Common Electrolyte Abnormality Research Articles

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 < 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 & 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.

Sodium bicarbonate and salbutamol facilitate recovery from hyperkalemia-induced electrocardiogram abnormalities in bullfrog hearts.

Hyperkalemia is a common electrolyte abnormality frequently complicated with chronic kidney disease. By injecting potassium chloride (KCl) solutions intravenously into bullfrogs, we reproduced typical electrocardiogram (ECG) abnormalities of hyperkalemia in the frog hearts, such as the peaked T waves and the widening of QRS complexes. Simultaneous recordings of cardiac action potentials showed morphological changes that synchronized with those of ECG. After 100 mM KCl injection, the widened QRS complexes continued for a while and gradually restored to their baseline widths. However, pre-treatment with sodium bicarbonate or salbutamol, which directly or indirectly stimulates Na+/K+-ATPase activity, significantly facilitated the recovery from the widened QRS duration, indicating the transcellular movement of potassium ions from the extracellular fluid into the intracellular stores.

An observational study on the effectiveness of tolvaptan in patients with euvolemic and hypervolemic hyponatremia admitted to a tertiary care center

Background: Hyponatremia is a common electrolyte abnormality encountered in hospital wards. Even mild hyponatremia can result in significant morbidity and mortality especially in elderly. Treatment of the condition depends on the volume status of the patient, duration and severity of hyponatremia, and clinical condition of the patient. Aims and Objectives: Tolvaptan is an oral vasopressin receptor antagonist approved for use in euvolemic and hypervolemic hyponatremia. The present study aimed to assess the effectiveness and safety of tolvaptan 15 mg daily for 3 days in patients with euvolemic and hypervolemic hyponatremia. Materials and Methods: This study was a prospective observational study conducted on 82 patients with euvolemic and hypervolemic hyponatremia in whom tolvaptan was given in the Department of General Medicine in a tertiary care teaching hospital in south India. History, clinical examination findings, and baseline laboratory values were recorded in the structured proforma. Serum sodium levels were done daily along with other laboratory parameters such as renal function test, serum electrolytes, liver function tests, and random blood sugar. The rise in serum sodium level and the occurrence of overcorrection was noted. Adverse effects developing during treatment were recorded. Results: By day 3, 27% of patients achieved normonatremia and hence tolvaptan was stopped after 2 doses. By day 4, 84% of patients who took tolvaptan achieved normonatremia. Overly rapid correction of hyponatremia was observed in 9.8% of patients. There was a significant correlation between day 1 sodium and day 4 sodium as well as day 1 sodium and total correction. The mean increase in serum sodium with 3 doses of tolvaptan was 18.24 mEq/L with a P < 0.0001. The adverse events during the study period were mild and included increased thirst, dry mouth, and polyuria. There was no significant change in transaminase levels during treatment. Conclusion: Tolvaptan is highly effective in increasing serum sodium level in hyponatremia with minimal adverse effects. The risk of an overly rapid correction is present with its use and is more in severe hyponatremia. This can be minimized by frequent monitoring of sodium level and ensuring adequate fluid intake.

Safety and Efficacy of Patiromer in Hyperkalemic Patients with CKD: A Pooled Analysis of Three Randomized Trials.

Hyperkalemia is a common electrolyte abnormality in patients with CKD, which is associated with worse outcomes and limits use of renin-angiotensin-aldosterone system inhibitors (RAASi). This post hoc subgroup analysis of three clinical trials evaluated the efficacy and safety of the sodium-free, potassium-binding polymer, patiromer, for the treatment of hyperkalemia in adults with nondialysis CKD. Data from the 4-week treatment periods of AMETHYST-DN, OPAL-HK, and TOURMALINE studies were combined. Patients had baseline diagnosis of CKD, hyperkalemia (serum potassium >5.0 mEq/L), and received patiromer 8.4-33.6 g/day. Patients were stratified by baseline eGFR into two subgroups: severe/end-stage CKD (stage 3b-5; eGFR <45 ml/min per 1.73 m2) and mild/moderate CKD (stage 1-3a; eGFR ≥45 ml/min per 1.73 m2). Efficacy was assessed by the change in serum potassium (mean±SE) from baseline to week 4. Safety assessments included incidence and severity of adverse events (AEs). Efficacy analyses (n=626; 62% male, mean age 66 years) included 417 (67%) patients with severe/end-stage CKD and 209 (33%) with mild/moderate CKD. Most patients were receiving RAASi therapy at baseline (severe/end-stage CKD 92%; mild/moderate CKD 98%). The mean±SE change in serum potassium (baseline to week 4) was -0.84±0.03 in the severe/end-stage CKD subgroup, and -0.60±0.04 mEq/L in the mild/moderate CKD subgroup. AEs were reported for 40% and 27% patients in the severe/end-stage and mild/moderate CKD subgroups, respectively, with 16% and 12% reporting AEs considered related to patiromer. The most frequent AEs were mild-to-moderate constipation (8% and 3%) and diarrhea (4% and 2%). AEs leading to patiromer discontinuation occurred in 6% and 2% of patients with severe/end-stage CKD, and mild/moderate CKD, respectively. Patiromer was effective for treatment of hyperkalemia and well tolerated in patients across stages of CKD, most of whom were receiving guideline-recommended RAASi therapy.

The electrolyte abnormalities and duration of hospitalisation in children with gastroenteritis

Background: Diarrhoea remains one of the major causes of death among infants significantly in Asia, Africa and Latin America. The major contributing factors for higher incidence and mortality rates are improper sanitation, unsafe drinking water, physiological conditions like malnutrition, weak immune system.Rotavirus is the major causative agent of diarrhoea in young children in developed and undeveloped countries. Electrolyte abnormalities is the leading causes of morbidity and mortality in younger children with acute gastroenteritis and increased mortality is seen in malnourished children. The common abnormalities associated with acute gastroenteritis are hyponatremia and hypokalaemia. The average duration of hospital stay is 2.5 days.Methods: This is a descriptive cross-sectional study which studied 173 patients of acute gastroenteritis which have been admitted to the CMC, Tehran in 1 year. (June 2021-May2022).Results: In this study 173 patients were studied. 101 patients (58.4%) were infants, 55 patients (31.8%) were preschool children and 17 patients (9.8%) were older children. 70 patients (40.5%) were females and 103 patients (59.5%) were males. The most common electrolyte abnormality that was encountered in this study is hyponatremia (51.4%) &gt;hypokalaemia (11.6%) &gt;hypernatremia (6.9%) &gt;hyperkalaemia (1.2%).Conclusions: The order of electrolyte abnormalities seen: Hyponatremia (51.4%), hypokalaemia (11.6%), hypernatremia (6.9%), hyperkalaemia (1.2%). Duration of hospitalisation is 1 day for majority of the patients and is high for patients with hyponatremia.

Hyponatremia in Patients Admitted to Intensive Care Unit of a Tertiary Center: A Descriptive Cross-sectional Study.

Hyponatremia is one of the common electrolyte abnormalities in intensive care unit settings. Hyponatremia may lead to an increased hospital stay, morbidity and mortality. Hyponatremia can occur due to a variety of iatrogenic as well as part of complex disease processes during hospital admission. The objective of this study was to find the prevalence of hyponatremia in patients admitted to the intensive care unit of a tertiary care centre. A descriptive cross-sectional study was conducted in the intensive care unit of a tertiary care centre for a duration of six months from 12 August 2015 to 11 January 2016. Ethical approval was taken from the Institutional Review Committee (Reference number: 124/6-11-E/072/073). Data was collected from hospital records. Patients with abnormal serum sodium levels after admission to the intensive care unit were included in the study. Hyponatremia was defined as a serum sodium level less than 135 mEq/L. Convenience sampling methods were used. Point estimate and 95% Confidence Interval were calculated. Among 102 patients, the prevalence of hyponatremia was found to be 21 (20.59%) (12.74-28.44, 95% Confidence Interval). The prevalence of hyponatremia in patients admitted to the intensive care unit was higher than in other studies conducted in similar settings. cross-sectional study; prevalence; sodium.

Association of Serum Magnesium and Risk of Morbidity and Mortality in ICU-Admitted Patients Based on COVID-19 Infection Classification

Background: Magnesium (Mg) deficiency is a common clinical electrolyte abnormality in critically ill patients, which is related to higher mortality and is easily ignored. Objectives: We aimed to investigate the association of Mg levels with mortality and comorbidity in patients admitted to the intensive care unit (ICU) based on COVID-19 infection classification. Methods: A total of 69 patients admitted to the ICU of Shahid Mohammadi Hospital, Bandar Abbas, Iran, from June to December 2021were included in the present study. The serum Mg was measured in these patients. Data from sequential organ failure assessment (SOFA), acute physiologic assessment and chronic health evaluation (APACHE), ICU stay length, mechanical ventilation duration, mortality, and comorbidity were determined. Moreover, the COVID-19 infection was detected by PCR. Results: The mean ± SD age of patients (34.8% male) was 52.56 ± 16.43 years. Out of 69 patients, 18 (26.1%) died during hospitalization, and 24 (34.8%) required mechanical ventilation. The prevalence of COVID-19 was 39.1% (27 patients). Our results showed no difference in serum Mg between patients based on mortality and comorbidity status. However, the Mg level of patients with kidney failure was significantly higher than patients without kidney failure (P &lt; 0.05). Based on the COVID-19 classification, there was only a positive correlation between hypomagnesemia and the length of ICU hospitalization in patients without COVID-19 (P &lt; 0.05). Conclusions: Our findings showed no difference in the Mg levels of patients based on mortality status. Patients with kidney failure had higher serum Mg than those without kidney failure. Furthermore, our results showed no difference in the Mg levels of critically ill patients based on COVID-19 infection status.

Mucormycosis, Diabetes and COVID-19 Pneumonia: Unleashing the Facts.

BackgroundMucormycosis (MM) is an angioinvasive locally destructive fungal infection. Before the coronavirus disease 2019 (COVID-19) pandemic, it was associated with diabetes (particularly diabetic ketoacidosis), immunosuppressive drugs and trauma. Among its various forms, cerebral invasion is considered to be highly fatal even if with long-term treatment. Treatment with injection amphotericin B (Amph-B) with early surgical interventions is highly efficacious. Liposomal preparation is considered to be superior in the context of fewer side effects.MethodsWe present a single-centre prospective study of 124 patients with MM in a tertiary care hospital. After the approval from the ethics committee, basic information was taken from all patients including all available past history about the COVID-19 infection and treatment. The studied outcomes were discharge, death and number of days of hospitalisation. Secondary objectives were to estimate the association of MM with known risk factors, to find the association of an outcome with various inflammatory markers, to determine adverse events with the use of injection Amph-B and posaconazole and to find the case fatality rate of MM.ResultsIn our study, we observed that the number of patients with MM was double in the less than 60 years age group. However, mortality was 33.3% in the elderly as compared to 15.29% in patients less than 60 years of age. The majority of the patients (69.35%) were males, but no significant difference in mortality was seen between males and females. The case fatality rate was 20.97%. Ocular symptoms such as orbital swelling and pain were the common presenting symptoms. Almost all patients (93.54%) were diabetics. The non-diabetic group consisted of only 8 (6.4%) patients, and therefore, the comparison was not possible. A total of 20 (16%) out of 124 patients who had received high-dose steroids showed higher mortality (55%). Maximum patients (65.32%) had presented with MM following a past COVID-19 infection. However, a significant number of MM patients (20.96%) had a recent COVID infection and had higher mortality (57.69%) compared to their counterparts. The most common site of involvement in our study was the paranasal sinus (50%) and the outcome was the best in those patients whose disease was localised only to the sinuses, although among 14 (11.29%) patients with cerebral involvement, mortality was maximum (42.85%). Renal impairment and dyselectrolytemia were the most common adverse effects of Amph-B, and 46.42% of patients required surgical removal of the local part.ConclusionWe saw that diabetes was a major contributory factor in the etiopathogenesis of MM. COVID-19 could also be a major causative factor by impairing the immune system; however, further studies at the molecular level are required to establish an association. The use of steroid cannot be the only independent risk factor, and other associated factors must be present. Treatment with antifungal and early surgical intervention had good outcomes. Treatment with conventional lyophilized Amph-B was equally efficacious as lipid-based solutions, but with more side effects. Hypokalemia and hypocalcemia were the most common electrolyte abnormalities associated with the use of injection Amph-B. Uncontrolled diabetes, the severity of the COVID-19 infection at presentation, acidosis, a high C-reactive protein level (above 100) and local brain involvement were associated with a poor outcome.

Severe hyponatremia due to surreptitious water intoxication in a hospitalized patient.

Hyponatremia is a common electrolyte abnormality among hospitalized patients and often present as first sign of other underlying medical conditions. Severe hyponatremia can be life threatening and requires prompt diagnosis and treatment. We present a case of refractory hyponatremia that was a diagnostic challenge requiring a prolonged hospitalization. Diagnosis of primary polydipsia was ultimately suspected due to improbable 24-h urine studies and confirmed through complete removal of free water access in the form of disconnecting the bathroom faucet in the patient’s hospital room. Diagnosis and management of primary polydipsia is further discussed.

Correlation of electrolyte abnormalities with severity of illness in critically ill patients of NICU and PICU at CRGH and associated hospital of RD Gardi Medical College Ujjain (MP)

Objective: To determine the type of electrolytes abnormalities observed among critically ill patients of NICU and PICU. Material and Methods: A Hospital based prospective and observational study conducted among 99 critically ill patients between 0 to 15 years age. Results: Out of total patients,78 (78.8%) cases had abnormal electrolytes level, and 21(21.2%) cases had normal electrolytes level. 10(12.8%) cases had imbalance of single electrolyte, 17(21.7%) cases had imbalance of two electrolytes, 16(20.5%) cases had imbalance of three electrolytes, and 35(44.8%) cases had imbalance of more than three electrolytes. This shows that majority of patients in PICU had multiple electrolyte (&gt;3) abnormalities. In our study, maximum prevalence is of sodium abnormalities 63(63.6%) followed by potassium abnormalities 50(50.5%). Calcium, Phosphate and Chloride has same prevalence 40(40.3%). Conclusion: Our study findings conclude that maximum prevalence 80.7% is of sodium abnormalities. Hyponatremia is most common electrolyte abnormalities present in 63.5% cases. Early recognition with a thorough understanding of common electrolyte abnormalities and their prompt management definitely pose an implication on the final outcome of the patient. Aggressive &amp; strict adherence to correction of in particular to sodium and potassium before weaning is necessary for successful weaning from ventilator.

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.

Incidence and risk factors of overcorrection in patients presenting with severe hyponatremia to the emergency department.

Hyponatremia is one of the most common electrolyte abnormalities. Overcorrection of severe hyponatremia can result in serious neurological complications such as osmotic demyelination syndrome, but the incidence and risk factors of overcorrection and osmotic demyelination have not been thoroughly investigated. This is a single-center retrospective cohort study of 50 patients admitted through the emergency department with initial serum sodium (serum Na) < 125mEq/L between January 2015 and December 2017. Incidence and risk factors of overcorrection and osmotic demyelination were examined. Overcorrection was defined as an increase in serum sodium concentration > 10mEq/L at 24h and/or > 18mEq/L at 48h, respectively. Six patients (12%) and one patient (2%) had overcorrection at 24h and 48h, respectively. A total of 5 (10%) patients had a brain MRI completed after overcorrection, and no patient showed radiologic evidence of osmotic demyelination. Symptomatic hyponatremia at presentation and 3% saline use were associated with the risk of overcorrection in univariable analysis (p < 0.001; p = 0.006, respectively). Among patients admitted with severe hyponatremia, overcorrection occurred in 14%. Symptomatic hyponatremia at presentation and 3% saline use were associated with the risk of overcorrection.