Disorders Of Sodium Balance Research Articles

Порушення натрієвого балансу у хворих з ураженням гіпоталамо-гіпофізарної ділянки при черепно-мозковій травмі

Актуальність. Черепно-мозкова травма (ЧМТ) до цього часу залишається провідною причиною смерті людей працездатного віку. В Україні частота ЧМТ щорічно становить у різних регіонах від 2,3 до 6 випадків (у середньому 4–4,2) на 1000 населення. Пацієнти з первинним ураженням головного мозку і гіпоталамо-гіпофізарної системи становлять групу ризику з розвитку набряку головного мозку через виникнення у них порушення водно-електролітної рівноваги та відповідно порушення рівноваги осмолярності між клітинним та позаклітинним простором. Порушення водно-електролітного балансу як наслідок ураження гіпоталамо-гіпофізарної системи при ЧМТ в літературі висвітлено недостатньо. Мало вивчені особливості функціонування центральних та периферичних ланцюжків ендокринної системи залежно від локалізації, характеру і тяжкості травми. Недостатньо вивчене питання про діагностичні та прогностичні цінності різних показників волемічного статусу у хворих із ЧМТ. Мета: вивчити види дизнатріємії у хворих з ізольованою ЧМТ і ураженням гіпоталамо-гіпофізарної ділянки головного мозку; вияснити вплив виду порушення натрієвого балансу на летальність у хворих із ЧМТ та ураженням гіпоталамо-гіпофізарної ділянки головного мозку. Матеріали та методи. Нами було обстежено 74 пацієнтів (чоловіків/жінок = 60/14) із вогнищевим забоєм головного мозку й ураженням гіпоталамічної ділянки. Серед 74 хворих з ізольованою ЧМТ і ураженням гіпоталамо-гіпофізарної ділянки головного мозку в 47 хворих було діагностовано гіповолемію, що поєднувалась з гіпонатріємією. У 15 хворих було виявлено гіпернатріємію з гіперволемією. Моніторинг внутрішньочерепного тиску здійснювали за допомогою поліфункціонального монітора (Monitor Model BSM-3562 (Nihon Konden Corporation, Японія, 2018)) із лінією для інвазивного вимірювання тиску. Постійне неінвазивне вимірювання оксигенації тканин органів (rSO2) проводили на моніторі Somanetics Invos Oximeter Cerebral/Somatik (Covidien, Mansfield, MA, США, 2020). В усіх хворих визначали рівень електролітів плазми крові. Висновки. У хворих із ЧМТ і ураженням гіпоталамо-гіпофізарної системи виникають різнонаправлені зміни водно-натрієвого балансу, що вимагають диференційованого підходу до їх лікування. Зважаючи на невелику кількість спостережень, ми не наважуємося пов’язувати вид дизнатріємії у хворих із ЧМТ і ураженням гіпоталамо-гіпофізарної ділянки головного мозку з летальністю. Вважаємо за доцільне продовжувати дослідження в цьому напрямку.

44. RELATIONSHIP BETWEEN HYPERTENSION AND HYPONATREMIA IN CORONAVIRUS DISEASE PATIENTS: A CROSS-SECTIONAL STUDY

Background : Hypertension has been presumed to be associated with the severity of coronavirus disease (COVID-19) related to angiotensin-converting enzyme 2 (ACE2). Besides, hyponatremia is the most common electrolyte disorder in COVID-19 patients and has been reported to be associated with increased mortality. Objective: This study aimed to evaluate the association between hypertension and hyponatremia in COVID-19 patients who were admitted to Wahidin Sudirohusodo General Hospital Mojokerto. Method: In this study, we cross-sectionally investigated COVID-19 patients who were admitted to Wahidin Sudirohusodo General Hospital Mojokerto between December 2020 and January 2021. According to medical records, we evaluated COVID-19 patients who have hypertension as comorbidities and hyponatremia from laboratory results. Result: There were 98 COVID-19 patients consisted of 50 men and 48 women included in this study. The mean number of patients’ age was 55.6 ± 12.4 years. The prevalence of hypertension among patients was 55.1%. The mean number of sodium level was 131.50 ± 11.29 mmol/L. There was a strong correlation between blood pressure and sodium balance disorders (p < 0.002). Hypertension was associated with a nearly 5.5-fold increased risk of hyponatremia in COVID-19 patients (OR 5.06; 95% CI: 1.66–15.4; p < 0.05). Conclusion: Hypertension comorbidity was associated with a higher risk of hyponatremia in COVID-19 patients.

Disorders of sodium balance and its clinical implications in COVID-19 patients: a multicenter retrospective study.

BackgroundThe worldwide spread of SARS-CoV-2 has infected millions of people leading to over 0.3 million mortalities. The disruption of sodium homeostasis, tends to be a common occurrence in patients with COVID-19.Methods and resultsA total of 1,254 COVID-19 patients comprising 124 (9.9%) hyponatremic patients (under 135 mmol/L) and 30 (2.4%) hypernatremic patients (over 145 mmol/L) from three hospitals in Hubei, China, were enrolled in the study. The relationships between sodium balance disorders in COVID-19 patients, its clinical features, implications, and the underlying causes were presented. Hyponatremia patients were observed to be elderly, had more comorbidities, with severe pneumonic chest radiographic findings. They were also more likely to have a fever, nausea, higher leukocyte and neutrophils count, and a high sensitivity C-reactive protein (HS-CRP). Compared to normonatremia patients, renal insufficiency was common in both hyponatremia and hypernatremia patients. In addition, hyponatremia patients required extensive treatment with oxygen, antibiotics, and corticosteroids. The only significant differences between the hypernatremia and normonatremia patients were laboratory findings and clinical complications, and patients with hypernatremia were more likely to use traditional Chinese medicine for treatment compared to normonatremia patients. This study indicates that severity of the disease, the length of stay in the hospital of surviving patients, and mortality were higher among COVID-19 patients with sodium balance disorders.ConclusionSodium balance disorder, particularly hyponatremia, is a common condition among hospitalized patients with COVID-19 in Hubei, China, and it is associated with a higher risk of severe illness and increased in-hospital mortality.

Early postoperative HPA-axis testing after pituitary tumor surgery: reliability and safety of basal cortisol and CRH test

PurposeTo assess the reliability and safety of a postsurgical evaluation strategy of adrenal function using CRH stimulation and basal cortisol concentrations after transsphenoidal pituitary surgery.MethodsRetrospective cohort study of all patients undergoing endoscopic transsphenoidal surgery from 2010 to 2017, in whom early postoperative basal cortisol and/or CRH-stimulated cortisol secretion were available, including confirmation of adrenal function during follow-up. Patients with Cushing’s disease were excluded. Optimal test performances were assessed using ROC analysis.ResultsA total of 156 patients were included. Sensitivity and specificity of the CRH test were 78% and 90%, respectively, and 86% and 92% for basal cortisol, respectively, using an optimal cutoff of 220 nmol/L. Eight patients had false-negative test results with the CRH test (normal test but adrenal insufficient at follow-up), and six patients with basal cortisol, the majority of which had multiple pituitary hormone deficiencies and fluid imbalances. No clinical adverse events occurred in patients with false-negative test results. The diagnostic performance of a single basal cortisol measurement was superior to the CRH test.ConclusionsThe early postoperative basal cortisol is a safe and simple measurement to guide (dis)continuation of hydrocortisone replacement. However, disturbing factors, e.g., sodium balance disorders, contraceptives, untreated hypopituitarism, and illness impact the interpretation and in those cases this measure is unreliable. We propose an algorithm in which hydrocortisone replacement at discharge is based on basal cortisol <220 nmol/L on postoperative day 2 or 3 in a stable condition.

Can mild disorders of sodium balance after brain tumor surgeries impact the prognosis?

Can mild disorders of sodium balance after brain tumor surgeries impact the prognosis?

Treatment of Disorders of Sodium Balance in Chronic Kidney Disease.

Extracellular fluid volume expansion is nearly universal in patients with CKD. Such volume expansion has features similar to the syndrome of heart failure with preserved ejection fraction, which not only leads to symptoms but can also lead to further organ damage. Unique treatment challenges are present in this patient population, including low glomerular filtration, which limits sodium chloride filtration, intrinsic tubule predisposition to sodium chloride retention, and proteinuria. In addition, pharmacokinetic considerations alter the disposition of diuretics in patients with CKD and nephrotic syndrome. Maintaining extracellular fluid volume near to normal is often necessary for hypertension treatment in this population, but it may also help prevent progressive cardiovascular and kidney damage. Although powerful diuretics can often accomplish this goal, this often comes at a cost of competing adverse effects. An approach to reduce extracellular fluid volume while avoiding adverse effects, therefore, requires a nuanced yet aggressive therapeutic approach.

Toxic epidermal necrolysis: A study of clinical profile and treatment outcome in children

Objectives: The objective of this study is to study the clinical and laboratory profile, risk factors for the development of blood culture positive septicemia and treatment outcome of children admitted with toxic epidermal necrolysis (TEN). Methods: All children admitted with TEN from January 2012 to January 2017 were included in the study. Blood culture, organ functions, and serum electrolytes were sent at admission and repeated as clinically indicated. Children were managed with reverse isolation in workforce limited setting of a Government Medical College Hospital. Outcome measure analyzed were the duration of hospital stay, development of blood culture positive septicemia and death. Children were followed up for a variable period from 2-month to 1-year. Results: A total of 13 children were admitted with TEN in the 5-year study period, aged 7.9±3.2 years. Mean area of skin involvement was 69±19.9%. Drugs were found to be the most common cause of TEN accounting for 12 cases (92%). Evidence of renal injury was seen in 6 cases (46%). Disorders of sodium balance were the most common electrolyte abnormality observed in 11 cases (85%). There was no statistically significant difference in duration of progression of skin lesions in children who received ?2 g/kg of intravenous immunoglobulin (IVIG) and those who received &lt;2 g/kg of IVIG. The mortality rate was 7.6%. At follow-up, all patients had dyspigmentation and none had scarring. 6 children (46%) had ophthalmic complaints at follow-up. Conclusion: Non-steroidal anti-inflammatory drugs were found to be the most common cause of TEN in children. Furthermore, TEN was found to be a disease causing critical kidney disease in children. Multi-organ dysfunction, hyperglycemia, and need for invasive ventilation were found to be associated with increased risk of developing culture positive sepsis. Low-dose IVIG, parenteral steroids and skin care with normal saline washes and sterile liquid paraffin impregnated gauze are the effective and safe treatment options for children with TEN in resource-limited setting.

Hyponatremia effect in patients with alcohol dependence on their physical and mental health status.

Hyponatremia, i.e. reduction of sodium level in the blood plasma below 135mmol/L, is one of the most common electrolyte disorders occurring in people addicted to alcohol. Numerous psychopathological symptoms may be significantly associated with its occurrence. Since sodium is one of the main bioelements, which is responsible for proper neuromuscular excitability maintenance and contributes in nerve impulses conduction, sodium balance disorders may be related to a risk to basic life functions. The tested group included 100 alcohol dependent patients (M=90, F=10). Sodium was determined using biochemical Indiko Plus analyzer. Analysis of sodium concentration demonstrated that 64% of people with alcohol dependence had low (<135mmol/L) plasma sodium level, of which: 7% had severe hyponatremia (<120mmol/L), 13% had moderate hyponatremia (120-130mmol/L) and 44% had mild hyponatremia (130-135mmol/L). The analysis showed an occurrence of significant differences in terms of: impulsivity, quality of life, clinical symptoms occurrence, maximum amount of alcohol consumed and general health state. The lower concentration of sodium in blood plasma in alcohol dependent people, the worse psychical and psychological quality of their life.

The adult patient with hyponatraemia

### Key points Sodium is the most abundant cation in extracellular fluid (ECF), accounting for 86% of plasma osmolality, and is therefore of major importance when considering the physiological effects of hyponatraemia.1 Disorders of sodium balance (usually mild) can occur in up to 30% of in-patients,2 and are associated with increased mortality and length of hospital stay. Hyponatraemia usually reflects an excess of body water relative to sodium, being classified as hypervolaemic , hypovolaemic , or euvolaemic . It has varying osmolar states and can become life-threatening if unrecognized or managed incorrectly because of a failure to appreciate changes in plasma osmolality and subsequent osmotic movement of water (below). This article describes sodium homeostasis, the pathophysiology of hyponatraemia, plus the assessment and management of hyponatraemia via clinical scenarios to illustrate educational and practical points. ### Sodium homeostasis Sodium in the ECF is normally maintained at 134–146 mmol litre−1. Total body sodium content is 58 mmol kg−1 and daily requirement is 2 mmol kg−1. Osmolarity is defined as the number of osmoles per litre of solution. Osmolality is the number of osmoles per kilogram of solvent and may be estimated by the following calculation: Osmolality=2 (Na+K) +Glucose+Urea (mOsm kg−1) (all in mmol litre−1). From the above equation, it …

Alteraciones del balance hidrosalino

Disorders of water balance and sodium balance are common, specially in hospitalized patients. Water homeostasis is critical for maintaining sodium concentration and tonicity of the plasma within a narrow range for optimal cellular function. Sodium is the primary extracellular solute. Disorders of sodium balance initiate water movement across the cell membrane. Clinical symptoms depend on the severity and rapidity of development of the disorder. Treatment centers on identifying and correcting de underlying cause and restoring normal plasma osmolality. There are different formulas to guide treatment. Frequent monitoring of plasma sodium concentration is necessary to avoid complications.

Antidepressant Induced Hyponatremia

Electrolyte imbalance is a very common cause as well as comorbidity of hospitalization, especially in elderly individuals. It also enhances the morbidity and mortality in this group of patients. Disorders of sodium balance are the most prevalent types of electrolyte disturbance in clinical settings. Among several etiological factors related to disturbed serum sodium concentration, iatrogenic causes are very common. Antidepressants are noteworthy contributors among the drugs causing reduced plasma sodium concentration and as these drugs are quite commonly used in elderly patients due to high prevalence of depression in this age group, here we discuss about antidepressant induced hyponatremia.

The internal medicine specialist and neurosurgery

BACKGROUND The neurosurgical patient is often a real challenge for the physicians, because of a frequent multimorbidity and a higher risk for severe complications. Cooperation between internal medicine specialist and neurosurgeon is essential to prevent the fatal effects of cranial and spinal injuries. The topic issues of medical interest in neurosurgery are the disorders of sodium balance, the glycemic control, the thromboembolic risk, the intracerebral bleeding management and the infective problems. The neurosurgeons could be worried by treating these complications that are mostly of internal medicine interest and that could unfortunately rise the risk of death or irreversible insults. AIM OF THE REVIEW This review summarizes the modality of diagnosis and therapy of the foremost concerns in neurosurgical field.

Anomalies de l’équilibre hydrosodé

Water balance control is aimed at normalizing cellular hydration, and sodium balance control at normalizing extracellular volume. Water balance control is based on the regulation of body fluid tonicity, while the control of sodium balance is based on the regulation of effective arterial volume. Disorders of water balance act on cellular hydration: primary disorders induce a proportional change in tonicity; secondary disorders are induced by a change in tonicity or effective arterial volume. Disorders of sodium balance act on extracellular volume: primary disorders of sodium balance induce a change in effective arterial volume; secondary disorders are induced by a change in effective arterial volume. Physical examination of the patient allows assessing the extracellular volume and the severity of the sodium balance disorder. Natremia – that generally reflects tonicity – allows to assess cellular hydration and to determine the type of water balance disorder. In the case of natremia disturbance, the assessment of both the tonicity and the extracellular volume allows the determination of the type of water and/or sodium balance disorder that is necessary for prescribing the adequate therapy.

Diuretics and Disorders of Calcium Homeostasis

Diuretics commonly are administered in disorders of sodium balance. Loop diuretics inhibit the Na-K-2Cl transporter and also increase calcium excretion. They are often used in the treatment of hypercalcemia. Thiazide diuretics block the thiazide-sensitive NaCl transporter in the distal convoluted tubule, and can decrease calcium excretion. They are often used in the treatment of nephrolithiasis. Carbonic anhydrase inhibitors decrease bicarbonate absorption and the resultant metabolic acidosis can increase calcium excretion. Their use can promote nephrocalcinosis and nephrolithiasis. This review will address the use of diuretics on disorders of calcium homeostasis.

Incidence and prognosis of dysnatremias present on ICU admission

Dysnatremias are common in patients admitted to the intensive care unit (ICU). Whether the presence of disorders of sodium balance on ICU admission is independently associated with excess mortality is unknown. We hypothesized that dysnatremias at the time of ICU admission are independent risk factors for increased mortality in critically ill patients. We conducted a retrospective study in 77 medical, surgical, and mixed ICUs in Austria, with a database of 151,486 adults admitted consecutively over a period of 10 years (1998-2007). Most patients (114,170, 75.4%) had normal sodium levels (135 < or = Na < or = 145 mmol/L) on ICU admission. The frequencies of borderline (130 < or = Na < 135 mmol/L), mild (125 < or = Na < 130 mmol/L), and severe hyponatremia (Na < 125 mmol/L) were 13.8%, 2.7%, and 1.2%, respectively. The frequencies of borderline (145 < Na < or = 150 mmol/L), mild (150 < Na < or = 155 mmol/L), and severe hypernatremia (Na > 155 mmol/L) were 5.1%, 1.2%, and 0.6%, respectively. All types and grades of dysnatremia were associated with increased raw and risk-adjusted hospital mortality ratios. Multiple logistic regression analysis showed an independent mortality risk rising with increasing severity of both hyponatremia and hypernatremia. Odds ratios and 95% confidence interval (CI) for borderline, mild, and severe hyponatremia were 1.32 (1.25-1.39), 1.89 (1.71-2.09), and 1.81 (1.56-2.10), respectively. Odds ratios and 95% CI for borderline, mild, and severe hypernatremia were 1.48 (1.36-1.61), 2.32 (1.98-2.73), and 3.64 (2.88-4.61), respectively. Our results suggest that both hypo- and hypernatremia present on admission to the ICU are independent risk factors for poor prognosis.

Disorders of sodium balance after brain injury

Sodium disturbances are common in patients with brain injury because of the major role that the central nervous system plays in the regulation of sodium and water homeostasis. In addition, treatment of the injured brain can itself disturb regulation of sodium and water. Sodium disturbances can lead to serious complications and adverse outcomes, including death. Complications can be minimized by a systematic approach to recognition, diagnosis, and treatment of the sodium disturbance.

Troubles de l’hydratation cellulaire et extracellulaire

In the organism, water balance control is aimed at normalizing cellular hydration and sodium balance control at normalizing extracellular volume. Hydration disorders are caused by a disorder in sodium and/or water balance. Water balance control is based on the regulation of body fluid tonicity while the control of sodium balance is based on the regulation of effective arterial volume. Disorders of water balance act on cellular hydration; primary disorders induce a change in tonicity and secondary disorders are induced by a change in tonicity. Primary water balance disorders induce a proportional change in tonicity and natremia and do not affect extracellular and effective arterial volumes in a clinically perceptible manner, and thus induce only a disturbance of cellular hydration. Disorders of sodium balance act on extracellular volume; primary sodium balance disorders induce a change in effective arterial volume and secondary disorders are induced by a change in the effective arterial volume. A sodium balance disorder may be due to an isotonic sodium load or loss; in this case there are no changes in tonicity and natremia and thus no change in cellular hydration. However, sodium balance disorders are often complex and induce a variation in both cellular and extracellular hydration. Physical examination of the patient allows assessing the extracellular volume and the severity of the sodium balance disorder. Natremia that reflects tonicity allows assessing cellular hydration and determining the type of water balance disorder. In the case of natremia disturbance, the estimation of both the tonicity and the extracellular volume allows the determination of the type of water and/or sodium balance disorder which is necessary to prescribe the adequate therapy.

Serum Sodium Does Not Correlate With Seizure Length or Seizure Threshold in Electroconvulsive Therapy

Disorders of sodium balance can result in seizures. In electroconvulsive therapy (ECT) practice, it is customary to obtain electrolytes, including sodium, before treatment. A question that arises is whether the patient with mild disturbances of sodium can safely be treated with ECT or whether normalization of serum sodium is needed first. In this series, 207 patients were treated with ECT and had a serum sodium performed within a week before the first treatment. A few patients were mildly hypernatremic or hyponatremic. We found no correlation between baseline sodium and seizure threshold or seizure duration at the first treatment session. We conclude that although it is ideal to have normal sodium values before ECT, mild abnormalities do not necessarily presage prolonged seizures or lower seizure thresholds in ECT.

Treatment of Sodium Balance Disorders: Water Intoxication and Salt Toxicity

Electrolyte disorders are commonly identified in food animal medicine. Some of these electrolyte disturbances require that the veterinarian be aware of the potential for causing harm during routine fluid therapy. Hyponatremia (water intoxication) and hypernatremia (salt toxicity) are two such disorders. Both create osmolar disturbances that effect changes in the brain's osmolar state. During fluid resuscitation it is possible to cause iatrogenic central nervous system damage in these cases. It is important to recognize those cases where sodium imbalance may complicate routine therapy, understand the underlying mechanisms for osmolar changes in the plasma and brain, and know the appropriate steps to take for safe correction of the sodium disturbance.

Sodium balance in very-low-birth-weight infants

Maintaining sodium balance in the VLBW infant is not straightforward. Several predisposing factors appear in more than one imbalance constellation. In addition, the same patient circumstance can produce two types of imbalance. Understanding the physical properties of electrolytes and water enables critical care nurses to anticipate outcomes of specific situations in the neonatal ICU. Careful assessment of renal function, urine output, and water balance are crucial in determining proper treatment of sodium balance disorders. The high potential risk of errors in the neonatal ICU requires verification of all fluid and electrolyte orders, as well as serial safety checks of IV fluids and additives to avoid complications. An expert nurse's ability to predict the needs of VLBW infants places the nurse in a pivotal position to recognize subtle changes before actual physiologic change occurs. Although the multiple variations can be confusing to the bedside clinician, sorting through them helps in selecting interventions that are timely and improve the outcomes and morbidity of our smallest patients at risk.