremia are key factors to its manifestations and classification and subsequently to its management. Hypotonic hyponatremia is differentiated on the basis of urine osmolality, urine electrolytes and volume status and its treatment is decided based on chronicity and the presence or absence of central nervous (CNS) symptoms. Proper knowledge of sodium and water homeostasis is essential in individualizing therapeutic plans and avoid iatrogenic complications while managing this disorder.
Hyponatremia and hypernatremia: disorders of water balance
The Journal of the Association of Physicians of India, 2009
Total body water and tonicity is tightly regulated by renal action of antidiuretic hormone (ADH), renin-angiotensinaldosterone system, norepinephrine and by the thirst mechanism. Abnormalities in water balance are manifested as sodium disturbances -hyponatremia and hypernatremia. Hyponatremia ([Na + <136meq/l]) is a common abnormality in hospitalized patients and is associated with increased morbidity and mortality. A common cause of hyponatremia is impaired renal water excretion either due to low extracellular fluid volume or inappropriate secretion of ADH. Clinical assessment of total body water and urine studies help in determining cause and guiding treatment of hyponatremia. Acute and severe hyponatremia cause neurological symptoms necessitating rapid correction with hypertonic saline. Careful administration and monitoring of serum [Na + ] is required to avoid overcorrection and complication of osmotic demyelination. Vasopressin receptor antagonists are being evaluated in management of euvolemic and hypervolemic hyponatremia. Hypernatremia ([Na + ]>145meq/l) is caused by primary water deficit (with or without Na + loss) and commonly occurs from inadequate access to water or impaired thirst mechanism. Assessment of the clinical circumstances and urine studies help determine the etiology, while management of hypernatremia involves fluid resuscitation and avoiding neurological complications from hypernatremia or its correction. Frequent monitoring of [Na + ] is of paramount importance in the treatment of sodium disorders that overcomes the limitations of prediction equations. ©
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.
ABSTRACTBackgroundOsmotic demyelination syndrome (ODS) is a rare but devastating complication of rapid correction of hyponatremia. Current guidelines recommend limiting the sodium correction rate to no more than 8 mmol/L per 24 hours, but this is based on expert opinion and small observational studies.MethodsWe conducted a multicenter cohort study of patients admitted into hospital with hyponatremia at five academic hospitals in Toronto between April 1, 2010 and December 31, 2019. We identified all adult patients with hyponatremia (sodium <130 mmol/L) based on their initial serum sodium measured on presentation to the emergency department. The primary outcome was the rate of ODS. ODS cases were identified using medical record review and neuroimaging results. The secondary outcome was the rate of rapid correction of sodium (>8 mmol/L in any 24-hour period).ResultsOur cohort included 21182 hospitalizations with hyponatremia. Approximately 50% were women, the average age was 68 y...
Ten common pitfalls in the evaluation of patients with hyponatremia
European Journal of Internal Medicine, 2015
Hyponatremia is the most common electrolyte disorder in hospitalized patients associated with increased morbidity and mortality. On the other hand, inappropriate treatment of hyponatremia (under-or mainly overtreatment) may also lead to devastating consequences. The appropriate diagnosis of the causative factor is of paramount importance for the proper management and avoidance of treatment pitfalls. Herein, we describe the most common pitfalls in the evaluation of the hyponatremic patient, such as failure to exclude pseudohyponatremia or hypertonic hyponatremia (related to glucose, mannitol or glycine), to properly assess urine sodium concentration and other laboratory findings, to diagnose other causes of hyponatremia (cerebral salt wasting, reset osmostat, nephrogenic syndrome of inappropriate antidiuresis, prolonged strenuous exercise, drugs) as well as inability to measure urine osmolality or delineate the diagnosis and cause of the syndrome of inappropriate antidiuretic hormone secretion. Clinicians should be aware of these common clinical practice pitfalls, which could endanger patients with hyponatremia.