Common Electrolyte Abnormality Research Articles

#1926 Persistence to first- and second- generation potassium binder treatment—an observational study based on the DEMONSTRATE database

Abstract Background and Aims Hyperkalemia (HK) is a common electrolyte abnormality mainly caused by reduced renal potassium excretion in patients with chronic kidney disease (CKD). Potassium binders, such as sodium polystyrene sulfonates (SPS) are widely used but may lead to adverse gastrointestinal (GI) symptoms, reducing their tolerability. Patiromer and sodium zirconium cyclosilicate (SZC) are newer ion exchange resins for treatment of HK which may cause fewer GI side-effects. This study aims to evaluate the persistence to first- (SPS) and second-generation potassium binder (patiromer and SZC) treatment and the related clinical characteristics. Method In this observational study based on the DEMONSTRATE database, a novel national and regional database comprising laboratory data from six regions in central Sweden (18% of the Swedish population), linked to the national health registry data, we selected all patients in Sweden having at least one pharmacy dispensation of either first (SPS) or second (patiromer or SZC) generation potassium binder between July 2005 and December 2022. By semi-automatically interpreting the prescribed dosages in combination with the amount of medical supply, duration for each dispensation was estimated and episodes of potassium binder treatments were established. For all potassium binder episodes, we described patient characteristics and persistence to treatment. Results are mainly presented by treatment episodes and by strata of (a) all, (b) first and (c) second generation potassium binders. Results Between July 2005 and December 2022, we identified 68 133 treatment episodes of potassium binders for 32 424 patients (Table 1). Of these, 31 730 individuals and 66 309 treatment episodes were attributed to first generation (throughout the study period), and 1,276 individuals and 1,824 treatment episodes to second-generation potassium binders (between 2018-2022) Mean (SD) age was slightly lower in patients initiating second compared to first generation potassium binders; 68.5 (15.6) vs 65.2 (16.6) years. Potassium binder treatment was more common in men compared to women (66.9% vs. 33.1%) with similar gender distribution between first- and second-generation potassium binders. Comorbidities were more common in patients initiating treatment with second than first generation potassium binders, notably for heart failure (40.0% vs. 29.7%) and dialysis (38.8% vs 29.2%). RAASi and MRA were more often prescribed to the second generation potassium binders vs first; 70.8% vs 62.9% for RAASi and 18.8% vs. 8.5% for MRA. Second generation potassium binders were more commonly initiated in cardiology/internal medicine units (41.7% vs. 34.8%) and dialysis (38.8% vs. 29.2%). Persistence was higher among patients treated with second generation potassium binders (Fig. 1). Conclusion Second generation potassium binders were more often prescribed to younger patients that had more co-morbidities being slightly more persistent to treatment when compared to patients on first generation potassium binders.

A case of hyponatraemia cured by delivery

Hyponatraemia is the most common electrolyte abnormality in pregnancy. In severe cases, it can result in significant maternal and fetal morbidity and mortality. The prevalence of hyponatraemia in pregnancy has been estimated to be 0.27%, with the major causes being hyperemesis gravidarum in the first half and preeclampsia in the latter half of pregnancy. Pregnancy-specific causes of the syndrome of inappropriate antidiuretic hormone release include preeclampsia, prolonged labour, caesarean section, postpartum haemorrhage, cortisol deficiency and oxytocin. Excess water intake can also lead to hyponatraemia during labour, a period of excess antidiuretic hormone secretion. A case of idiopathic severe hyponatraemia with biochemistry consistent with inappropriate antidiuretic hormone secretion progressing during the third trimester with rapid spontaneous resolution post-partum is presented.

Hyperkalaemia in bleeding trauma patients: A potential marker of disease severity – A retrospective cohort study

BackgroundHyperkalaemia is a common electrolyte abnormality seen in critically ill patients. In haemorrhagic shock, it may contribute to cardiac arrest and has been identified as a potential marker for tissue hypoxia. However, the significance of its role in haemorrhagic shock and its contribution to mortality remains unclear. This study aimed to examine the potential underlying pathophysiology and evaluate the incidence and characteristics of patients with hyperkalaemia on hospital arrival in bleeding trauma patients before transfusions and its mortality. MethodsA retrospective cohort study was conducted on adult patients with traumatic bleeding admitted to a European Major Trauma Centre between January 2016 and December 2021. Patients were classified according to their serum potassium levels on arrival, and relevant clinical parameters between non-hyperkalaemic and hyperkalaemic patients were compared. ResultsAmong the 83 patients in this study, 8 (9.6 %) presented with hyperkalaemia on arrival. The median shock index showed a higher tendency in the hyperkalaemic group. Hyperkalaemia was found to be more common among younger patients who sustained penetrating trauma. Mortality rates were higher in the hyperkalaemic group, but the difference was not statistically significant. ConclusionOur results suggest that hyperkalaemia occurs frequently in bleeding trauma patients on hospital arrival pre-transfusions, indicating a more severe illness. Our findings provide insights into the pathophysiology and characteristics of hyperkalaemia in bleeding trauma patients. Further studies are required to investigate the mechanisms by which hyperkalaemia contributes to mortality in haemorrhagic shock patients.

Abstract TP164: Predisposing Factors and Outcomes of Primary Intracerebral Hemorrhage in Patients Presenting With Hyponatremia

Background: Hyponatremia is the most common electrolyte abnormality seen in intracerebral hemorrhage (ICH) and is associated with a nearly doubled mortality rate and more severe presentations. However, the current literature has not addressed what factors might predispose ICH patients to presenting with hyponatremia or developing it during their hospital stay. The aim of this study was to evaluate the characteristics, comorbidities, and inpatient outcomes prevalent amongst ICH patients with hyponatremia. Methods: A retrospective study was performed for 814 adult patients admitted from January 2011-December 2022 with primary ICH at Stony Brook University Hospital. We recorded sodium and serum chemistry levels throughout admission, medical history, radiographic hematoma volumes, and Modified Rankin Scale (MRS) and Glasgow Coma Scale (GCS) up to 1-year follow-up. Results: Hyponatremia on admission was seen in 79 (9.8%) patients. Another 311 patients (38.3%) developed hyponatremia during their hospital stay. Pre-existing hyponatremia was correlated with a history of diabetes while hyponatremia during stay was correlated with diabetes, liver disease, heavy drinking, and prior valve replacement. Complications such as pneumonia, UTI, or a bloodstream infection were more prevalent in patients with hyponatremia. They also had a longer hospital stay and higher inpatient mortality (χ2(1)=5.176, p=0.023). Patients with hyponatremia had significantly lower GCS values on discharge. A multivariate regression analysis of age, admission MRS, diabetes, liver disease, ICH score, volume, and minimum Na was statistically significant ( R 2=0.255, F(7,704)=34.46, p<0.001). Minimum Na reliably predicted death in this model (β=0.007, p=0.023). Conclusions: Several factors can predispose ICH patients to hyponatremia on presentation or be associated with developing hyponatremia during their hospital stay. This study showed that developing hyponatremia during the hospital stay was associated with worse outcomes at discharge. In addition, hyponatremia can significantly predict inpatient mortality when controlling for ICH severity and common aggravating factors.

Clinical presentation and outcomes in patients with antiphospholipid syndrome-associated adrenal hemorrhage. A multicenter cohort study and systematic literature review

BackgroundAdrenal hemorrhage (AH) can occur in patients with antiphospholipid Syndrome (APS). We aimed to characterize the clinical manifestations, treatments, and outcomes of patients presenting with APS-associated AH (APS-AH) through a retrospective cohort and a systematic literature review (SLR). MethodsWe performed a mixed-source approach combining a multicenter cohort with an SLR of patients with incident APS-AH. We included patients from Mayo Clinic and published cases with persistent positivity for antiphospholipid antibodies and presenting with AH, demonstrated by imaging or biopsy. We extracted demographics, clinical characteristics, laboratory findings, treatment strategies, and outcomes (primary adrenal insufficiency and mortality). We used Kaplan-Meier and Cox models for survival analysis. ResultsWe included 256 patients in total, 61 (24%) from Mayo Clinic and 195 (76%) from the SLR. The mean age was 46.8 (SD 15.2) years, and 45% were female. 69% of patients had bilateral adrenal involvement and 64% presented adrenal insufficiency. The most common symptoms at presentation were abdominal pain in 79%, and nausea and vomiting 46%. Hyponatremia (77%) was the most common electrolyte abnormality. Factors associated with primary adrenal insufficiency were bilateral adrenal involvement at initial imaging (OR 3.73, CI; 95%, 1.47–9.46) and anticardiolipin IgG positivity (OR 3.80, CI; 95%, 1.30–11.09). The survival rate at five years was 82%. History of stroke was associated with 3.6-fold increase in mortality (HR 3.62, 95% CI; 1.33–9.85). ConclusionAH is a severe manifestation of APS with increased mortality. Most patients developed permanent primary adrenal insufficiency, particularly those positive for anticardiolipin IgG and bilateral adrenal involvement.

Impact of a Hyperkalemia Protocol Tailored to Glucose Concentration and Renal Function on Insulin-Induced Hypoglycemia in Patients with Low Pretreatment Glucose

BackgroundHyperkalemia is a common electrolyte abnormality that requires urgent treatment. Insulin is an effective treatment for hyperkalemia, but risk factors for developing insulin-induced hypoglycemia exist (e.g., low pretreatment glucose or renal impairment). ObjectiveThis study evaluated the impact of a hyperkalemia protocol tailored to glucose concentration and renal function on insulin-induced hypoglycemia. MethodsThis was a retrospective cohort study of emergency department patients with glucose ≤ 100 mg/dL treated with insulin for hyperkalemia. The primary outcome was incidence of hypoglycemia in patients treated prior to (July 1, 2018–June 30, 2019) vs. after (January 1, 2020–December 31, 2020) the protocol update, which individualized insulin and dextrose doses by glucose concentration and renal function. Secondary outcomes included change in potassium and protocol safety. We assessed factors associated with hypoglycemia using multiple logistic regression. ResultsWe included 202 total patients (preimplementation: 114, postimplementation: 88). Initial insulin dose was lower in the postimplementation group (p < 0.001). We found a nonsignificant reduction in hypoglycemia in the postimplementation group (42.1% vs. 30.7%, p = 0.10). Degree of potassium reduction was similar in patients who received insulin 5 units vs. 10 units (p = 0.72). Higher pretreatment glucose (log odds ratio [OR] −0.05, 95% confidence interval [CI] −0.08 to −0.02) and additional insulin administration (log OR −1.55, 95% CI −3.01 to −0.25) were associated with reduced risk of developing hypoglycemia. ConclusionA hyperkalemia protocol update was not associated with a significant reduction in hypoglycemia, and the incidence of hypoglycemia remained higher than anticipated. Future studies attempting to optimize treatment in this high-risk population are warranted.

Hyponatremia and Identification of Seniors at Risk (ISAR) Score in Geriatric Patients: An Analytical Cross-Sectional Study.

Aim and objective Hyponatremia is the most common electrolyte abnormality in hospitalized patients. Age is an important, strong independent factor for hyponatremia. Geriatric at-risk groups are identified with six straightforward dichotomous questions. The research aims to determine the incidence of hyponatremia and correlate the identification of seniors at risk (ISAR) score with electrolytes in elderly individuals. Materials and methods The 334 geriatric population of elderly men and women were recruited based on age cut-off as more than 70 to 75, 76 to 80, and more than 80. Patients were categorized based on serum sodium levels as severe hyponatremia group A (< 125 mEq/L), moderate hyponatremia B (126 to 130 mEq/L), mild hyponatremia C (131 to 135 mEq/L) and normonatremia D (136 to 145 mEq/L). At the time of admission, the ISAR Tool was utilized to identify the participants with hyponatremia at risk. Electrolytes sodium, potassium, and chloride were analyzed in the Beckman Coulter AU480 autoanalyzer by indirect ISE method. The mean of the data was compared with ANOVA, and the ISAR risk score was correlated with electrolytes by Pearson correlation analysis; p < 0.5 is considered significant. Results and discussion About 16.76 % (56 patients) had severe hyponatremia (Serum sodium 119.14± 4.14 mEq/L) with a high ISARscore (6.0) and were reported as critical alert results by the central laboratory. Based on age-wise category, 70 to 75 yrs had serum sodium levels of 133.82 mEq/L, 76 to 80 yrs had 128.4 mEq/L, and more than 80 years had serum hyponatremia 119.17 mEq/L. Geriatrics with normonatremia had a 1.22 ISAR score, whereas geriatrics with severe hyponatremia had a 6.0 ISAR score. Correlation analysis of the ISAR score revealed a statistically significant negative correlation with sodium (r = - 0.53), potassium (r = - 0.34), and chloride (r = - 0.30) levels. Likewise, the length of hospital stay of the geriatrics with severe hyponatremia was prolonged (19 days), which contributed to the deterioration of health status; thereby, better healthcare follow-up is encouraged. Conclusion Hyponatremia is a critical alert analyte that is common in hospitalized geriatric patients. The ISAR score system points towards the individuals who are at risk and need immediate correction. Thereby, correction of sodium levels and close monitoring of the elderly patient enables quick recovery, and the consequences of hyponatremia are circumvented.

Diagnostic and Therapeutic Strategies to Severe Hyponatremia in the Intensive Care Unit.

Hyponatremia is the most common electrolyte abnormality encountered in critically ill patients and is linked to heightened morbidity, mortality, and healthcare resource utilization. However, its causal role in these poor outcomes and the impact of treatment remain unclear. Plasma sodium is the main determinant of plasma tonicity; consequently, hyponatremia commonly indicates hypotonicity but can also occur in conjunction with isotonicity and hypertonicity. Plasma sodium is a function of total body exchangeable sodium and potassium and total body water. Hypotonic hyponatremia arises when total body water is proportionally greater than the sum of total body exchangeable cations, that is, electrolyte-free water excess; the latter is the result of increased intake or decreased (kidney) excretion. Hypotonic hyponatremia leads to water movement into brain cells resulting in cerebral edema. Brain cells adapt by eliminating solutes, a process that is largely completed by 48 h. Clinical manifestations of hyponatremia depend on its biochemical severity and duration. Symptoms of hyponatremia are more pronounced with acute hyponatremia where brain adaptation is incomplete while they are less prominent in chronic hyponatremia. The authors recommend a physiological approach to determine if hyponatremia is hypotonic, if it is mediated by arginine vasopressin, and if arginine vasopressin secretion is physiologically appropriate. The treatment of hyponatremia depends on the presence and severity of symptoms. Brain herniation is a concern when severe symptoms are present, and current guidelines recommend immediate treatment with hypertonic saline. In the absence of significant symptoms, the concern is neurologic sequelae resulting from rapid correction of hyponatremia which is usually the result of a large water diuresis. Some studies have found desmopressin useful to effectively curtail the water diuresis responsible for rapid correction.

Hyponatremia and takotsubo syndrome: a review of pathogenetic and clinical implications.

Hyponatremia is a common electrolyte abnormality with important prognostic and therapeutic implications. It might exert detrimental effects on various organ systems including the central nervous system (CNS), bone, and heart along with its potential association with poor quality of life. These adverse effects might be largely mediated through a variety of mechanisms including osmotic stress, dysfunctional transmembrane exchangers, and enhanced oxidative stress.Interestingly, hyponatremia might also have an important association with takotsubo syndrome (TTS) that has been universally considered as a reversible form of cardiomyopathy usually emerging in response to various stressors. In this context, severe hyponatremia was previously reported to serve as a direct trigger of TTS evolution largely through its potential impact on CNS and heart. However, pathogenetic and clinical implications of hyponatremia still need to be thoroughly evaluated in patients with TTS. This paper aims to analyze the clinical features of published cases with TTS primarily triggered by hyponatremia and also aims to discuss the association between hyponatremia and TTS from a broader perspective.

Clinical Profile, Laboratory Findings and Outcome of Severe Dengue Infection among Children Admitted at a Tertiary Care Hospital in Bangladesh

Background: Dengue infection is endemic in Bangladesh and presents with varying degrees of severity of illness in children. Objective: The purpose of the present study was to assess the common clinical profile, biochemical findings and outcome of severe dengue fever in children. Methodology: This prospective cohot study was conducted on dengue NS1 or IgM or RT-PCR positive admitted children up to 14 years of age from April 2019 to October 2019 for a period of 6 months at the Pediatrics Department of Evercare Hospital, Dhaka. Data were analyzed after collection of demographic variables, presenting complaints and examination findings of 75 enrolled children. Results: A total of 75 cases were classified as severe dengue fever. The most common age of presentation was 4 to 7 years. The most common presenting symptom of severe dengue cases were fever (97.3%), abdominal pain and vomiting (77.3%) and shock (62.7%). Pleural effusion was the most common physical findings seen in 35 cases (46.6%) followed by ascites in 26 cases (34.7%). Elevation in aspartate amino transaminase AST (IU/L) was found in 82.6%, low albumin was found in 78.7% of the cases. Hypernatremia was the most common electrolyte abnormality found in 35 cases (46.7%). Regarding coagulation profile, raised D-dimer &amp; low fibrinogen were found in 53 (70.7%) &amp; 42 cases (56.0%) respectively. Activated partial thromboplastin time (aPTT) was prolonged in 37.3%. Case fatality rate (CFR) was 5.3%. Conclusion: In conclusion, raised AST and D-dimer, low fibrinogen &amp; albumin level as well as hyponatremia are significant laboratory findings indicating severity of the disease. Shock is a common presentation of severe dengue in children. Bangladesh Journal of Infectious Diseases, December 2022;9(2):40-46

Hyponatremia and Outcome: Is Severity More Important Than Etiology?

Hyponatremia is the most commonelectrolyte abnormality encountered in a hospital setting, and the data regarding the contribution of hyponatremia to overall mortality are conflicting. The study objective was to determine patients' clinical profiles and outcomes with hyponatremia. This prospective cross-sectional study was conducted at Dayanand Medical College and Hospital, Ludhiana, and included 375 adult patients aged more than 18 years with a confirmed diagnosis of hyponatremia. Patients were subdivided into three groups based on the severity of hyponatremia: mild (130-135 mmol/L), moderate (125-129 mmol/L), and profound (<125 mmol/L). The most common symptom was confusion (57.3%) followed by deep somnolence (40%) and nausea (36.8%). The most common cause of hyponatremia was diuretics (30.7%), followed by the syndrome of inappropriate antidiuretic hormone secretion (SIADH) (17.8%) and chronic liver disease (CLD) (14.1%). The severity of hyponatremia did not significantly influence the outcome. Patients with CLD and chronic kidney disease (CKD) as the etiology of hyponatremia had significantly worse outcomes compared to other causes of hyponatremia. The most common type was hypovolemic hypotonic followed by euvolemic hypotonic and hypervolemia hypotonic hyponatremia. Nearly half of the total deaths were observed in the hypervolemic hyponatremia group and were significantly higher compared to the other two groups (p=0.001). Correction of hyponatremia (i.e., serum sodium >135 mmol/L) was significantly linked with good outcomes (p=0.003). Our study showed that the etiology of hyponatremia was a more important prognostic indicator rather than the severity of hyponatremia. Normalization of serum sodium was associated with improved survival.

Clinical profile and prognosis of severe dengue infection in pediatric population admitted to tertiary care hospital

Background: Dengue fever is one of the most important emerging vector-borne viral diseases. Approximately 500,000 out of 100 million cases develop severe dengue infection. Dengue infection is endemic to Bangladesh and presents with varying degrees of severity of illness in Bangladeshi children. Objectives was to assess the common clinical profile, biochemical findings associated with severe dengue fever, and their outcome in children less than 14 years of age. Methods: This was an observational study conducted from April 2022 to October 2022 at the Pediatrics Department of Dhaka Medical College Hospital and Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Results: A total of 150 cases were classified as severe dengue. The most common age of presentation was 6-8 years. The most common presenting symptom was fever (97.3%) followed by abdominal pain and vomiting (77.3%) followed by shock in 94 cases (62.7%) of severe dengue. Pleural effusion was the most common physical finding seen in 70 cases (46.6%) followed by ascites in 52 cases (34.7%). Elevation in aspartate transaminase AST (IU/L) was found in 60.0%, low albumin was found in 78.7% of the cases. Hyponatremia was the most common electrolyte abnormality found in 70 cases (46.7%). Regarding coagulation profile raised D-dimer and low fibrinogen were found in 106 cases (70.7%) and 84 cases (56.0%) respectively. Activated partial thromboplastin time (aPTT) was prolonged in 37.3% of cases. The case fatality rate (CFR) was (5.3%). Conclusions: Abdominal pain and vomiting, shock, as-cities and pleural effusion were dominant features of severe disease. Raised AST and D-dimer, low fibrinogen and albumin level as well as hyponatremia are very significant findings in severe disease. Early suspicion and effective management can reduce the severity.

Hypophosphatemia in Patients With Multiple Myeloma.

Hypophosphatemia is among the most common electrolyte abnormalities, especially among patients with underlying malignancies, and is frequently associated with adverse prognoses. Phosphorus levels are regulated through a number of mechanisms, including parathyroid hormone (PTH), fibroblast growth factor-23 (FGF-23), vitamin D, and other electrolyte levels themselves. Clinically, the findings are nonspecific, and the diagnosis is frequently delayed. This article is a narrative literature review. The PubMed database was searched for relevant articles pertaining to hypophosphatemia causes and consequences in patients suffering from multiple myeloma. We found a variety of causes of hypophosphatemia in patients with multiple myeloma. Tumor-induced osteopenia, although more common among patients with small squamous cell carcinomas, can occur with multiple myeloma as well. Additionally, both light chains themselves and medications can trigger Fanconi syndrome, which leads to phosphorus wasting by the kidney. Bisphosphonates, in addition to being a possible cause of Fanconi syndrome, lead to a decrease in calcium levels, which then stimulates parathyroid hormone (PTH) release, predisposing the patient to significant hypophosphatemia. Additionally, many of the more modern medications used to manage multiple myeloma have been associated with hypophosphatemia.A better understanding of those mechanisms may give clinicians a clearer idea of which patients may need more frequent screening as well as what the potential triggers in the individual patient may be.

A STUDY OF CLINICAL PROFILE OF LEPTOSPIROSIS IN A TERTIARY CARE HOSPITAL

Introduction: Leptospirosis is a zoonotic infection that can be lethal and is common in many tropical areas. It often spreads through huge epidemics following periods of high precipitation and floods. Exposure to infected reservoir host animals either directly or indirectly transmits infection. To study the clinical profile of leptospi Aim: rosis patients admitted in a tertiary care hospital. The present electronic record based retrospective study was co Methods nducted among eighty patients admitted with a diagnosis of leptospirosis at the Saveetha Medical College Hospital for the period of one year between January 2022 and December 2022. A total of 80 patients were included in the study Results . Among the study population 53.75% of the patients were males. The median age of the patients was 41.5 years. Most of the cases presented in the rainy season. In our study. most common symptom was fever (90%). Other symptoms were myalgia (87.5%), headache (41%), Abdominal pain (35%), Vomiting (25%), Loose stools (20%) and Dyspnea (10). Comorbidities in our study population include diabetes mellitus(n=8), systemic hypertension (n=6), coronary artery disease (n=1), hypothyroidism (n=2) and asthma (n=3). Complete hemogram revealed leucocytosis in 60% (n= 48) of the patients leucopenia in 2.5% (n=2), thrombocytopenia in 60% (n= 48) of the patients. Electrolyte abnormalities include hypokalemia (60%) , hyponatremia (40%) and hyperkalemia (n=2). Liver function tests (LFT) was deranged in 47.5% of the patients. Acute kidney injury was found in 27.5% patients (n=22) among which dialysis was needed for six patients. Liver was the most common organ affected followed by kidney. Bleeding manifestations occurred in 20% of the patients. Other complications include septic shock (18.75%) , acute respiratory distress syndrome (15%), encephalopathy (6.25%) and myocarditis (5%). Death occurred in 6.25% (n= 5) of the patients. Eventhough case fatal Conclusion: ity rate in leptospirosis is low, incidence of complications are higher. severe thrombocytopenia is associated with worse outcomes. Hypokalemia and hyponatremia are the most common electrolyte abnormalities. Liver and kidney are the most common organs affected. Incidence of cardiac and pulmonary manifestations leads to fatal outcomes.

AB169. SOH23ABS_236. Multi-factorial hyponatraemia exacerbated by linezolid (case report)

Background: Hyponatremia is a common electrolyte abnormality in the setting of the intensive care unit. Critically ill patients often have multiple factors making them susceptible to hyponatremia. The syndrome of inappropriate antidiuretic hormone (SIADH) secretion is one of the main causes of euvolemic hyponatremia and is often associated with medications. Linezolid is a potent antibiotic against resistant Gram-positive microorganisms. Some studies report an association between hyponatremia and linezolid.

Hyponatremia Is an Overlooked Sign of Trouble Following Total Joint Arthroplasty.

Hyponatremia is a common electrolyte abnormality in arthroplasty patients. This issue, underrecognized by surgeons, can impact the postoperative course of patients. There are, however, little data on the implications of sodium disturbances following total joint arthroplasty (TJA). The primary aims of this study were to (1) report the rate of hyponatremia following TJA, and (2) examine the impact of hyponatremia on the perioperative course of TJA patients. This was a retrospective analysis of 3,071 primary and revision TJAs performed between 2015 and 2017. Based on preoperative and postoperative sodium values (pre-post), patients were classified into 4 groups: normonatremic-normonatremic (Group 1), normonatremic-hyponatremic (Group 2), hyponatremic-normonatremic (Group 3), and hyponatremic-hyponatremic (Group 4). Primary end points were length of stay (LOS), postoperative discharge, in-hospital complications, and 90-day readmissions. The distribution of cases was 84.6% Group 1, 9.4% Group 2, 2.1% Group 3, and 3.8% Group 4. Overall, 13.2% of patients had hyponatremia after TJA. Older age, hip arthroplasty, general anesthesia, higher Charlson Comorbidity Index, congestive heart failure, revision surgery, and history of stroke, liver disease, and chronic kidney disease were risk factors for postoperative hyponatremia. Patients with postoperative hyponatremia (Groups 2 and 4) had greater likelihoods of having a 90-day complication and non-home discharge and greater LOS. Postoperative hyponatremia was a relatively common occurrence in patients undergoing TJA, and was associated with greater LOS, complications, and non-home discharge. Surgeons should identify patients at risk for developing sodium abnormalities in order to optimize these patients and avoid increased resource utilization. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Etiology, Clinical Profile and Outcome of Symptomatic Hyponatremia - A Hospital Based Study

Background: Hyponatremia (serum sodium &lt; 135 mEq/litre) is one of the most common electrolyte abnormalities in hospitalised patients. It is more common in elderly, multi-morbid patients taking multiple medications and in those having lack of access to food and water. Prognosis in such patients depends upon the severity and underlying condition causing it. It therefore becomes imminent to identify the etiology of hyponatremia and also to correct it at an appropriate pace (10-12mEq/litre/day) such that a drastic neurological outcome is averted. Aims and Objectives: To study the clinico-etiological profile in admitted patients of hyponatremia in a tertiary care hospital of North India and their in-hospital outcome. Study Design: A hospital-based observational study. Materials and Methods: A total of 250 patients were studied over a period of 18 months. Detailed clinical and drug history, physical examination, assessment of volume status, routine baseline biochemical parameters, spot urinary sodium followed by paired urine and serum osmolality was done in all patients. Results: The mean age of patients was 62.4 years with a male to female ratio of 1:1.6. GI symptoms like nausea and vomiting was the most common symptom seen in 60% of patients. Commonest neurological complaints were confusion (52%) followed by lethargy (22%), seizures (18%) and coma (8%). Diuretic use was the most common cause of hyponatremia (36%) followed by SIADH (26%) and GI losses (10%). 52% patients were euvolemic, 40% were hypervolemic and 8% were hypovolemic. Mortality in our study was 14%. Conclusion: From our study, we concluded that diuretics are the most common cause of hyponatremia followed by SIADH, with a significant mortality in euvolemic type of hyponatremia. Keywords: Hyponatremia, Diuretics, Euvolemic, Hypervolemic, Hypovolemic, SIADH.

A case of hyponatraemia secondary to vitamin D deficiency

Hyponatraemia and Vitamin D deficiency are common conditions in older adults. Both conditions cause bone fragility and gait abnormalities, which are risk factors for falls and poor health outcomes in older adults. Vitamin D deficiency is a risk factor for osteoporosis and increases the risk for fragility fractures. Hyponatraemia, the commonest electrolyte abnormality, causes bone resorption and contributes to falls by impairing cognition and by causing gait abnormalities. Sodium homeostasis is complex and the syndrome of inappropriate antidiuretic hormone secretion (SIADH), a diagnosis of exclusion, is one of the most common causes of hyponatraemia. Instability is a feared geriatric syndrome, as falls can have devastating consequences for the older adult, leading to significant morbidity and mortality. Previous studies have shown that patients with hyponatraemia had a higher rate of vitamin D deficiency and, conversely, those with vitamin D deficiency had a higher rate of hyponatraemia. The exact pathophysiological mechanism behind this correlation is unclear but may involve bone derived hormone fibroblast growth factor 23 and the renin–angiotensin–aldosterone system. A case of an 83-year-old Asian female, who presented with an osteoporotic intertrochanteric femoral fracture following a fall, is presented. She was found to have chronic hyponatraemia and was subsequently diagnosed with SIADH due to vitamin D deficiency.

Study on Quality of Life and Management of Hyponatremia and Hypertension in Stroke Patients in the Neurology Department of a Tertiary Care Teaching Hospital in South India

A stroke or cerebrovascular accident is an abrupt onset of a neurologic deficit that lasts for at least 24 hours and is mainly of vascular origin. Stroke is one of the leading causes of death and disability in our country and leads to long-term disability and functional dependency. Hyponatremia is one of the common electrolyte abnormalities seen in patients with neurological disorders which may be due to SIADH or CSWS. Hypertension is one of the important risk factors and it is proven that anti-hypertensive therapy can reduce the risk of developing stroke. The various scales that have proved reliability and valid in stroke trials are the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin scale (Mrs), the Barthel index (BI),

Arrhythmias in children with congenital heart defects.

Objective: To find out the prevalence of different types of arrhythmias in children with congenital heart defects (CHDs) presenting at a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha Pakistan. Period: July 2021 to June 2022. Material &amp; Methods: A total of 120 children of both genders aged 1 day to 16 years and presenting to study setting with confirmed CHDs were evaluated. At the time of enrollment, demographical information and disease history were noted. Necessary laboratory investigations like complete blood count and serum electrolytes were analyzed while standard electrocardiography (ECG) was performed. Prevalence of different types of arrhythmias was noted. Results: In a total of 120 children with CHDs, 64 (53.3%) were boys. Mean age was be 2.7±2.1. Most common electrolyte abnormalities were noted to be hyponatremia and hypermagnesemia found in 39 (32.5%) and 26 (21.7%) children respectively. There were 31 (25.8%) children who were diagnosed to have arrhythmias. Out of these 31 children, first degree A-V block was the most common types of arrhythmias observed in 24 (77.4%) cases while ectopic A-V rhythm were found in 3 (9.7%). Conclusion: The findings of this research revealed that arrhythmias are quite common among children having CHDs. There is a need to routine assessment for the possible presence of arrhythmias among children presenting with CHDs.