Decrease In Serum Sodium Level Research Articles

Does Desmopressin Reduce Intraoperative Bleeding in Patients Who Undergo Nasal Surgery? A Systematic Review and Meta-Analysis

Background and Objectives: This study aimed to determine the efficacy of prophylactic desmopressin administered via the intranasal or intravenous route in reducing intraoperative bleeding during nasal surgery. We conducted a meta-analysis of the relevant literature to investigate the role of preoperative desmopressin in minimizing bleeding complications associated with nasal surgery.Methods: We screened the relevant literature published before February 2023. Nine articles that compared the perioperative use of desmopressin (treatment) with a placebo or no treatment (control) were included. The analyzed outcomes were intraoperative bleeding during nasal surgery and postoperative morbidity.Results: The treatment group showed significant improvements in intraoperative bleeding, the surgical field, and surgeon satisfaction compared to the control group. However, the prophylactic use of desmopressin was associated with elevated blood pressure and decreased serum sodium levels compared to the control group. Nonetheless, no significant adverse effects were reported in the included studies. Subgroup analyses comparing the route of administration (intravenous vs. intranasal) and type of surgery (rhinoplasty vs. endoscopic sinus surgery) showed that desmopressin had a beneficial effect on intraoperative bleeding and the surgical field, regardless of the route of administration or type of surgery.Conclusion: The prophylactic use of desmopressin for nasal surgery effectively reduced intraoperative bleeding, improved the surgical field, and increased surgeon satisfaction, with no significant adverse effects. However, caution should be exercised when administering desmopressin as it may cause an elevation in postoperative blood pressure in patients with cardiopulmonary problems.

Management of Hyponatremia in Heart Failure: Practical Considerations.

Hyponatremia is commonly encountered in the setting of heart failure, especially in decompensated, fluid-overloaded patients. The pathophysiology of hyponatremia in patients with heart failure is complex, including numerous mechanisms: increased activity of the sympathetic nervous system and the renin-angiotensin-aldosterone system, high levels of arginine vasopressin and diuretic use. Symptoms are usually mild but hyponatremic encephalopathy can occur if there is an acute decrease in serum sodium levels. It is crucial to differentiate between dilutional hyponatremia, where free water excretion should be promoted, and depletional hyponatremia, where administration of saline is needed. An inappropriate correction of hyponatremia may lead to osmotic demyelination syndrome which can cause severe neurological symptoms. Treatment options for hyponatremia in heart failure, such as water restriction or the use of hypertonic saline with loop diuretics, have limited efficacy. The aim of this review is to summarize the principal mechanisms involved in the occurrence of hyponatremia, to present the main guidelines for the treatment of hyponatremia, and to collect and analyze data from studies which target new treatment options, such as vaptans.

Evaluation of Ultrasonography as an Adjunct for Diagnosis of Dengue Fever Among Children

Introduction: This study aims to evaluate the role of ultrasonography (USG) for early diagnosis of clinically suspected dengue fever before it becomes serologically positive and usefulness of USG in predicting severity of the disease. Methods: Prospective observational study conducted at a tertiary care hospital from April 2020 to March 2021, 70 cases of clinically suspected dengue within the age group of 6 months to 15 years presenting with fever for less than 5days underwent whole abdomen and chest ultrasonography. For seropositive cases, ultrasonography findings and their utility in early diagnosis and prediction of disease severity was analyzed along with their correlation to the clinical and laboratory profiles.Results:75.8% had primary dengue and 24.2% had secondary dengue. 94% cases demonstrated ultrasonography features suggestive of dengue like hepatomegaly (81%), ascites (63.8%), splenomegaly (56.9%), gall bladder wall thickness (46.6%), Cholecystitis (44.8%) and Pleural effusion (41.4%). Ascites and pleural effusion correlated well with clinical severity (p<0.05). Ascites also had significant correlation with increased hematocrit (p=0.040) and thrombocytopenia (p=0). Significant correlation was observed between pleural effusion with decreased platelet count ((p=0.004) and decreased serum sodium levels (p=0.044). Gall bladder wall thickening >5mm correlated well with disease severity. USG showed 94.3% sensitivity, 16.67% specificity and 81.43% of diagnostic accuracy in the seropositive cases of this study. Conclusion: Ultrasonography is useful not only as an adjuvant for early diagnosis of Dengue fever but also as a marker of disease severity.

Effects of Psidium guajava and Ribes americanum Aqueous Extracts and Dietary Modification on some Markers of Renal, Cardiac Dysfunction in Rats

The effect of aqueous extract of P. guajava and R. americanum and dietary modification interactions on serum renal function markers levels (urea, creatinine) cardiac function markers (lactate dehydrogenase, creatinine kinase), serum ions (calcium, sodium, and potassium ions) were investigated in rats. Fully grown Wister strain rats were exposed to high fat and salted diet formulation and treated with the aqueous extract for a period of 6 weeks. The diets were formulated by adding 25% animal fat and 5% palm oil to standard feeds (Vital feeds, Bukuru Jos, Plateau. Significant decrease in serum urea, creatinine, and lactate dehydrogenase and creatine kinase activities in the group treated with P. guajava and R. americanum aqueous extract compared to the high fat-salted water group. There was no significant difference in plasma urea and Creatinine, LDH and CK levels between the standard feeds and standard feed plus salted water group. Significant increase in the plasma Creatinine and lactate dehydrogenase levels (at p<0.05) of the high-fat plus salted water group when compared with the high fat group. Significant (at p<0.05) increase in serum sodium of the group exposed to salted water when compared with the non-salted water group. There was a significant (p<0.05) decrease in serum sodium levels of extract administered groups compared to the high fat-salted water and standard feed salted water groups. There was also a significant increase, at p<0.05, in serum potassium and calcium of the extracts administered group when compared with the standard feed salted water, high fat and high fat salted water groups. The study showed that the combined effects of high fat and high salt increased serum sodium and decreased serum potassium and calcium. Administration of the aqueous extract administration reversed by the effects

Hyponatremia and Recurrent Febrile Seizures During Febrile Episodes: A Meta-Analysis.

Several studies have investigated the potential effects of hyponatremia on recurrent febrile seizures (RFS) during febrile illness. Because findings were inconsistent across studies, we aimed to evaluate the serum sodium levels in febrile seizures (FS) of children with or without RFS during the same episode.We conducted electronic searches in three databases (PubMed, EMBASE, Cochrane Library) and one scholarly search engine (Google Scholar) up to June 2021 for studies on FS. Screening was done based on the titles and abstracts of primary studies. Then, eligibility was reviewed based on the abstracts. Finally, in order to match the inclusion and exclusion criteria, full-text articles were evaluated by two authors and inconsistencies were discussed. Data extraction was carried out by two independent authors. The extracted variables were author's name, article title, journal name, year of publication, study location, study design, sample size, and mean and standard deviation of blood Na concentration in FS. We performed a risk of bias assessment of included studies using the Newcastle-Ottawa Scale (NOS). The effect size was calculated using the standardized mean difference (SMD), and random-effects models were used for the analysis.A total of 12 articles were included with a single outlier. This analysis suggested that serum sodium level was lower in patients with RFS during the same febrile episode than in those with single FS, with SMD of -0.70, (n=1784; 95% CI: -1.03, -0.36; Z=-4.10, p<0.01; I2 86.67%, p<0.01). In the sensitivity analysis, no significant change was observed in pooled SMD. The optimal cutoff value of serum sodium level was 134.72 mmol/L with an area under the receiver operating characteristic curve of 0.81 (95% CI: 0.61, 1.00), with sensitivity of 80.0% and specificity of 70.0%.This result indicated a significant association between hyponatremia and RFS during the same febrile episode. Decreased serum sodium levels may be involved in seizure recurrence and may play a role in FS pathogenesis.

Efficacy and safety of rapid intermittent bolus compared with slow continuous infusion in patients with severe hypernatremia (SALSA II trial): a study protocol for a randomized controlled trial.

BackgroundHypernatremia is a common electrolyte disorder in children and elderly people and has high short-term mortality. However, no high-quality studies have examined the correction rate of hypernatremia and the amount of fluid required for correction. Therefore, in this study, we will compare the efficacy and safety of rapid intermittent bolus (RIB) and slow continuous infusion (SCI) of electrolyte-free solution in hypernatremia treatment. MethodsThis is a prospective, investigator-initiated, multicenter, open-label, randomized controlled study with two experimental groups. A total of 166 participants with severe hypernatremia will be enrolled and divided into two randomized groups; both the RIB and SCI groups will be managed with electrolyte-free water. We plan to infuse the same amount of fluid to both groups, for 1 hour in the RIB group and continuously in the SCI group. The primary outcome is a rapid decrease in serum sodium levels within 24 hours. The secondary outcomes will further compare the efficacy and safety of the two treatment protocols.ConclusionThis is the first randomized controlled trial to evaluate the efficacy and safety of RIB correction compared with SCI in adult patients with severe hypernatremia.

Identifying Antidepressants Less Likely to Cause Hyponatremia: Triangulation of Retrospective Cohort, Disproportionality, and Pharmacodynamic Studies.

Antidepressants are known to cause hyponatremia, but conflicting evidence exists regarding specific antidepressants. To identify antidepressants less likely to cause hyponatremia, we conducted a triangulation study integrating retrospective cohort, disproportionality, and pharmacodynamic studies. In the retrospective cohort study of patients (≥ 60 years) in Nihon University School of Medicine’s Clinical Data Warehouse (2004–2020), a significant decrease in serum sodium levels was observed within 30 days after initiation of a selective serotonin reuptake inhibitor (SSRI; mean change −1.00 ± 0.23 mmol/L, P < 0.001) or serotonin‐noradrenaline reuptake inhibitor (SNRI; −1.01 ± 0.31 mmol/L, P = 0.0013), whereas no decrease was found for a noradrenergic and specific serotonergic antidepressant (mirtazapine; +0.55 ± 0.47 mmol/L, P = 0.24). Within‐class comparison revealed no decrease in serum sodium levels for fluvoxamine (+0.74 ± 0.75 mmol/L, P = 0.33) among SSRIs and milnacipran (+0.08 ± 0.87 mmol/L, P = 0.93) among SNRIs. In the disproportionality analysis of patients (≥ 60 years) in the Japanese Adverse Drug Event Report database (2004–2020), a significant increase in hyponatremia reports was observed for SSRIs (reporting odds ratio 4.41, 95% confidence interval 3.58–5.45) and SNRIs (5.66, 4.38–7.31), but not for mirtazapine (1.08, 0.74–1.58), fluvoxamine (1.48, 0.94–2.32), and milnacipran (0.85, 0.45–1.62). Finally, pharmacoepidemiological–pharmacodynamic analysis revealed a significant correlation between the decrease in serum sodium levels and binding affinity for serotonin transporter (SERT; r = −0.84, P = 0.02), suggesting that lower binding affinity of mirtazapine, fluvoxamine, and milnacipran against SERT is responsible for the above difference. Although further research is needed, our data suggest that mirtazapine, fluvoxamine, and milnacipran are less likely to cause hyponatremia.

Association of early hyponatremia and the development of acute kidney injury in critically ill children.

Hyponatremia is an independent prognostic factor for mortality; however, the reason for this remains unclear. An observed relationship between hyponatremia and the development of acute kidney injury (AKI) has been reported in certain disease states, but hyponatremia has not been evaluated as a predictor of AKI in critically ill patients or children. This is a single-center retrospective cohort study of critically ill children admitted to a tertiary care center. We performed regression analysis to assess the association between hyponatremia at ICU admission and the development of new or worsening stage 2 or 3 (severe) AKI on days 2-3 following ICU admission. Among the 5057 children included in the study, early hyponatremia was present in 13.3% of children. Severe AKI occurred in 9.2% of children with hyponatremia compared to 4.5% of children with normonatremia. Following covariate adjustment, hyponatremia at ICU admission was associated with a 75% increase in the odds of developing severe AKI when compared to critically ill children with normonatremia (aOR 1.75, 95% CI 1.28-2.39). Evaluating sodium levels continuously, for every 1mEq/L decrease in serum sodium level, there was a 0.05% increase in the odds of developing severe AKI (aOR 1.05, 95% CI 1.02-1.08). Hyponatremic children who developed severe AKI had a higher frequency of kidney replacement therapy, AKI or acute kidney disease at hospital discharge, and hospital mortality when compared to those without. Hyponatremia at ICU admission is associated with the development of new or worsening AKI in critically ill children. A higher resolution version of the Graphical abstract is available as Supplementary information.

Analysis of the incidence and influencing factors of hyponatremia before 131I treatment of differentiated thyroid carcinoma.

BACKGROUNDHyponatremia is a common clinical electrolyte disorder. However, the association between hyponatremia and acute hypothyroidism is unclear. Acute hypothyroidism is usually seen in patients who undergo preparation for radioactive iodine therapy.AIMTo analyze the incidence and influencing factors of hyponatremia in a condition of iatrogenic acute hypothyroidism in patients with differentiated thyroid cancer (DTC) before 131I treatment.METHODSThe study group consisted of 903 DTC patients who received 131I treatment. The clinical data before and after surgery, as well as on the day of 131I treatment were analyzed. According to the blood sodium level before 131I treatment, patients were divided into the non-hyponatremia group and hyponatremia group. Correlations between serum sodium levels before 131I treatment and baseline data were analyzed. Univariate analysis and binary logistic regression were performed to identify the influencing factors of hyponatremia.RESULTSA total of 903 patients with DTC, including 283 (31.3%) males and 620 (68.7%) females, with an average age of 43.8 ± 12.7 years, were included in this study. The serum sodium levels before surgery and 131I treatment were 141.3 ± 2.3 and 140.5 ± 2.1 mmol/L, respectively (P = 0.001). However, the serum sodium levels in males and females before 131I treatment were lower than those before surgery. Patients aged more than 60 years and less than 60 years also showed decreased serum sodium levels before 131I treatment. In addition, the estimated glomerular filtration rate (eGFR) in males and females decreased before 131I treatment compared with those before surgery (P = 0.001). Moreover, eGFR in patients over 60 years and under 60 years decreased before 131I treatment, when compared with that before surgery. There were no significant differences in serum potassium, calcium, albumin, hemoglobin, and blood glucose in patients before surgery and 131I treatment (P > 0.05). Among the 903 patients, 23 (2.5%) were diagnosed with hyponatremia before 131I treatment, including 21 cases (91.3%) of mild hyponatremia and 2 cases (8.7%) of moderate hyponatremia. Clinical data showed that patients with mild hyponatremia had no specific clinical manifestations, while moderate hyponatremia cases were mainly characterized by fatigue and dizziness, which were similar to neurological symptoms caused by hypothyroidism and were difficult to distinguish. Correlation analysis showed a correlation between serum sodium before 131I treatment and the preoperative level (r = 0.395, P = 0.001). There was no significant correlation between blood sodium and thyroid-stimulating hormone (TSH) levels and urine iodine before 131I treatment (r = 0.045, P = 0.174; r = 0.013, P = 0.697). Univariate analysis showed that there were significant differences in age, sex, history of diuretic use, distant metastasis, preoperative blood sodium, blood urea nitrogen (BUN), eGFR, TSH and urinary iodine between the two groups (all P < 0.05). Logistic regression analysis showed that factors such as history of diuretic use, distant metastases, preoperative sodium and BUN were all influencing factors of hyponatremia. The Hosmer and Lemeshow test (c2 = 2.841, P = 0.944) suggested a high fit of the model. Omnibus tests of model coefficients indicated the overall significance of the model in this fitted model (P < 0.05). Preoperative serum sodium was a significant factor associated with pre-131I therapy hyponatremia (OR = 0.763; 95%CI: 0.627-0.928; P = 0.007).CONCLUSIONThe incidence of hyponatremia induced by 131I treatment preparation was not high. Preparation for radioactive iodine therapy was not a risk factor for the development of hyponatremia in thyroid cancer patients.

Thermal strain and fluid balance during a 72-km military route march in a field setting.

A physiological profiling study was conducted to evaluate thermal strain as well as fluid and electrolyte balances on heat-acclimatised men performing a 72-km route march in a field setting. 38 male soldiers (age range 18-23 years) participated in the study, as part of a cohort that marched for 72 km, with loads for about 26 hours. Core temperature and heart rate sensors were used for the duration of the march. Fluid and food intake and output were monitored for the duration of the march. Blood samples were taken one day before the march (pre-march), immediately after the march (Post 1) and on the 15th day after the march to ascertain recovery (Post 2) to assess fluid and electrolyte profiles. Mean core temperature was within safe limits, ranging from 37.1 to 38.1°C throughout the march. There was an overall decrease in serum sodium levels, a decline in serum sodium concentration in 28 participants and three instances of hyponatraemia (serum sodium concentration <135 mmol/L). Our study found low thermal strain heat-acclimatised individuals during a 72-km route march. However, there was an overall decrease in serum sodium levels, even when the participants were allowed to drink ad libitum. Challenges of exercise-associated hyponatraemia during prolonged activities remain to be addressed.

ICU acquired hypernatremia treated by enteral free water - A retrospective cohort study.

ICU acquired hypernatremia (IAH) is associated with increased morbidity and mortality, however treatment remains controversial. This study aims to determine the effect of enteral free water suppletion in patients with IAH. Retrospective single center study in a tertiary ICU. patients with IAH and treatment with enteral free water. patients with renal replacement therapy, diabetic ketoacidosis or hyperosmolar hyperglycaemic state. change in plasma sodium (in mmol/l) after 5days treatment. Responders were defined as patients with a decrease in sodium level of 5mmol/l or more. In total 382 consecutive patients were included. The median sodium level at the start of water therapy was 149mmol/l (IQR 147-150). The median volume of enteral water was 4423ml (IQR 3349-5379ml) after 5days and mean sodium decrease was 1.87mmol/l (SD 4.84). There was no significant correlation between the volume of enteral water and sodium decrease (r2=0.01). Treatment with enteral free water did not result in a clinically relevant decrease in serum sodium level in patients with IAH. In addition, the volume of enteral free water and the use of diuretics was unrelated with sodium change over 5days.

Incidence of Hyponatremia in Patients With Indwelling Peritoneal Catheters for Drainage of Malignant Ascites

Indwelling peritoneal catheters (IPCs) are frequently used to drain tense, symptomatic, malignant ascites. Large-volume drainage may lead to hyponatremia owing to massive salt depletion. To date, no studies have examined the epidemiology of hyponatremia after placement of an IPC. To evaluate the incidence of hyponatremia after IPC placement, the risk factors associated with its development, and how it is managed. This cohort study retrospectively reviewed the medical records of 461 patients who had IPCs placed during the period between 2006 and 2016 at a tertiary care hospital in Boston, Massachusetts, of whom 309 patients met the inclusion criteria. Data analysis was performed from June to November 2019. Main outcomes were the incidence of hyponatremia (with a serum sodium level <135 mEq/L) after IPC placement, the risk factors for its development, and how it was managed. We also examined the clinical course of a subset of 21 patients with hypovolemic hyponatremia. Of the 309 eligible patients with laboratory results both before IPC placement and 2 days or more after IPC placement, 189 (72.1%) were female, and the mean (SD) age was 59 (12) years. The overall incidence of hyponatremia after IPC placement was 84.8% (n = 262), of whom 21 patients (8.0%) had severe hyponatremia. The mean (SD) decrease in serum sodium level before vs after IPC placement was 5 (5.1) mEq/L and decreased by 10 mEq/L or more among 52 patients (16.8%). Patients with hyponatremia prior to IPC placement had an 8-fold higher adjusted odds of having persistent hyponatremia after IPC placement (odds ratio, 7.9; 95% CI, 2.9-21.7). Patients with hepatopancreatobiliary malignant neoplasms were more likely to develop hyponatremia (78 of 262 patients with hyponatremia [29.8%] vs 7 of 47 patients without hyponatremia [14.9%]). Hyponatremia was either unrecognized or untreated in 189 patients (72.1%). Although the placement of an IPC is often a palliative measure, hyponatremia is common and is often untreated or unrecognized. Patients at highest risk, such as those with hyponatremia at baseline and those with hepatopancreatobiliary malignant neoplams, should be evaluated carefully prior to IPC placement and may warrant closer monitoring after placement. In all cases, hyponatremia should be evaluated and managed within the context of a patient's overall goals of care.

Clinical characteristics of hospitalized patients with 2019 novel coronavirus disease indicate potential proximal tubular dysfunction.

Clinical characteristics of hospitalized patients with 2019 novel coronavirus disease indicate potential proximal tubular dysfunction.

Evaluation of significance of hyponatremia in hypothyroidism in an urban female population of Eastern India: A cross-sectional study

Background: Hypothyroid patients may have reduced sodium levels, but the strength of such a link is still not clearly defined. Aims: This study aims to evaluate the significance of hyponatremia in hypothyroidism in an urban young female population of eastern India. Materials and Methods: This cross-sectional study was conducted on 200 hypothyroid patients in Burdwan Medical College in a period of 12 months after taking Institutional Ethical Clearance. 100 controls were taken for the study. Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and sodium levels were estimated. The individuals were age matched. The computer software Statistical Package for the Social Sciences, version 16.0 was used for analyzing data. Results: 200 hypothyroid patients were enrolled for the study. 31 hypothyroid patients presented with reduced serum sodium level (15.5%). Significant difference was observed between controls and hypothyroid patients for mean TSH (P < 0.0001), mean FT4 (P < 0.0001), and mean sodium (P < 0.0001). No significant difference of age was observed between two groups. Serum sodium level was negatively correlated with TSH (r: -0.59, P < 0.00001), and serum sodium was positively correlated with serum FT4 (r: 0.29, P: <0.0000). Conclusions: Hypothyroid females in reproductive age group may have significant decrease in serum sodium levels as compared to normal individuals, and serum sodium needs to be estimated in hypothyroid patients for better management of patients.

Abstract TP532: Decreased Serum Sodium Levels Predict Symptomatic Vasospasm in Patients With Subarachnoid Hemorrhage

Background: Symptomatic vasospasm (SVS) is one of the major causes of morbidity and mortality in patients with subarachnoid hemorrhage (SAH). Hyponatremia and dehydration due to natriuresis after SAH is related to SVS and predicts it. Therefore, nowadays most institutions target to euvolemia and eunatremia in SAH patients to avoid complications. In this study, we retrospectively investigated the predictors of SVS in terms of water and sodium homeostasisunder maintaining euvolemia and eunatremia after SAH. We also analyzed the relationship between hyponatremia and the effect of treatment modality (clipping and endovascular coiling). Methods: We monitored changes in serum sodium levels, serum osmolarity, daily sodium intake, daily urine volume, and daily water balance during 14 days after SAH. Outcome was assessed using the modified Rankin scale one month after subarachnoid hemorrhage. Results: Among 105 patients, 29 (27.6%) had SVS. Patients with SVS were older than those without SVS and SVS affected outcome. Serum sodium levels were sequentially significantly decreased within normal range from one day before occurrence of SVS.Among the patients, 67 (63.8%) were treated with surgical clipping and 38 (36.2%) were treated with endovascular coiling. The group with coiling suffered significantly more severe hyponatremia and had less urine volume compared with the clipping group. Conclusions: SVS occurs more often in older patients and affects outcome. Serum sodium level decrease occurs one day before SVS. This observation may help predict SVS. A further large prospective study is necessary to resolve the detailed relationships among hyponatremia, urine volume, treatment modality and SVS in patients with SAH.

A swine model of intracellular cerebral edema – Cerebral physiology and intracranial compliance

Cerebral edema leading to elevated intracranial pressure (ICP) is a fundamental concern after severe traumatic brain injury (TBI), stroke, and severe acute hyponatremia. We describe a swine model of water intoxication and its cerebral histological and physiological sequela. We studied female swine weighing 35–45 kg. Four serum sodium intervals were designated: baseline, mild, moderate, and severe hyponatremia attained by infusing hypotonic saline. Intracranial fluid injections were performed to assess intracranial compliance. At baseline and following water intoxication wedge biopsy was obtained for pathological examination and electron microscopy. We studied 8 swine and found an increase in ICP that was strongly related to the decrease in serum sodium level. Mean ICP rose from a baseline of 6 ± 2 to 28 ± 6 mm Hg during severe hyponatremia, while cerebral perfusion pressure (CPP) decreased from 72 ± 10 to 46 ± 11 mm Hg. Brain tissue oxygen tension (PbtO2) decreased from 18.4 ± 8.9 to 5.3 ± 3.0 mm Hg. Electron microscopy demonstrated intracellular edema and astrocytic foot process swelling following water intoxication. With severe hyponatremia, 2 cc intracranial fluid injection resulted in progressively greater ICP dose, indicating a worsening intracranial compliance. Our model leads to graded and sustained elevation of ICP, lower CPP, and decreased PbtO2, all of which cross clinically relevant thresholds. Intracranial compliance worsens with increased cerebral swelling. This model may serve as a platform to study which therapeutic interventions best improve the cerebral physiological profile in the face of severe brain edema.

CLINICAL AND PROGNOSTIC VALUE OF HYPONATREMIA IN PATIENTS WITH CHRONIC HEART FAILURE

The aim : to assess the short-term prognostic value of different types of hyponatremia in patients hospitalized for acute decompensated chronic heart failure. Material and methods. A prospective study included 396 patients hospitalized for acute decompensated chronic heart failure. Hyponatremia was diagnosed in cases of serum sodium level less than 135 mmol/l. The pre-hospital hyponatremia was defined as a decreased serum sodium level on admission, whereas the hospital hyponatremia was referred to cases occurred during hospitalization. In patients with pre-hospital hyponatremia drop of sodium levels ≥ 3 mmol/l during hospitalization was defined as a progressive hyponatraemia. The influence of different types of hyponatremia on the hospital prognosis was determined, while the composite primary endpoint was all-cause mortality and/or transfer to the intensive care unit. Results. Patients with hyponatremia were older and had more severe clinical signs of chronic heart failure, lower left ventricle ejection fraction and higher diastolic dysfunction than normonatremic patients. After adjustment for age, comorbidity and severity of chronic heart failure in Cox regression models hyponatremia was an independent predictor of all-cause mortality and transfer to the intensive care unit (odds ratio 3.1; p &lt; 0.05). Pre-hospital hyponatremia had a higher prognostic value on outcome compared with hospital hyponartemia (odds ratio 3.9 versus 2.9, respectively; p &lt; 0.05). Progressive hyponatremia was associated with a marked increase of mortality and transfer to the intensive care unit (odds ratio 6.8; p &lt; 0.05). Conclusion. Pre-hospital and hospital hyponatremia are independent predictors for short-term outcomes in patients hospitalized for acute decompensated chronic heart failure. Progression of the pre-hospital hyponatremia is associated with significantly increase of all-cause mortality and risk of transfer to the intensive care unit.

Association between the Serum Sodium Levels and the Response to Tolvaptan in Liver Cirrhosis Patients with Ascites and Hyponatremia.

Objective Hyponatremia is closely associated with the pathophysiology of cirrhosis. However, the association between the serum sodium level and the response to tolvaptan is unclear. This study evaluated the factors related to the tolvaptan response and the prognosis in cirrhosis patients with ascites and hyponatremia. Methods We retrospectively reviewed the clinical records of cirrhosis patients hospitalized for treatment with tolvaptan. The associations of patient baseline characteristics with the tolvaptan response after one week and of the characteristics after one-month tolvaptan treatment with the prognosis were analyzed. Results We analyzed 83 cirrhosis patients with ascites, including 34 patients with hyponatremia. The response rates to tolvaptan in patients with serum sodium <130 mEq/L, 130-135 mEq/L, and >135 mEq/L were 20%, 66%, and 58%, respectively (p=0.22). The serum sodium level was associated with the response to tolvaptan [odds ratio=1.18; 95% confidence interval (CI)=1.02-1.37; p=0.029]. In patients with hyponatremia, the serum sodium level after 1-month tolvaptan treatment was increased compared to baseline (132 mEq/L vs. 136 mEq/L, p=0.006), and an increasing serum sodium level was associated with a lower risk of mortality (hazard ratio=0.85; 95% CI=0.75-0.97; p=0.016). The survival rate was higher in patients with an increase in the serum sodium level after 1 month than in patients with a decreased serum sodium level (p=0.023). Conclusion Tolvaptan treatment was effective in cirrhosis patients with ascites and hyponatremia, but a low serum sodium level was associated with non-responsiveness to tolvaptan. An increased serum sodium level after one-month tolvaptan treatment may positively influence the mortality risk in cirrhosis patients with hyponatremia.

Schwartz-Bartter Syndrome: A Subtle Complication of Small Cell Lung Carcinoma

Paraneoplastic syndromes are defined as a conglomerate of clinical disorders that are caused by neoplastic diseases, specifically lung cancer. The clinical symptomatology of paraneoplastic syndromes usually precedes the diagnosis of the associated neoplasm, however, according to our current literature; the extent of the symptoms is not associated with the size of the tumor. Syndrome of inappropriate anti-diuretic hormone release (SIADH), also known as Schwartz-Bartter syndrome, is commonly caused by small cell lung carcinoma (SCLC) and is characterized by euvolemic hypoosmolar hyponatremia, which will lead to a low serum osmolality as well as a significantly high urine osmolality in the absence of other medical conditions such as adrenal insufficiency, heart failure, cirrhosis, and diuretic syndrome among others. The clinical presentation related to SIADH varies based upon the severity of the hyponatremia as well as the acuteness of the decrease in serum sodium levels. Symptoms due to SIADH include anorexia, nausea, vomiting, and in more severe cases, cerebral edema due to rapid of onset hyponatremia thus causing confusion, restlessness, coma, seizures, and respiratory arrest.

Decreased serum sodium levels predict symptomatic vasospasm in patients with subarachnoid hemorrhage

Background: Symptomatic vasospasm is a major cause of morbidity and mortality in subarachnoid hemorrhage patients. Hyponatremia and dehydration due to natriuresis after subarachnoid hemorrhage are related to symptomatic vasospasm. Therefore, most institutions are currently targeting euvolemia and eunatremia in subarachnoid hemorrhage patients to avoid complications. We retrospectively investigated the predictors of symptomatic vasospasm with respect to water and sodium homeostasis, while maintaining euvolemia and eunatremia after subarachnoid hemorrhage. Methods: We monitored changes in serum sodium levels, serum osmolarity, daily sodium intake, daily urine volume, and daily water balance for 14days after subarachnoid hemorrhage. Outcomes were assessed using the modified Rankin scale at 1month after subarachnoid hemorrhage. Results: Among 97 patients, 27 (27.8%) had symptomatic vasospasm. Patients with symptomatic vasospasm were older than those without symptomatic vasospasm; the occurrence of symptomatic vasospasm affected outcomes. Serum sodium levels were sequentially significantly decreased, but within the normal range from 1day before the occurrence of symptomatic vasospasm. Serum osmolarity of the spasm group was lower than that of the non-spasm group. Conclusions: Symptomatic vasospasm occurs more often in older patients and affects outcomes. A decrease in serum sodium levels occurs a day before symptomatic vasospasm. This observation may help predict symptomatic vasospasm.