Cause Of Hyponatremia Research Articles

PMON318 Nephrogenic syndrome of inappropriate antidiuresis in a 19 months old child with gross developmental delay

Abstract Case report 19 months old African American boy with nonsignificant past medical history presented with inability to walk, hypotonia chewing difficulties and speech delay. Initial laboratory evaluations demonstrated serum hyponatremia of 120-129 mEq/dl, low serum osmolality 261 mosm/kg (normal serum osmolality 275-295 mosm/kg) with inappropriately high urine osmolality 445 mosm/kg) (normal urine osmolality 300-1000 mosm/kg). Blood work for thyroid, adrenal, and pituitary function was unremarkable. Vasopressin level of 2.4 pg/ml (normal 0.0 - 4.7 pg/mL) did not support the diagnosis of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Fludrocortisone challenge test ruled out aldosterone deficiency with insufficient decrease in urine sodium and no response in serum sodium. Renal ultrasound and brain MRI were normal. Genetic testing revealed AVPR2 X-linked mutation c.409C>T p.R137C, consistent with nephrogenic syndrome of inappropriate antidiuresis (NSIAD). The patient was discharged on sodium chloride tablets 2g every 8 hours and remained stable, asymptomatic. One month after discharge patient showed significant neurological improvement. Discussion Sodium is known to play a significant role in growth and maturation of the whole body, especially of the nervous system. Moderate (120-129 mEq/L) to severe (<120 mEq/L) hyponatremia can present with nausea, malaise, headache, lethargy, motor and speech delay, seizures and even death due to brain herniation. Normal fluid and electrolyte balance is achieved by the thirst mechanism and free water excretion in kidneys. This is mediated by Vasopressin, which acts through V2R receptor in distal renal collecting duct. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of hyponatremia. Reset osmostat syndrome with a congenitally low serum osmolality threshold is one of the rare disorders on the differential. Hereditary nephrogenic syndrome of inappropriate antidiuresis is very rare mutation in vasopressin receptor, which clinically resembles SIADH except for normal/low vasopressin levels in set of hyponatremia. It causes gain of function and inappropriately high water retention. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

ODP325 Inverse Relationship Between IL-6 and Sodium Levels in Patients With COVID-19 and Other Respiratory Tract Infections

Abstract Background Hyponatremia is highly prevalent in patients with COVID-19. One of the most common causes of hyponatremia in these patients is the syndrome of inadequate antidiuresis (SIAD). Interleukin 6 (IL-6) is a key mediator of inflammation in COVID-19. We hypothesized that hyponatremia in COVID-19 is due to IL-6 mediated non-osmotic arginine vasopressin (AVP) secretion, and that the inverse association between IL-6 and plasma sodium concentration is stronger in COVID-19 compared to other respiratory infections. METHODS This is a secondary analysis of a prospective, observational, cohort study including patients with COVID-19 suspicion admitted to the Emergency Department, University Hospital of Basel, Switzerland, between March and July 2020. We included patients with PCR-confirmed COVID-19 and patients without COVID-19 but similar symptoms, further subclassified in bacterial and other viral respiratory infections. The primary objective was to investigate the association between plasma sodium levels and IL-6 levels. Results 500 patients were included, of whom 184 (37%) with COVID-19, 92 (18%) with bacterial respiratory infections, 224 (45%) with other viral respiratory infections. Hyponatremia prevalence was higher in patients with COVID-19 compared to patients with other viral respiratory infections (28% vs 12%, p<0. 01), and similar to patients with bacterial respiratory infections (28% vs 30%, p<0.41). In all three groups, median [IQR] IL-6 levels were significantly higher in hyponatremic compared to normonatremic patients (COVID-19: 43.4 [28.4, 59.8] vs 9.2 [2.8, 32.7] pg/ml, p<0. 0001; bacterial: 122.1 [63. 0, 282. 0] vs 67.1 [24.9, 252. 0] pg/ml, p<0. 05; viral: 14.1 [6.9, 84.7] vs 4.3 [2.1, 14.4] pg/ml, p<0. 05). IL-6 levels were negatively correlated with plasma sodium levels in COVID-19, whereas the correlation in bacterial and other viral infections was weaker (COVID-19: ρ = − 0.52, p < 0. 001; bacterial: ρ = − 0.24, p = 0. 056, viral: ρ = − 0.24, p < 0. 001). Conclusion IL-6 levels were inversely correlated with plasma sodium levels, with a stronger correlation in patients with COVID-19 compared to patients with bacterial and other viral infections. IL-6 might stimulate AVP secretion and lead to higher rates of hyponatremia due to the syndrome of inadequate antidiuresis in these patients. Presentation: No date and time listed

Risk of pre-existing hyponatremia and mortality in patients with traumatic brain injury across age groups

Traumatic brain injurySodiumClinical outcomes.

Syndrome of Inappropriate Antidiuretic Hormone secretion due to hydroxyurea

Hyponatremia is the most common electrolyte disorder in clinical practice: Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) is the most common cause of hyponatremia, especially in euvolemic patients. Drugs are among the most common causes of SIADH. While our patient was using hydroxyurea due to polycythemia vera, he was diagnosed with SIADH due to hydroxyurea treatment after investigation due to resistant hyponatremia. The improvement of hyponatremia after hydroxyurea is discontinued and the development of hyponatremia after the drug is re-started supports the development of drug-induced hyponatremia. Careful follow-up is required in terms of hyponatremia in patients using hydroxyurea.

1621P miRNA signature as early predictor of hyponatremia and survival in lung cancer: Preliminary results from the ISA retrospective study

Syndrome of inappropriate antidiuresis (SIAD) in cancer is the main cause of hyponatremia and is associated with poorer survival, hospitalization and health costs in lung cancer (LC) patients (pts). Micro-RNAs (miRNAs) represent promising biomarkers with therapeutic potential. Our retrospective study aims to assess a miRNA signature to discriminate hyponatremia and predict clinical outcome in LC pts. We performed a miRNA sequencing in 20 FFPE tumor samples of 10 eunatremic and 10 hyponatremia-developing LC pts through Illumina NextSeq500 sequencer. Pts’ records were reviewed to assess outcome measures. The differential miRNA expression profile was analyzed between the two groups. miRNAs with |log2(fold change)|>0.58 and p<0.05 were considered statistically significant and correlated with survival outcomes, relapse-free survival (RFS), progression-free survival (PFS) and overall survival (OS), using three Cox multivariate regression models. 12 miRNAs were differentially expressed at diagnosis between hypo- and eunatremic pts at univariate analysis (p<0.05). At multivariate analysis, miR-147b-3p (median expression 10.8 vs 92.6, p=0.025), miR-147b-5p (2.6 vs 15.9, p=0.002), miR-937-3p (3.4 vs 14.6, p=0.039) and miR-146a-5p (6106.6 vs 16601.4, p=0.035) were significantly downregulated in hypo- vs eunatremic pts. Similarly, miR-539-3p (3.4 vs 14.9, p=0.083) and miR-625-3p (97.8 vs 308.9, p=0.061) showed a trend towards significance for downregulation. Contrarily, miR-190a-5p (304.2 vs 179.5, p=0.006) and miR-32-3p (7 vs 3, p=0.017) were upregulated in the hyponatremic vs control group. Looking at survival outcomes, the upregulation of miR-937-3p (p=0.042), miR-190a-5p (p=0.001) and miR-9-3p (p=0.035) was associated with worse OS, while the upregulation of miR-32-3p was associated with improved OS (p=0.010) and RFS (p=0.064). Our results reveal new insights into the role of vasopressin pathways in LC. These miRNAs appear as valuable early predictors of hyponatremia and their expression is associated with a significant impact on pts’ survival. Further investigations, including our prospective study, are warranted to provide advances in SIAD management.

Hyponatremia and SARS-CoV-2 infection: A narrative review.

A novel rapid spreading and changing virus called SARS-CoV-2 appeared in Wuhan city in December 2019. It was announced by the World Health Organization (WHO) as a pandemic disease in March 2020. It commonly presents with respiratory symptoms; however, it may be asymptomatic. Electrolyte abnormalities are not uncommon features of SARS-CoV-2 infection. Hyponatremia is one of these electrolyte disturbances among SARS-CoV-2 patients, and it may produce symptoms such as weakness and seizure as the initial presenting symptoms. The underlying mechanism(s) of hyponatremia due to SARS-CoV-2 infection is (are) not established.The aim of this review is to evaluate the possible mechanism of hyponatremia in patients with COVID-19. Understanding and categorizing the hyponatremia in these patients will lead to better treatment and correction of the hyponatremia.A review of the literature between December 2019 and March 2022 was conducted searching for the possible reported mechanism(s) of hyponatremia in SARS-CoV-2.Although SIADH is the commonly reported cause of hyponatremia in SARS-CoV-2 infection, other causes such as diarrhea, vomiting, and kidney salt loss must be considered before SIADH.

Hyponatraemia and the syndrome of inappropriate antidiuresis (SIAD) in cancer.

Hyponatraemia is a common electrolyte abnormality seen in a wide range of oncological and haematological malignancies and confers poor performance status, prolonged hospital admission and reduced overall survival, in patients with cancer. Syndrome of inappropriate antidiuresis (SIAD) is the commonest cause of hyponatraemia in malignancy and is characterised by clinical euvolaemia, low plasma osmolality and concentrated urine, with normal renal, adrenal and thyroid function. Causes of SIAD include ectopic production of vasopressin (AVP) from an underlying tumour, cancer treatments, nausea and pain. Cortisol deficiency is an important differential in the assessment of hyponatraemia, as it has an identical biochemical pattern to SIAD and is easily treatable. This is particularly relevant with the increasing use of immune checkpoint inhibitors, which can cause hypophysitis and adrenalitis, leading to cortisol deficiency. Guidelines on the management of acute, symptomatic hyponatraemia recommend 100 mL bolus of 3% saline with careful monitoring of the serum sodium to prevent overcorrection. In cases of chronic hyponatraemia, fluid restriction is recommended as first-line treatment; however, this is frequently not feasible in patients with cancer and has been shown to have limited efficacy. Vasopressin-2 receptor antagonists (vaptans) may be preferable, as they effectively increase sodium levels in SIAD and do not require fluid restriction. Active management of hyponatraemia is increasingly recognised as an important component of oncological management; correction of hyponatraemia is associated with shorter hospital stay and prolonged survival. The awareness of the impact of hyponatraemia and the positive benefits of active restoration of normonatraemia remain challenging in oncology.

Hiccups as the first presentation of secondary adrenal insufficiency associated with advanced cervical cancer.

SummaryHiccups are a common symptom characterized by intermittent spasmodic contraction of the diaphragm. Most hiccups are transient, but some are refractory. Patients with intractable hiccups often have abnormalities of the diaphragm, medulla oblongata, and lesions affecting nerve fibers connecting them. Moreover, electrolyte abnormalities, including hyponatremia, are frequently observed in patients with intractable hiccups. Adrenal insufficiency (AI) is one of the causes of hyponatremia. However, hiccups are not commonly the first presentation. Herein, we describe a case of a 45-year-old woman complaining of refractory hiccups. The patient was initially diagnosed with hiccups associated with cervical cancer metastasis to the liver and peritoneum. The administration of chlorpromazine did not have a beneficial effect on her hiccup. Fasting hypoglycemia and hyponatremia were later found. Her serum cortisol level was low without an elevation of adrenocorticotropic hormone level. MRI of the pituitary gland showed metastatic lesion in the pituitary gland and stalk. Thus, the patient was diagnosed with secondary AI due to cervical cancer metastasis to the pituitary gland and stalk. Administration of hydrocortisone improved her hiccups with the normalization of serum sodium level. Therefore, differential diagnosis in advanced cancer patients with hiccups should include AI-induced hyponatremia.Learning pointsHiccups could be the first manifestation of adrenal insufficiency (AI).Hiccups in patients with AI are often mediated by hyponatremia.Hyponatremia is less frequent in secondary AI than in primary AI. However, hyponatremia can result from increased antidiuretic hormone due to loss of cortisol.The differential diagnosis should include AI-induced hyponatremia if hiccups occur in patients with advanced cancer, as metastasis to adrenal gland or pituitary gland could cause AI.

Electrolyte and Acid-Base Disorders Associated with Cancer Immunotherapy.

Novel immunotherapy drugs have changed the landscape of cancer medicine. Immune checkpoint inhibitors and chimeric antigen receptor T cells are being used and investigated in almost all types of cancers. Immune-related adverse events have been associated with immunotherapies. AKI has been the most commonly associated kidney adverse event. In this review, we showcase the several associated electrolyte disorders seen with immunotherapy. Immune checkpoint inhibitors can lead to hyponatremia by several mechanisms, with the syndrome of inappropriate antidiuresis being the most common. Endocrine causes of hyponatremia are rare. Hypokalemia is not uncommon and is associated with both proximal and distal renal tubular acidosis. Hypercalcemia associated with immune checkpoint inhibitors has led to some interesting observations, including immune checkpoint inhibitor-induced parathyroid hormone-related peptide production, sarcoid-like granulomas, and hyperprogression of the disease. Hypocalcemia and hyperphosphatemia may be seen with immune checkpoint inhibitor-induced tumor lysis syndrome. Chimeric antigen receptor T cell therapy-associated electrolyte disorders are also common. This is associated chiefly with hyponatremia, although other electrolyte abnormalities can occur. Early recognition and prompt diagnosis may help providers manage the mechanistically varied and novel electrolyte disorders associated with immunotherapy.

Approach to the Patient: Hyponatremia and the Syndrome of Inappropriate Antidiuresis (SIAD).

Hyponatremia is the most common electrolyte disturbance seen in clinical practice, affecting up to 30% of acute hospital admissions, and is associated with significant adverse clinical outcomes. Acute or severe symptomatic hyponatremia carries a high risk of neurological morbidity and mortality. In contrast, chronic hyponatremia is associated with significant morbidity including increased risk of falls, osteoporosis, fractures, gait instability, and cognitive decline; prolonged hospital admissions; and etiology-specific increase in mortality. In this Approach to the Patient, we review and compare the current recommendations, guidelines, and literature for diagnosis and treatment options for both acute and chronic hyponatremia, illustrated by 2 case studies. Particular focus is concentrated on the diagnosis and management of the syndrome of inappropriate antidiuresis. An understanding of the pathophysiology of hyponatremia, along with a synthesis of the duration of hyponatremia, biochemical severity, symptomatology, and blood volume status, forms the structure to guide the appropriate and timely management of hyponatremia. We present 2 illustrative cases that represent common presentations with hyponatremia and discuss the approach to management of these and other causes of hyponatremia.

Glimepiride induced Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH): A case report

The Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) is an important cause of hyponatremia in hospitalized patients and can be caused by a variety of drugs. SIADH is a recognized side effect of 1st generation sulfonylurea (Chlorpropamide) due to its effect on vasopressin secretion. Here we described a 55-year-old woman with uncontrolled type 2 diabetes on glimepiride with SIADH presenting with anorexia, asthenia, and altered mental status. After the withdrawal of glimepiride, these symptoms were improved and sodium level returned to a normal value which demand monitoring of serum sodium level during treatment with glimepiride.

Kidney Transplant Recipient with Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Secondary to COVID-19 Pneumonia: A Case Report

BackgroundCurrently, COVID-19 is becoming one of the most common causes of viral pneumonia worldwide. In the medical literature, very few case reports describe the association between COVID-19 and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in kidney transplant patients.MethodsA 74-year-old immunocompromised man post–kidney transplant presented with nonspecific symptoms consisting of fatigue, malaise, and anorexia. He was also found to have hyponatremia in the context of pulmonary insults. SIADH in the setting of COVID-19 pneumonia was diagnosed after exclusion of other causes of hyponatremia. He was treated for COVID-19 pneumonia with antiviral therapy, secondary bacterial infection prophylaxis, dexamethasone and ventilatory support in addition to modification of antirejection medications.ResultsThe patient has improved and his serum sodium normalized with management of primary insult.Conclusions. SIADH should be suspected in transplant patients with COVID-19 pneumonia once they develops hyponatremia. The decision of intravenous fluid administration should be taken carefully in these settings.

Pattern Recognition versus Pathogenesis: Electrolytes in a Patient with Adrenal Insufficiency.

Pattern Recognition versus Pathogenesis: Electrolytes in a Patient with Adrenal Insufficiency.

Etiology, Clinical Features and Outcomes of Treatment of Hyponatremia - A Prospective Study

Hyponatremia is a common problem encountered in patients presenting with non- specific 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 Ramkrishna 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&lt;0.0001). Keywords: Hyponatremia-serum sodium &lt; 135 meq/L.

A Retrospective Chart Review: The Prevalence of Hyponatremia Among Elderly Inpatients in a Tertiary Care Centre in Saudi Arabia.

Introduction: Hyponatremia is commonly seen in inpatient care; however, the availability of data regarding the prevalence of hyponatremia in the elderly in Jeddah, Saudi Arabia is insufficient.Objectives: The objective of this study is to estimate the prevalence of hyponatremia in a sample of older inpatients.Materials and Methods: A retrospective chart review conducted in a tertiary care hospital, Jeddah, Saudi Arabia included all patients 60 years and older who were admitted to the internal medicine department between January 2017 and November 2020. Patients with hyponatremia were identified by looking through the hospital’s laboratory database of inpatients. Patients’ demographics, serum sodium level, medication history, and disease history were recorded and those with pseudohyponatremia were excluded.Results: During the study period, 322 out of a total of 2,893 elderly patients admitted to the internal medicine department were diagnosed with hyponatremia (11.1%). Of these patients, 183 (56.8%) were female and 139 (43.2%) were male. Hyponatremia was more prevalent in patients with cardiovascular diseases (84.2%), followed by endocrine diseases (73.3%). The most prescribed medications for the studied hyponatremic patients were proton pump inhibitors (38.8%), diuretics (29.8%), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (22.4%), all of which are commonly known to be associated with hyponatremia.Conclusions: Hyponatremia has severe consequences if left untreated. Therefore, estimating the prevalence of this condition in the older population will direct more clinical attention to evaluate the serum sodium level on a regular basis. It is recommended that future studies focus on finding an association between hyponatremia and older patients with multi-drug usage as well as identifying the causes of hyponatremia.

Aetiological diagnosis of hyponatraemia in non-critical patients on total parenteral nutrition: A prospective multicentre study

BackgroundIn 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. MethodsProspective 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. Results162 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%). ConclusionsSIADH 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.

CLINICO-ETIOLOGICAL PROFILE OF HYPONATREMIA IN HOSPITALISED ADULT PATIENTS - A CROSS- SECTIONAL, OBSERVATIONAL STUDY

Introduction: Hyponatremia is dened as a serum sodium level less than 135meq/L. An abnormal sodium level does not necessarily imply abnormal sodium balance, but can be due to abnormal water balance as well. Serum sodium levels and serum osmolality are normally maintained under precise control by homeostatic mechanisms involving thirst, anti-diuretic hormone and the renal handling of ltered sodium. Hyponatremia occurs in a broad spectrum of patients who are asymptomatic to critically ill patients. The clinical presentation has a wide spectrum, varying from asymptomatic patients to ones having seizures and coma. Aim: To nd out co-relation between grade of hyponatremia with hospital stay, mortality rate and to study whether the primary disease is a cause for hyponatremia and whether other features cause hyponatremia also. Materials And Methods: A 1 year cross-sectional observational study was conducted, including 100 adult patients admitted in Vivekananda Institute of Medical Sciences, Kolkata with hyponatremia (serum sodium &lt;135 mEq/L) in General Medicine ward and in Orthopedics ward (with fragility fracture). Results: There was a wide range of etiologies, most common being SIADH (47%), renal disorder (13%), diuretic use (13%), congestive heart failure (8%), and liver disorder (4%). 16% patients had multiple causes. In 5% patients no cause could be found after extensive investigations. Mean duration of hospital stay was 7.04 days, which was signicantly higher in patients with severe hyponatremia. Incidence of fragility fracture in our study was 16%. Conclusion: SIADH was the single most important etiology of hyponatremia. Use of diuretics and chronic kidney disease were also signicant cause of hyponatremia in this study. Other major causes of hyponatremia were CHF, acute gastroenteritis and chronic liver disease. A relatively large number of patients had endocrine abnormalities (thyroid, adrenal and pituitary).Hyponatremia was found to be related to multiple etiological factors in a signicant number of patients. Neurological symptoms are common in hyponatremia patients. Symptoms of hyponatremia increased with severity of hyponatremia.

Renin, antidiuretic hormone (ADH), and ADH receptor levels in cerebral salt wasting associated with tuberculous meningitis.

To evaluate serum antidiuretic hormone (ADH), its receptors, and renin levels in cerebral salt wasting (CSW) in tuberculous meningitis (TBM). Patients diagnosed with definite (n = 30) or probable TBM (n = 47) who developed hyponatremia (CSW, SIADH, or miscellaneous causes) were included. Sequential measurement of serum ADH, ADH-R, and renin activity by enzyme-linked immunosorbent assay was done and correlated with serum sodium level, urinary output, and fluid balance. Out of 79 TBM patients, CSW was observed in 36, SIADH in four, and miscellaneous hyponatremia in eight patients. CSW patients had a longer hospital stay (P < 0.001), lower GCS score (P < 0.007), higher MRC grade (P < 0.007), and a lower serum Na (P < 0.001) compared to non-CSW TBM patients. In severe CSW patients, serum ADH and ADH-R were correlated with hyponatremia and returned to baseline on correction; however, serum renin levels remained elevated. Serum ADH was related to hyponatremia but ADH-R and renin were not. ADH-R and renin levels did not significantly differ in CSW and SIADH. CSW is the commonest cause of hyponatremia in TBM and correlates with disease severity. ADH is related to hyponatremia, but ADH receptor and renin are not.

Hyponatremia in Melioidosis: Analysis of 10-year Data from a Hospital-Based Registry.

Introduction:Hyponatremia is a frequent finding in hospitalized patients and is associated with poor clinical outcomes. While hyponatremia is known to commonly occur in certain infections, its association with melioidosis has not been studied previously. We studied incidence and impact of hyponatremia on clinical outcomes in melioidosis.Methods:This was a retrospective analysis of a single-center hospital registry of culture-positive patients with melioidosis hospitalized during a 10-year period (January 01, 2010, through January 31, 2021). Hyponatremia was defined as serum sodium of <135 mmol/L, and severe hyponatremia as serum sodium <120 mmol/L. The association of hyponatremia with in-hospital mortality, need for intensive care unit (ICU) stay and mechanical ventilation was studied.Results:Of 201 patients with melioidosis, 169 (84.1%) had hyponatremia, with severe hyponatremia in 35 (17.4%) patients. Older age (adjusted odds ratios [OR] 1.03, 95% confidence intervals [CI]: 1.00–1.06; P = 0.049) and acute kidney injury (AKI) (adjusted OR 3.30, 95% CI: 1.19-9.19; P = 0.02) were independently associated with hyponatremia. Twenty-two patients had been evaluated for cause of hyponatremia and of these, 11 (50%) had syndrome of inappropriate antidiuresis. Severe hyponatremia was associated with in-hospital mortality (adjusted OR 3.75, 95% CI: 1.37–10.27; P = 0.01), need for ICU stay (adjusted OR 7.04, 95% CI: 2.88–17.19; P < 0.001) and mechanical ventilation (adjusted OR 3.99, 95% CI: 1.54–10.32; P = 0.004).Conclusion:Hyponatremia occurs in 84.1% of hospitalized patients with melioidosis. Older age and AKI are associated with a higher incidence of hyponatremia. The presence of severe hyponatremia is an independent predictor of in-hospital mortality, need for mechanical ventilation and ICU stay.

Osmotic demyelination syndrome and overly rapid correction of hyponatremia

Hyponatremia is a frequent condition in hospitalized patients and is associated with significant morbidity and mortality. An association between rapid correction of hyponatremia and the occurrence of osmotic demyelination syndrome has been reported. Osmotic demyelination syndrome may present with severe neurologic symptoms, including in rare cases locked-in. Therefore, rapid correction of hyponatremia is recommended only in the presence of severe symptoms. In those cases, hypertonic saline (NaCl 3% 2 ml/Kg over 20 minutes) is recommended with close plasma sodium monitoring. After symptoms improvement, increases in sodium concentration should not exceed 8 mmol/l/24h. In cases without severe neurologic symptoms, the use of 3% NaCl solution should be avoided, and management should target the underlying causes of hyponatremia.