Changes In Sodium Levels Research Articles

The efficacy and safety of isotonic and hypotonic fluids in intravenous maintenance fluid therapy in term newborns: national multicenter observational "neofluid" study.

The objective of this study was to evaluate the efficacy and safety of isotonic and hypotonic intravenous fluids in maintenance fluid therapy for term infants. This was a multi-centre, prospective, observational study conducted in 21 participating centres from December 30, 2020, to June 30, 2023. The study included term newborns requiring parenteral fluid therapy for maintenance (NCT04781361). The fluid treatment was divided into two groups based on the concentration of sodium in the parenteral fluid, designated as hypotonic (NaCl <130 mmol/L) and isotonic (NaCl = 130-154 mmol/L). The primary outcomes were the change in mean plasma sodium (pNa) levels per hour (∆pNa mmol/L/h), the incidence of hyponatremia (pNa <135 mmol/L) and hypernatremia (pNa >145 mmol/L), and the occurrence of clinically significant changes in sodium levels (∆pNa >0.5 mmol/L/h). A total of 420 patients from 21 centers were included. The ∆pNa was negative in the hypotonic fluid group and positive in the isotonic fluid group, with a significant difference between the groups [respectively -0.07 ± 0.03 (95% CI: -0.13 to -0.02); 0.04 ± 0.03 (95%CI: -0.02 to 0.09), p = 0.04]. There was no difference between the groups in terms of the development of hypernatremia or a clinically meaningful pNa increase. The hypotonic fluid group had a higher incidence of hyponatremia and a clinically meaningful sodium decrease compared to the isotonic fluid group [7.9% vs. 1.2% (OR:6.5, p:0.03)] and [12.2% vs.4.2% (OR:2.9, p = 0.03)]. Contrary to current understanding, this large-scale study is the first to demonstrate that the use of hypotonic fluids in maintenance fluid therapy for newborns poses a risk of hyponatremia development, whereas isotonic fluid therapy appears safe.

Association between postoperative changes in natremia and outcomes in patients undergoing elective craniotomy.

Postoperative dysnatremias, characterized by imbalances in serum sodium levels, have been linked to increased resource utilization and mortality in surgical and intensive care patients. The management of dysnatremias may involve medical interventions based on changes in sodium levels. In this study, we aimed to investigate the impact of postoperative changes in natremia on outcomes specifically in patients undergoing craniotomy.We conducted a retrospective analysis of patient records from the Department of Neurosurgery at West China Hospital, Sichuan University, covering the period from January 2011 to March 2021. We compared the highest and lowest sodium values in the first 14 postoperative days with the baseline values to define four categories for analysis: no change < 5mmol/L; decrease > 5mmol/L; increase > 5mmol/L; both increase and decrease > 5mmol/L. The primary outcome measure was 30-day mortality.A total of 12,713 patients were included in the study, and the overall postoperative mortality rate at 30days was 2.1% (264 patients). The increase in sodium levels carried a particularly high risk, with a tenfold increase (OR 10.21; 95% CI 7.25-14.39) compared to patients with minimal or no change. Decreases in sodium levels were associated with an increase in mortality (OR 1.60; 95% CI 1.11-2.23).Moreover, the study revealed that postoperative sodium decrease was correlated with various complications, such as deep venous thrombosis, pneumonia, intracranial infection, urinary infection, seizures, myocardial infarction, and prolonged hospital length of stay. On the other hand, postoperative sodium increases were associated with acute kidney injury, deep venous thrombosis, pneumonia, intracranial infection, urinary infection, surgical site infection, seizures, myocardial infarction, and prolonged hospital length of stay.Changes in postoperative sodium levels were associated with increased complications, prolonged length of hospital stay, and 30-day mortality. Moreover, the severity of sodium change values correlated with higher mortality rates.

Gastroenteritis Rehydration Of children with Severe Acute Malnutrition (GASTROSAM): A Phase II Randomised Controlled trial: Trial Protocol.

Children hospitalised with severe acute malnutrition (SAM) are frequently complicated (>50%) by diarrhoea ( ≥3 watery stools/day) which is accompanied by poor outcomes. Rehydration guidelines for SAM are exceptionally conservative and controversial, based upon expert opinion. The guidelines only permit use of intravenous fluids for cases with advanced shock and exclusive use of low sodium intravenous and oral rehydration solutions (ORS) for fear of fluid and/or sodium overload. Children managed in accordance to these guidelines have a very high mortality. The proposed GASTROSAM trial will reappraise current recommendations with mortality as the primary outcome. We hypothesize that liberal rehydration strategies for both intravenous and oral rehydration in SAM children with diarrhoea may reduce adverse outcomes. An open Phase II trial, with a partial factorial design, enrolling children in Uganda, Kenya, Nigeria and Niger aged 6 months to 12 years with SAM hospitalised with gastroenteritis (>3 loose stools/day) and signs of moderate and severe dehydration. In Stratum A (severe dehydration) children will be randomised (1:1:2) to WHO plan C (100mls/kg Ringers Lactate (RL) with intravenous rehydration (IV) given over 3-6 hours according to age including boluses for shock), slow rehydration (100 mls/kg RL over 8 hours (no boluses)) or WHO SAM rehydration regime (ORS only (boluses for shock (standard of care)). Stratum B incorporates all children with moderate dehydration and severe dehydration post-intravenous rehydration and compares (1:1 ratio) standard WHO ORS given for non-SAM (experimental) versus WHO SAM-recommended low-sodium ReSoMal. The primary outcome for intravenous rehydration is mortality to 96 hours and for oral rehydration a change in sodium levels at 24 hours post-randomisation. Secondary outcomes include measures assessing safety (evidence of pulmonary oedema or heart failure); change in sodium from post-iv levels for those in Stratum A; perturbations of electrolyte abnormalities (severe hyponatraemia <125 mmols/L or hypokalaemia. If the trial shows that rehydration strategies for non-malnourished children are safe and improve mortality in SAM this could prompt revisions to the current treatment recommendations or may prompt future Phase III trials.

Changes in sodium levels in Australian packaged foods between 2014 and 2019: an interrupted time series analysis of the impact of the Victorian Salt Reduction Partnership’s media advocacy strategy

BackgroundThe Victorian Salt Reduction Partnership (VSRP) implemented a media advocacy strategy (intervention) to stimulate food manufacturers to reduce sodium levels across targeted Australian packaged foods between 2017 and 2019. This study assessed changes in sodium levels of targeted and non-targeted packaged foods during the intervention (2017 to 2019) compared to before the intervention (2014 to 2016) in Australia.MethodsAnnually collected branded-food composition data from 2014 to 2019 were used. Interrupted time series analyses was conducted to compare the trend in sodium levels in packaged foods during the intervention (2017–2019) to the trend in the pre-intervention period (2014–2016). The difference between these trends was derived to estimate the effect of the intervention.ResultsA total of 90,807 products were included in the analysis, of which 14,743 were targeted by the intervention. The difference in before and during intervention trends between targeted and non-targeted food categories was 2.59 mg/100 g (95% CI: -13.88 to 19.06). There was a difference in the pre-intervention slope (2014, 2015, 2016) and intervention slope (2017, 2018, 2019) for four of 17 targeted food categories. There was a decrease in sodium levels (mg/100 g) in one food category: frozen ready meals (-13.47; 95% CI: -25.40 to -1.53), and an increase in three categories: flat bread (20.46; 95% CI: 9.11 to 31.81), plain dry biscuits (24.53; 95% CI: 5.87 to 43.19), and bacon (44.54; 95% CI: 6.36 to 82.72). For the other 13 targeted categories, the difference in slopes crossed the line of null effect.ConclusionsThe VSRP’s media advocacy strategy did not result in a meaningful reduction in sodium levels of targeted packaged food products during the intervention years compared to trends in sodium levels before the intervention. Our study suggests media advocacy activities highlighting the differences in sodium levels in packaged food products and industry meetings alone are not sufficient to lower average sodium levels in packaged foods in the absence of government leadership and measurable sodium targets.

Intracranial pressure changes during continuous renal replacement therapy in acute period of severe traumatic brain injury

The objective was to study the effect of continuous renal replacement therapy (CRRT) in the acute period of traumatic brain injury (TBI) on intracranial pressure (ICP). Materials and methods. An analysis of the dynamics of ICP during CRRT in patients with severe TBI was performed. The division of procedures into three groups, depending on the variant of ICP change, allowed to perform a comparative analysis of a number of factors that were potential predictors of aggravation of intracranial hypertension. Results. During CRRT, ICP decreased in 39 % of cases (Group 1) and increased in 29 % of cases (Group 2). In 32 % of cases (Group 3), ICP did not change significantly during the procedure. The initial sodium level and the degree of sodium decrease during the first 6 hours of the procedurediffered between the groups, which turned out to be significantly higher in the group 2. An inverse correlation was found between the change in sodium level during the first 6 hours of the procedure and the change in ICP. Conclusions. CRRT in the acute period of severe TBI can be associated with both a decrease and increase of ICP. The main risk factor for worsening intracranial hypertension during CRRT is hypernatremia.

Sonographic Optic Nerve Sheath Diameter as a Guide for Correction of Hyponatremia in the Emergency Department: A Cross-sectional Study.

Monitoring sodium levels during the correction of hyponatremia is essential. There is cell swelling due to the movement of water from extracellular to intracellular by osmotic effect in hyponatremia. The cellular swelling in a closed space causes increased intracranial pressure (ICP). The raised ICP correlates with the optic nerve sheath diameter (ONSD). So, the research question was whether the ONSD can be used as a guide for the correction of hyponatremia. It was a prospective observational study conducted on patients with serum sodium below 135 mEq/L presented to the emergency department (ED). The ONSD was measured at the time of presentation and discharge of the patient. The receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to test the predictive ability of the ONSD to diagnose hyponatremia. A total of 54 subjects were included in the study. The mean sodium level was 109.3 mEq/L at presentation. The mean ONSD on the right side was 6.24 ± 0.71 mm and on the left side was 6.26 ± 0.64 mm at presentation to ED. The mean ONSD on the right side was 5.81 ± 0.58 mm and on the left side was 5.79 ± 0.56 mm at discharge. The ONSD was not able to predict the sodium level measured both by laboratory and POC methods. The ONSD failed to predict the sodium level in patients with hyponatremia during the correction. The change in ONSD did not correlate with the change in sodium level. Uttanganakam S, Hansda U, Sahoo S, Shaji IM, Guru S, Topno N, et al. Sonographic Optic Nerve Sheath Diameter as a Guide for Correction of Hyponatremia in the Emergency Department: A Cross-sectional Study. Indian J Crit Care Med 2023;27(4):265-269.

Central Pontine Myelinolysis without Rapid Changes in Sodium Level: Possible Association with Malnutrition, Hypophosphatemia and Hypokalemia

Central Pontine Myelinolysis without Rapid Changes in Sodium Level: Possible Association with Malnutrition, Hypophosphatemia and Hypokalemia

Transient alterations in plasma sodium concentrations with NER1006 bowel preparation: an analysis of three phase III, randomized clinical trials

BackgroundThis analysis characterized changes in sodium levels in patients receiving the 1 L polyethylene glycol-based preparation NER1006.MethodsData were pooled from three phase III, randomized clinical trials. A post hoc subanalysis included adults who received a 2-day split-dose (evening/morning) NER1006 regimen, a 1-day split-dose (morning only) regimen, or evening-before regimen and had an increase in sodium concentrations from normal to above the upper limit of normal (143–148 mmol/L) at ≥ 1 of three post-treatment visits. Blood samples were collected at baseline, day of colonoscopy (visit 2), 2 ± 1 days post-colonoscopy (visit 3), and 7 ± 1 days post-colonoscopy (visit 4).ResultsA total of 214 of 1028 patients were included. Of the 214 patients, sodium concentration increased from a mean baseline value of 141.8 mmol/L to a mean of 147.1 mmol/L (median increase from baseline of approximately 5 mmol/L). The mean sodium concentration was within normal range at visit 3 (142.3 mmol/L) and visit 4 (142.4 mmol/L), as was the median sodium concentration. Overall, ~ 90% of patients had a normal serum concentration at visits 3 and 4. Based on day of colonoscopy test results, there were four adverse events involving hypernatremia (0.4% of 1028), which were mild and did not require medical intervention; sodium levels returned to normal range by visit 3.ConclusionNER1006 was associated with small, transient increases in sodium levels that were not considered clinically significant.Trial registration NOCT (ClinicalTrials.gov: NCT02254486 [registered October 2, 2014]), MORA (ClinTrials.gov: NCT02273167 [registered October 23, 2014]; EudraCT number: 2014-002185-78 [registered August 13, 2014]), DAYB (ClinicalTrials.gov: NCT02273141 [registered October 23, 2014]; EudraCT Number: 2014-002186-30 [registered August 12, 2014])

Reducing Sodium Content of Foods Served in Arkansas's Largest School District: Evaluation of the Sodium Reduction in Communities Program.

Purpose and ObjectivesThe Centers for Disease Control and Prevention’s Sodium Reduction in Communities Program aims to reduce dietary sodium intake through policy, systems, and environmental approaches. The objective of our study was to evaluate changes in sodium levels over 5 years (2016–2021) in food served in school lunches as an outcome of a Sodium Reduction in Communities program in Arkansas’s largest school district.Intervention ApproachWe collaborated with Springdale Public Schools (SPS) to reduce dietary sodium intake in school lunches through increased implementation of 1) food service guidelines, 2) procurement practices, 3) food preparation practices, and 4) environmental strategies. These activities were maintained from year 1 through year 5. Implementation priorities were informed each year by evaluation findings from the preceding year.Evaluation MethodsWe collected lunch service records and information on nutritional content of menu items for the 30 schools under the direction of SPS’s Child Nutrition Department. We used a pretest–posttest quantitative evaluation design to analyze annual changes in the sodium content of meals, from baseline through year 5.ResultsFrom baseline through year 1, SPS reduced sodium served per diner, per entrée offered, and per entrée served. These reductions were maintained from baseline through 5 years of follow-up. Mean sodium per 1,000 kcal per diner served was 1,740 mg at baseline and was lower in each of the 5 follow-up years: 1,488 mg (14% decrease) in year 1; 1,495 mg (14% decrease) in year 2; 1,612 mg (7% decrease) in year 3; 1,560 mg (10% decrease) in year 4; and 1,532 mg (12% decrease) in year 5. Energy served per diner remained stable.Implications for Public HealthOur study provides evidence for sustained sodium reduction strategies in a large ethnically and socioeconomically diverse school district, pointing to the potential benefit of implementing similar strategies in other school districts. The study also shows how program evaluation can be used to support sustainability.

Diagnosis and Management of Refeeding Syndrome

Refeeding syndrome (RFS) is described as a syndrome of electrolyte abnormalities and changes in body fluids with metabolic abnormalities in malnourished patients who receive refeeding either orally, enteral, or parenterally. Patients at risk for RFS are patients who have lost 10% of their previous body weight in the last 3-6 months, cancer patients who are on chemotherapy, geriatric patients with malnutrition, and patients with anorexia. Clinical manifestations are caused by electrolyte changes that affect neurons, heart and muscle disorders with various symptoms, and even death. The specific characteristics of RFS are the presence of hypophosphatemia and accompanied by other symptoms of electrolyte imbalance such as changes in sodium levels, changes in glucose, protein, fat metabolism, vitamin B1 deficiency, hypokalemia, and hypomagnesemia. The principle of management of RFS is to correct biochemical abnormalities and electrolyte and fluid imbalances. Preventive steps that can be taken are identifying individuals at risk for RFS, monitoring refeeding and administering an appropriate diet regimen.

Electrolyte disturbances in PCR positive COVID-19 patients

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as coronavirus disease 2019 (COVID-19) pandemic agent has converted a worldwide key problem. This virus is extremely infectious between individuals and has expansion quickly. The most usual complaints related to electrolytes associated with COVID-19 are hypernatremia, hyponatremia, hypocalcemia and hypokalemia. The present study aimed to investigate electrolyte disorders in PCR positive COVID-19 patients in Yazd. This cross-sectional study was done from 2020 to 2021. All patients with COVID-19 that their PCR test was positive participated in this study. Age, gender, electrolytes levels and presence or absence of underlying disease were parameters used in this research. Finally, the data were entered into SPSS software version 22 and analyzed. Findings showed that no significant relationship was found between age and changes in sodium levels. No significant association was found between age and changes in potassium levels in individuals. There was a significant correlation between age and changes in calcium levels in patients. No significant relationship was found between age and random blood sugar levels in the studied patients. Changes in electrolyte levels can be a good indicator of the progression of COVID-19. Due to the importance of serum calcium levels, if there is an underlying disease or old age of the patient, calcium rates should be applied to detect the prognosis early and help treat the patient.

Gastroenteritis Rehydration Of children with Severe Acute Malnutrition (GASTROSAM): A Phase II Randomised Controlled trial: Trial Protocol

Background: Children hospitalised with severe acute malnutrition (SAM) are frequently complicated (>50%) by diarrhoea ( ≥3 watery stools/day) which is accompanied by poor outcomes. Rehydration guidelines for SAM are exceptionally conservative and controversial, based upon expert opinion. The guidelines only permit use of intravenous fluids for cases with advanced shock and exclusive use of low sodium intravenous and oral rehydration solutions (ORS) for fear of fluid and/or sodium overload. Children managed in accordance to these guidelines have a very high mortality. The proposed GASTROSAM trial is the first step in reappraising current recommendations. We hypothesize that liberal rehydration strategies for both intravenous and oral rehydration in SAM children with diarrhoea may reduce adverse outcomes. Methods An open Phase II trial, with a partial factorial design, enrolling Ugandan and Kenyan children aged 6 months to 12 years with SAM hospitalised with gastroenteritis (>3 loose stools/day) and signs of moderate and severe dehydration. In Stratum A (severe dehydration) children will be randomised (1:1:2) to WHO plan C (100mls/kg Ringers Lactate (RL) with intravenous rehydration given over 3-6 hours according to age including boluses for shock), slow rehydration (100 mls/kg RL over 8 hours (no boluses)) or WHO SAM rehydration regime (ORS only (boluses for shock (standard of care)). Stratum B incorporates all children with moderate dehydration and severe dehydration post-intravenous rehydration and compares (1:1 ratio) standard WHO ORS given for non-SAM (experimental) versus WHO SAM-recommended low-sodium ReSoMal. The primary outcome for intravenous rehydration is urine output (mls/kg/hour at 8 hours post-randomisation), and for oral rehydration a change in sodium levels at 24 hours post-randomisation. This trial will also generate feasibility, safety and preliminary data on survival to 28 days. Discussion. If current rehydration strategies for non-malnourished children are safe in SAM this could prompt future evaluation in Phase III trials.

Gastroenteritis Rehydration Of children with Severe Acute Malnutrition (GASTROSAM): A Phase II Randomised Controlled trial: Trial Protocol.

Background: Children hospitalised with severe acute malnutrition (SAM) are frequently complicated (>50%) by diarrhoea ( ≥3 watery stools/day) which is accompanied by poor outcomes. Rehydration guidelines for SAM are exceptionally conservative and controversial, based upon expert opinion. The guidelines only permit use of intravenous fluids for cases with advanced shock and exclusive use of low sodium intravenous and oral rehydration solutions (ORS) for fear of fluid and/or sodium overload. Children managed in accordance to these guidelines have a very high mortality. The proposed GASTROSAM trial is the first step in reappraising current recommendations. We hypothesize that liberal rehydration strategies for both intravenous and oral rehydration in SAM children with diarrhoea may reduce adverse outcomes. Methods An open Phase II trial, with a partial factorial design, enrolling Ugandan and Kenyan children aged 6 months to 12 years with SAM hospitalised with gastroenteritis (>3 loose stools/day) and signs of moderate and severe dehydration. In Stratum A (severe dehydration) children will be randomised (1:1:2) to WHO plan C (100mls/kg Ringers Lactate (RL) with intravenous rehydration given over 3-6 hours according to age including boluses for shock), slow rehydration (100 mls/kg RL over 8 hours (no boluses)) or WHO SAM rehydration regime (ORS only (boluses for shock (standard of care)). Stratum B incorporates all children with moderate dehydration and severe dehydration post-intravenous rehydration and compares (1:1 ratio) standard WHO ORS given for non-SAM (experimental) versus WHO SAM-recommended low-sodium ReSoMal. The primary outcome for intravenous rehydration is urine output (mls/kg/hour at 8 hours post-randomisation), and for oral rehydration a change in sodium levels at 24 hours post-randomisation. This trial will also generate feasibility, safety and preliminary data on survival to 28 days. Discussion. If current rehydration strategies for non-malnourished children are safe in SAM this could prompt future evaluation in Phase III trials.

Holmium laser enucleation of the prostate vs monopolar transurethral resection of the prostate in management of benign prostatic hyperplasia

Objective The aim was to compare the efficacy, safety, and cost-effectiveness of holmium laser enucleation of the prostate (HoLEP) vs monopolar transurethral resection of the prostate (TURP) in the management of benign prostatic hyperplasia. Materials and methods Between February 2018 and February 2020, 70 patients who underwent surgical treatment for benign prostatic hyperplasia were randomized into two equal groups, representing HoLEP and monopolar TURP. All the patients were assessed preoperatively and followed up for 12 months postoperatively. The primary preoperative and postoperative parameters were the international prostate symptom score (IPSS) and maximum urine flow rate (Qmax), whereas the secondary parameters were operative time, resected volume, postoperative drop in hemoglobin level, postoperative change in sodium level, postoperative catheterization time, duration of hospital stay, and postvoiding residual urine. All complications were recorded. Cost analysis was evaluated. Results A total of 60 patients (30 HoLEP and 30 TURP) of the initial 70 patients completed our study. Mean baseline prostate sizes were similar in both groups. HoLEP group had longer operative time of 80 min compared with 60 min in the TURP group. HoLEP was associated with shorter postoperative catheter time and hospital stay compared with those of TURP group. There were no statistically significant differences between both groups regarding perioperative parameters such as resected volume, hemoglobin drop, and sodium level drop. Moreover, postoperative international prostate symptom score, Qmax, postvoiding residual urine, prostatic specific antigen, and quality of life were comparable in both groups. There was no statistically significant difference between both groups regarding postoperative complications. Regarding cost analysis, HoLEP was more cost-effective than TURP. Conclusion Both HoLEP and monopolar TURP are safe and effective. However, HoLEP has shorter catheterization time and hospital stay and was more cost-effectiveness but had longer operative time than monopolar TURP.

Clinico-Biochemical Study of the Safety and Tolerability of Selective Serotonin Reuptake Inhibitors (SSRI) with Special Reference to SSRI Induced Hyponatremia in Humans and Animals

Introduction: Selective Serotonin Reuptake Inhibitors (SSRIs) are recommended as first-line anti-depressants in Major Depressive Disorder (MDD) because of their relatively benign safety profile. Hyponatremia is under reported and notorious adverse effect of SSRIs shown by few Randomised Clinical Trials (RCTs). There are only few published studies of SSRIs on serum sodium level in human and animal model. Aim: To determine SSRI induced hyponatremia in human and its correlation with age. Materials and Methods: The clinical part is a prospective cohort study whereas second part is experimental study involving animals. In clinical part-Patients of either sex, aged above 18 years, attending the Out-Patient Department (OPD) of Psychiatry of a tertiary hospital and diagnosed as MDD Diagnostic and Statistical Manual (DSM) V with the help of a senior psychiatrist, were screened and recruited in the study after satisfying the inclusion and exclusion criteria by consecutive sampling. Patients were prescribed fluoxetine (n=90), sertraline (n=55), paroxetine (n=30) and escitalopram (n=25). Parameters recorded (serum sodium) at baseline, 4th week, 8th week and 12th week. Symptoms due to hyponatremia and Adverse Drug Reactions (ADR) were also checked. Multiple group comparison at different visits for sodium level was done using one-way ANOVA and repeated measures ANOVA test and relationship of blood sodium level with age were estimated with bivariate correlation. Animal experiment was done in Pharmacology Department, animals were randomised into 5 groups control, fluoxetine, sertraline, paroxetine and escitalopram (n=6). Blood sodium checked at baseline, 2nd week and 4th week. Kruskal Wallis test and Friedman’s test done to detect changes in sodium level in follow-up period. Results: Mean age ranged between 40-50 years with equal gender distribution. Both within group and between group analysis revealed significant difference in blood sodium level (p-value&lt; 0.0001). Hyponatremia was strongly correlated with age (correlation coefficient &gt;-0.783). Most participants (184 out of 200) developed asymptomatic hyponatremia. Two among sertraline developed seizure leading to discontinuation to therapy. About 72 (38.09%) ADRs belonged to probable, mostly belonging to fluoxetine and sertraline group, developement of hyponatremia was 9 days (median) from starting SSRI. In animal part within group analysis revealed significant change of sodium from baseline in all drug treated animals (p-value&lt;0.0001). Conclusion: SSRI is associated with hyponatremia and is common in elderly patients. Monitoring of serum sodium is necessary for patients on SSRI.

(PSEUDO)HYPONATREMIA SECONDARY TO LIPOPROTEIN X

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Hyponatremia can be associated with clinically significant disease and often portends worse outcomes, significant hospital morbidity, increased length of stay and hospital cost.[1] Pseudohyponatremia, may be a culprit in overusing hospital resources and unnecessary workup. Here we present a case of altered mental status (AMS) thought initially to be due to hyponatremia. CASE PRESENTATION: A 58 year-old Caucasian male with a history of glioblastoma multiforme (GBM) treated with resection, radiation and temozolomide, on chronic tube feeds (TF) through gastrostomy tube presented with two weeks of AMS. The spouse reported maintenance of TF but was unsure of how much free water she was actually giving. The patient’s exam was significant for blood pressure of 89/60 mmHg, tachycardia at 101 beats per minute, he had lethargy with response to painful stimuli, significant scleral icterus, dry mucous membranes with no gross motor deficits and unremarkable lung and cardiac exams. His workup was significant for sodium of 120 mmol/L, blood urea nitrogen of 48 mg/dL, creatinine of 1.5 mg/dL, direct hyperbilirubinemia of 47 mg/dL (thought to be due to hepatic injury from temozolomide), aspartate aminotransferase of 1,025 U/L, alanine aminotransferase of 595 U/L, alkaline phosphatase of >1,200 U/L, undetectable ammonia level and a negative drug screen. He was started on intravenous fluids and lactulose without any clinical improvement and minimal change in sodium levels. Further workup showed a serum osmolality of 315 mOs/kg (which pointed towards a pseudohyponatremia picture), triglycerides of 343 mg/dL, cholesterol of 1,652 mg/dL, LDL of 24 mg/dL. Full lipoprotein profile and lipid electrophoresis identified lipoprotein X (LpX) which accounted for the observed pseudohyponatremia. MRI head showed possible recurrent GBM without intracranial shift, thought to be the culprit behind his AMS. DISCUSSION: LpX appears in the serum secondary to cholestasis. It is a result of reflux of bile acid into the serum that combines with albumin to form LpX. It is also composed of small amounts of triglycerides, free cholesterol and apolipoprotein C.[2] Interestingly, LpX was not found to be associated with ischemic heart disease. This is thought to be due to a particle size of 18-25 nm, which prevents it from incorporating into the endothelium. It may even be protective against LDL induced atherosclerosis as it decreases LDL oxidation.[3] Thus, lipid lowering medication may not be needed. It is important to note that LpX may cause a hyperviscosity syndrome and could require lipopheresis. CONCLUSIONS: Our case highlights LpX as a rare cause of pseudohyponatremia and the importance of differentiating between true hyponatremia and pseudohyponatremia to avoid unnecessary workup and therapy that may increase morbidity and length of hospital stay. Physicians should be aware of this entity and include it in future practice. Reference #1: Corona G, Giuliani C, Parenti G, et al. The Economic Burden of Hyponatremia: Systematic Review and Meta-Analysis. Am J Med. 2016;129(8):823-835.e4. doi:10.1016/j.amjmed.2016.03.007 Reference #2: Fellin R, Manzato E. Lipoprotein-X fifty years after its original discovery. Nutr Metab Cardiovasc Dis. 2019;29(1):4-8. doi:10.1016/j.numecd.2018.09.006 Reference #3: Chang PY, Lu SC, Su TC, et al. Lipoprotein-X reduces LDL atherogenicity in primary biliary cirrhosis by preventing LDL oxidation. J Lipid Res. 2004;45(11):2116-2122. doi:10.1194/jlr.M400229-JLR200 DISCLOSURES: No relevant relationships by Youssef Abouleish, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $5001 - $20000 Added 04/01/2020 by Joshua Sill, source=Web Response, value=Honoraria

Changes in sodium levels of processed foods among the International Food and Beverage Association member companies in Australia: 2013–2017

Excess dietary sodium is a modifiable cause of high blood pressure. The World Health Organization has targeted a 30 % reduction in mean population sodium consumption by 2025. In 2008, members of the International Food and Beverage Alliance (IFBA) made commitments to lower sodium content in their products. The aim of this study was to determine recent changes in sodium levels between 2013 and 2017 in foods and beverages produced by companies that are IFBA members (n = 10) and non-IFBA members (n = 6) that were included in the 2018 Global Access to Nutrition Index operating in Australia. Independent Samples t-tests and Mann Whitney U tests were used to test the differences in sodium levels. There was no clear difference in sodium content between 2013 and 2017 detectable for the IFBA members (mean difference 17 mg/100 g, 95 % confidence interval (CI), –82 to +48; p = 0.612; median difference 27 mg/100 g, p = 0.582). For the non-IFBA companies there was a decrease in median sodium content (−30 mg/100 g; P = 0.002) but not mean sodium content (−52 mg/100 g, 95 % CI −106 to +3; p = 0.064). Sodium reduction in IFBA companies appear to have had slow progress in Australia. Stronger implementation and monitoring programs are needed to drive industry action.

Continuous veno-venous hemofiltration in the treatment of severely burned patients with acute hypernatremia: A retrospective study of 13 cases.

This study aimed to evaluate the clinical effects of continuous veno-venous hemofiltration in the treatment of severely burned patients with acute hypernatremia. A total of 13 severely burned patients with acute hypernatremia admitted to Xijing Hospital were included in this study. All patients received continuous veno-venous hemofiltration treatment in addition to conventional treatment. The original sodium level in the replacement fluid was set to be lower than the serum sodium level by 8 mmol/L and subsequently undergoes a reduction rate of 2.16 ± 0.18 mmol/L every 4 h. Patients' clinical features, serum laboratory tests, hemodynamic variables, changes in sodium levels in serum, and replacement fluid during continuous veno-venous hemofiltration treatment were monitored. Patients had an average total burn surface area of 66.69% ± 20.28%. Two patients died of systematic Pseudomonas aeruginosa infections, and 11 patients survived. After continuous veno-venous hemofiltration treatment, patients showed a significant reduction in the serum sodium level (168.91 ± 4.88 mmol/L vs 144.62 ± 2.98 mmol/L, p < 0.01). Likewise, the serum levels of urea and creatinine decreased from 24.8 ± 6.5 mmol/L to 14.9 ± 8.3 mmol/L and from 278.6 ± 155.3 μmol/L to 152.6 ± 29.7 μmol/L, respectively (p < 0.05). The patients also displayed improvements in the Acute Physiology and Chronic Health Evaluation II and Glasgow scores (p < 0.05) and showed a significant reduction in hemoglobin and serum albumin levels (p < 0.05), but no obvious change in levels of platelets, alanine aminotransferase, and aspartate aminotransferase (p > 0.05). Our results indicate that continuous veno-venous hemofiltration with gradient sodium replacement fluid is effective in treating hypernatremia in severely burned patients with the controllable sodium reduction rate and satisfactory clinical outcomes.

Abstract 109: Changes in Plasma Renin Activity After Renal Denervation in the Spyral Htn-Off Med Trial

Results from recent sham-controlled clinical trials demonstrate the efficacy of renal denervation (RDN) in blood pressure reduction, however the effects of RDN on the renin-angiotensin system are not clear. We sought to evaluate changes in plasma renin activity (PRA) and serum sodium levels after RDN in the absence of anti-hypertensive medications in the SPYRAL HTN-OFF MED trial. SPYRAL HTN-OFF MED is a randomized, sham-controlled trial to evaluate the impact of RDN in the absence of anti-hypertensive medications. Patients were enrolled with an office systolic BP (SBP) ≥150 and &lt;180 mmHg, office diastolic BP ≥90 mmHg, and a mean 24-hour SBP ≥140 and &lt;170 mmHg. Patients were randomized 1:1 to RDN with the SYMPLICITY Spyral™ catheter (N=38) or sham procedure (N=42). PRA and serum sodium levels were measured at baseline and 3 months post-procedure. Changes were expressed using medians and interquartile ranges and compared between groups using the Mann-Whitney U-test. Change in PRA from baseline to 3 months was significantly greater for the RDN group (n=23) -0.15 ng/mL/h [-0.76, -0.02] compared to the sham control group (n=33) 0.02 ng/mL/h [-0.16, 0.16]; p=0.018 ( Figure ). Comparison of 3-month changes in PRA using a Wilcoxon test stratified by 3 equal groups of baseline PRA also found a significant difference between groups (p=0.033). Changes in sodium levels were similar between groups: 0 mmol/L [-2, 2] (RDN, N=37) vs. 0 mmol/L [-1, 1] (control, N=41), p=0.920). In this sham-controlled feasibility trial, renal denervation was associated with a reduction in PRA but no difference in serum sodium levels was observed. The impact on sodium excretion will need to be assessed in future studies.

The Science of Salt: A global review on changes in sodium levels in foods.

This review aims to summarize and synthesize studies reporting on changes in sodium levels in packaged food products, restaurant foods, and hospital or school meals, as a result of salt reduction interventions. Studies were extracted from those published in the Science of Salt Weekly between June 2013 and February 2018. Twenty-four studies were identified: 17 assessed the changes in packaged foods, four in restaurant foods, two in hospital or school meals, and one in both packaged and restaurant foods. Three types of interventions were evaluated as part of the studies: voluntary reductions (including targets), labeling, and interventions in institutional settings. Decreases in sodium were observed in all studies (n=8) that included the same packaged foods matched at two time points, and in the studies carried out in hospitals and schools. However, there was little to no change in mean sodium levels in restaurant foods. The pooled analysis of change in sodium levels in packaged foods showed a decrease in sodium in unmatched food products (-36mg/100g, 95% CI -51 to -20mg/100g) and in five food categories-breakfast cereals, breads, processed meats, crisps and snacks, and soups. Twenty-two of the 24 studies were from high-income countries, limiting the applicability of the findings to lower resource settings.