Correction Of Hyponatremia Research Articles

Benefit of correction of hyponatremia in the acute phase of myocardial infarction

The significant prognostic impact of hyponatremia in patients with heart failure is widely known. However, little data is available regarding its significance in myocardial infarction (MI). Furthermore, it is not known whether correction of hyponatraemia has an impact on outcomes in these patients. The aim of this study was to assess the prognostic value of hyponatremia in patients with myocardial infarction and the effect of its correction on all-cause mortality. Prospective study over 6 months. Inclusion of patients with myocardial infarction and whose serum sodium levels were measured within 24 hours of admission. Multivariate analysis was used to determine predictors of all-cause mortality. In total, 124 patients (61 ± 12 years, men 57%) were included in the study. There were 15 deaths (18.6%) in patients with corrected hyponatremia and 32 deaths (39.6%) in patients with persistent hyponatremia. Multivariate analysis indicated that corrected hyponatremia and persistent hyponatremia were independent predictors of all-cause mortality (P < 0.0001). When analysing short-term (30 days) and long-term mortality, the corrected hyponatraemia group had no associated long-term mortality or rehospitalisation. Persistent, corrected hyponatraemia in patients with MI was predictive of all-cause mortality, major adverse cardiac events, and rehospitalisation due to heart failure. In some cases, correction of hyponatremia may actually improve patient survival.

Clinical, Biochemical, and Outcome Profile of Hyponatremia in Geriatric and Non-Geriatric Individuals Admitted to a Tertiary Care Centre: A Prospective Cohort Study

Introduction: Hyponatremia is one of the most common electrolyte disturbances encountered in medical wards, occurring in up to 22% of hospitalised patients. Timely recognition and correction of hyponatremia in hospitalised patients may help decrease in-hospital mortality and symptom severity, reduce the need for intensive hospital care, decrease the duration of hospitalisation and associated costs, and improve the treatment of underlying co-morbid conditions and patient’s quality of life. Aim: To compare the clinical presentation, aetiology, biochemical profile, management strategies, and outcomes of hyponatremia in geriatric and non-geriatric individuals admitted to a tertiary care centre. Materials and Methods: This prospective cohort study was conducted in the Department of General Medicine at Mahatma Gandhi Medical College and Research Institute, Pondicherry, India, from March 2021 to September 2022. A total of 166 subjects (83 geriatric and 83 non-geriatric patients) receiving inpatient services with hyponatremia were enrolled in the study by consecutive sampling. Patients over 18 years of age admitted to the Department of General Medicine with serum sodium levels below 135 mEq/L were included. Comparison of both the groups were done based on clinical presentation, laboratory values, co-morbidities, prescription drugs taken, aetiology, treatment given, and outcomes. For quantitative variables, mean, standard deviation, and independent t-tests were used, while percentages were used for qualitative variables. Results: The majority of subjects in the non-geriatric group belonged to the age group of 50-59 years, with a mean age of 50.7 years. In the geriatric group, most subjects were in the age group of 65-74 years, with a mean age of 74.5 years. The most common cause of hyponatremia in both groups was Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), with 32 (38.6%) cases in the non-geriatric group and 27 (32.5%) cases in the geriatric group. This was followed by volume overload in the non-geriatric group, with 14 (16.9%) cases, and drug-induced hyponatremia in the geriatric group, with 22 (26.5%) cases. The most common drug causing hyponatremia was furosemide in both groups. In non-geriatric patients, the most common symptom was giddiness, with 28 (34.1%) cases, while in geriatric patients, it was nausea/vomiting, with 25 (30.1%) cases. Tolvaptan was the most common treatment used in both groups, with 12 (92.3%) of patients with mild hyponatremia receiving it in the non-geriatric group (p=0.042), and 46 (55.4%) patients in the geriatric group, with most of them having moderate hyponatremia (26, 86.7%, p&lt;0.001). Conclusion: The results of the non-geriatric and geriatric groups were similar in terms of clinical presentation, biochemical parameters, management strategies, and outcome of hyponatremia. However, the aetiology of hyponatremia appeared to be different. The most common cause of hyponatremia was SIADH in both groups, followed by volume overload in the non-geriatric group and drug-induced hyponatremia in the geriatric group.

Myélinolyse centropontine réversible sans hyponatrémie chez un enfant atteint de leucémie aigue lymphoblastique: à propos d’un cas

Central pontine myelinolysis is a demyelinating disorder mainly affecting the central pons. In some cases, it is associated with extrapontine myelinolysis. It is usually caused by rapid correction of hyponatremia and osmotic shock. We here report the case of a 3.5-year-old girl diagnosed with acute lymphoblastic leukemia admitted to our Oncology Unit with neutropenic fever and diarrhea. Laboratory tests showed mild neutropenia, normochromic normocytic anemia. Electrolyte tests were normal without hyponatremia. She received antibiotic therapy with Metronidazole. Five days later, she developed flaccid quadriparesis with mutism. Computerized tomography (CT) scan was normal, cerebrospinal fluid (CSF) examination was normal (there was no evidence of leukemic cells) and ophthalmological examination did not show any abnormalities. Brain MRI found hyperintense signal in the pons. The child improved without specific treatment, and clinical and complete neurological recovery was noted. This case highlights that myelinolysis can occur under some circumstances not related with hyponatremia such as malignancy, chemotherapy.

Centropontine myelinolysis after rapid correction of hyponatremia: a case report

Centropontine myelinolysis after rapid correction of hyponatremia: a case report

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 &lt; 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.

Association of hyponatremia with bone mineral density and fractures: a narrative review.

Recent studies suggest a possible association of hyponatremia with osteoporosis, falls and bone fractures. The objectives of this narrative review were to further explore this association and the related pathophysiological mechanisms and to suggest a practical approach to patients with osteoporosis or chronic hyponatremia in clinical practice. We conducted an extensive PubMed search until October 2022 with the combination of the following keywords: 'hyponatremia' or 'sodium' or 'SIADH' and 'fractures' or 'bone' or 'osteoporosis', as MeSH Terms. Review of numerous observational studies confirms a significant independent association of, even mild, hyponatremia with two- to three-fold increase in the occurrence of bone fractures. Hyponatremia is a risk factor for osteoporosis with a predilection to affect the hip, while the magnitude of association depends on the severity and chronicity of hyponatremia. Chronic hyponatremia also increases the risk for falls by inducing gait instability and neurocognitive deficits. Besides the detrimental impact of hyponatremia on bone mineral density and risk of falls, it also induces changes in bone quality. Emerging evidence suggests that acute hyponatremia shifts bone turnover dynamics towards less bone formation, while hyponatremia correction increases bone formation. The key unanswered question whether treatment of hyponatremia could improve osteoporosis and lower fracture risk highlights the need for prospective studies, evaluating the impact of sodium normalization on bone metabolism and occurrence of fractures. Recommendations for clinical approach should include measurement of serum sodium in all individuals with fracture or osteoporosis. Also, hyponatremia, as an independent risk factor for fracture, should be taken into consideration when estimating the likelihood for future fragility fracture and in clinical decision-making about pharmacological therapy of osteoporosis. Until it is proven that normalization of sodium can lower fracture occurrence, correcting hyponatremia cannot be universally recommended on this basis, but should be decided on a case-by-case basis.

OSMOTIC DEMYELINATION SYNDROME IN UNUSUAL SETTINGS

Objective: To highlight the occurrence of osmotic demyelination syndrome (ODS) in settings other than the classical ODS induced by rapid correction of hyponatremic states. The background, clinico- radiological features, treatment and outcome of eight ODS patients are discussed here. We encountered eight patients with ODS in Materials and Methods: uncommon clinical settings at the department of neurology, Government Stanley medical college hospital, Chennai between April 2017 to October 2018. Patients were evaluated, investigated, treated and outcome was assessed. Results: Eight patients in the age group 22 to 60 years had ODS. The clinical presentations were diverse. Akinetic mutism was the commonest presenting feature of ODS. Four out of eight patients had hyperglycemia out of which three had diabetic ketoacidosis (DKA) and one was in hyperglycemic hyperosmolar state (HHS). Two patients with chronic kidney disease (CKD) developed myelinolysis following hemodialysis. One patient each in post liver transplant state and following alcohol binge were diagnosed with ODS. Serum sodium levels were in normal range and there was no undue fluctuation in all. Four had central pontine myelinolysis (CPM), three had Extrapontine myelinolysis (EPM) and one had both in Magnetic Resonance Imaging (MRI) of Brain. Background illnesses were addressed. Five patients were independent with mRS of 1 and one patient had mRS of 2 at the end of 3 months and two CKD patients succumbed due to disease per se. ODS commonly occurs in the setting of rapid correction of hyponatremia especially in chronic Conclusion: alcoholics and debilitated individuals. We have described myelinolysis in diabetic ketoacidosis, hyperglycemic hyperosmolar state, Renal failure following dialysis, post liver transplant and alcohol binge drinking where there were no undue fluctuation in sodium levels. The prognosis is variable and also depends on presence of secondary complications like deep venous thrombosis, sepsis and aspiration pneumonitis.

Rapid correction of severe hyponatremia and control of subsequent overcorrection in operative hysteroscopy intravascular absorption syndrome: A case report

Operative hysteroscopy intravascular absorption syndrome (OHIAS) results from systemic absorption of hypotonic solution during hysteroscopy, which may induce severe hyponatremia within hours. Depending on the serum sodium (Na+) level, this can be life-threatening and requires prompt and careful remedial treatment. A 53-year-old woman underwent hysteroscopic myomectomy for submucosal leiomyoma. Approximately 3 hours postoperatively, the serum Na+ level decreased to 82 mM/L, accompanied by pulmonary edema and lactic acidosis. The patient was strongly suspicious of OHIAS. A rapid correction was made using 3% NaCl to prevent brain edema as an initial response. After the serum Na+ level reached 120 mM/L, gradual correction was performed considering osmotic demyelination syndrome, and desmopressin was administered to prevent overcorrection caused by excessive water diuresis. Serum Na+ level normalized in 4 days and the patient recovered without any specific sequelae. The detection of OHIAS may be delayed under general anesthesia, and prior vigilance is important if the operation time is prolonged. In severe hyponatremia with an apparently rapid onset, such as OHIAS, a two-step correction process may be safe and useful: rapid correction followed by more gradual correction.

With a grain of salt; A cautionary reminder. A case report of osmotic demyelination syndrome

Osmotic Demyelination Syndrome (ODS) is a demyelinating disease typically seen in the central pons, often associated with a rapid correction of hyponatraemia.

Severe rhabdomyolysis secondary to rapid correction of hyponatremia in a patient with psychogenic polydipsia

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Central and Extrapontine Myelinolysis in the Setting of Hyperglycemia.

Osmotic demyelination syndrome (ODS) was first described by Adams et al. in 1959 as a combination of quadriparesis, pseudobulbar paralysis, and the distinctive myelin loss in the pons, attributable to alcoholism or malnutrition.[1] ODS has since been commonly attributed to rapid correction of chronic hyponatremia. Other reported etiologies include alcohol withdrawal, liver transplantation, hypokalemia, hypernatremia as well as severe hyperglycemia. [2-6] (e1-20) Here, we describe a case of ODS associated with diabetic ketoacidosis (DKA) and review the existing literature on hyperglycemia-related ODS.

WATER INTOXICATION: A CASE OF HYPONATREMIA AND ACUTE RENAL FAILURE

WATER INTOXICATION: A CASE OF HYPONATREMIA AND ACUTE RENAL FAILURE

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

Traumatic brain injurySodiumClinical outcomes.

Correction and Prevention of Hyponatremia in Patients With Cirrhosis and Ascites: Post Hoc Analysis of the ANSWER Study Database.

We assessed the impact of long-term albumin administration to hyponatremic patients with ascites enrolled in the ANSWER trial. The normalization rate of baseline hyponatremia and the 18-month incidence rate of at least moderate hyponatremia were evaluated. The hyponatremia normalization rate was higher with albumin than with standard medical treatment (45% vs 28%, P = 0.042 at 1 month). Long-term albumin ensured a lower incidence of at least moderate hyponatremia than standard medical treatment (incidence rate ratio: 0.245 [CI 0.167-0.359], P < 0.001). Long-term albumin administration improves hyponatremia and reduces episodes of at least moderate hyponatremia in outpatients with cirrhosis and ascites.

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.

Correction and prevention of hyponatremia in patients with cirrhosis and ascites-post hoc analysis of the ANSWER study database

Correction and prevention of hyponatremia in patients with cirrhosis and ascites-post hoc analysis of the ANSWER study database

The impact of the correction of hyponatremia during hospital admission on the prognosis of SARS-CoV-2 infection

BackgroundSARS-CoV-2 infection is frequently associated with hyponatremia (plasma sodium <135 mmol/L), being associated with a worse prognosis. The incidence of hyponatremia is estimated to be 20–37% according to the series, but there are no data on the prognosis after correction of hyponatremia. Therefore, our objectives were: to analyse the incidence and severity of hyponatremia at hospital admission, and to determine the association of this hyponatremia with the prognosis of COVID-19. MethodsObservational and retrospective cohort study. Patients who were admitted with a diagnosis of COVID-19 infection and hyponatremia, in the period March-May 2020, were included. We recorded epidemiological, demographic, clinical, biochemical, and radiological variables of SARS-CoV-2 infection and hyponatremia at the time of diagnosis and during hospitalization. The clinical follow-up ranged from admission to death or discharge. Results91 patients (21.8%) of the 414 admitted for SARS-CoV-2 infection presented hyponatremia (81.32% mild hyponatremia, 9.89% moderate and 8.79% severe). The absence of correction of hyponatremia 72–96 h after hospital admission was associated with higher mortality in patients with COVID-19 (Odds Ratio 0.165; 95% confidence interval: 0.018−0.686; p = 0.011). 19 patients (20.9%) died. An increase in mortality was observed in patients with severe hyponatremia compared with moderate and mild hyponatremia during hospital admission (37.5% versus 11.1% versus 8.1%, p = 0.041). ConclusionWe conclude that persistence of hyponatremia at 72–96 h of hospital admission was associated with higher mortality in patients with SARS-Cov-2.

Central Pontine Myelinolysis Complicating Hodgkin Lymphoma: A Case Report &amp; Review of Literature

Central Pontine myelinolysis is a demyelinating disorder generally caused by rapid correction of hyponatremia and is a debilitating condition. Here we describe an interesting case of a 38 year old man diagnosed with Hodgkin lymphoma who developed CPM prior to start of the first cycle of chemotherapy with no antecedent hyponatremia and had complete neurological recovery.

Osmotic demyelination syndrome despite appropriate gradual correction of moderate hyponatraemia.

Osmotic demyelination syndrome characteristically follows rapid correction of hyponatraemia. We present a young woman with a subacute progressive brainstem syndrome and diffuse pontine signal abnormality on MR imaging, diagnosed as osmotic demyelination syndrome. The case posed a diagnostic challenge due to comorbid Behçet's disease and the absence of significant fluctuation in her serum sodium concentration. Osmotic demyelination syndrome is not limited to patients with rapidly corrected hyponatraemia, especially when there are other risk factors. These factors, all present in this patient, include hypokalaemia, hypophosphataemia, malnutrition, harmful alcohol use and liver dysfunction.

Perioperative Medicine: Managing for Outcome, 2nd Edition

Perioperative Medicine: Managing for Outcome, 2nd Edition