Mean Serum Sodium Level Research Articles

Biochemical profile of term neonates with perinatal asphyxia and their correlation with severity of asphyxia

ABSTRACT Background: Birth asphyxia is a major cause of neonatal mortality and neurological morbidity. This study was aimed to determine biochemical (sodium, potassium, and calcium) abnormalities and their correlation across different severities of perinatal asphyxia in term neonates. Methods: This observational analytical study was conducted in term neonates with perinatal asphyxia admitted at the neonatal intensive care unit of a tertiary care centre for a period of 18 months. Blood collection was done at baseline, 24 hours, and 48 hours of treatment to evaluate electrolyte abnormalities. The abnormality in serum electrolytes was correlated across different stages of hypoxic ischaemic encephalopathy (HIE) as per severity and at different time intervals. Results: A total of 74 neonates were included in the study and classified into HIE stage 1 (n = 37), stage 2 (n = 18), and stage 3 (n = 19). At baseline, hyponatremia, hyperkalaemia, and hypocalaemia were observed in 36.5% (n = 27), 20.3% (n = 15), and 10.8% (n = 8), respectively. The difference between mean serum sodium (p: 0.007), potassium (P: 0.004), and calcium levels (p: 0.001) at baseline in stage 1 and stage 3 was statistically significant. The degree of hyponatremia and hyperkalaemia was more and statistically significant as per increasing severity of HIE. All the deaths (n = 6.8.1%) belonged to stage 3 of HIE. Conclusion: The degree of hyponatremia, hypocalaemia, and hyperkalaemia in the asphyxiated newborns correlated with the severity of birth asphyxia. The mortality rate was greater in asphyxiated neonates with severe HIE and electrolyte abnormality. Effective perinatal care and meticulous management of dyselectrolytemia are crucial for improving neonatal outcomes.

Predictive factors of hyponatremia in subarachnoid hemorrhage and outcomes

Background & Objective: The prevalence of hyponatremia in subarachnoid hemorrhage (SAH) was 30-55%. There was lack of evidence about predictive factors and clinical outcomes of hyponatremia in SAH patients. This study aimed to evaluate factors associated with hyponatremia following SAH and to review the clinical outcomes and treatment of hyponatremia in SAH patients. Method: This is a retrospective cohort study. SAH patients presented during January 2013 to January 2019 were reviewed. They were divided into 2 groups: SAH with normonatremia and SAH with hyponatremia. Clinical data, laboratory profile, aneurysm characteristics and clinical outcomes were recorded and analyzed. Result: A total number of 278 patients with SAH were included, 139 patients in each group. The populations were female 66% with mean age of 56 years old and mean serum sodium (Na) level 132 mmol/L. Aneurysm location associated with hyponatremia; anterior cerebral artery (ACA) (OR 4.2, 95%CI 1.4-13.0, p-value 0.009) and posterior cerebral artery (PCA) (OR 3.7, 95%CI 1.2-11.5, p-value 0.017). Aneurysms clipping procedure was also associated with hyponatremia (OR 4.0, 95%CI 1.8-8.8, p-value < 0.001). Conclusion: ACA and PCA aneurysms and aneurysms clipping procedure were risk factors for hyponatremia following SAH. Mild hyponatremia was not associated with morbidity and mortality in SAH patients.

Association of Retinal Vein Occlusion With Serum Osmolality and Hydration Status.

The aim of this study was to evaluate serum osmolality and hydration status in patients with retinal vein occlusion (RVO). This cross-sectional study consisted of 79 patients with RVO and 81 age- and sex-matched peers without ocular disease. Data were collected from patient records and included a comprehensive ophthalmological examination, laboratory data of fasting blood test results, and internal medicine outpatient examination. Complete blood count and levels of fasting glucose, sodium, blood urea nitrogen (BUN), creatinine, triglyceride, low-density lipoprotein, high-density lipoprotein, HbA1c, and serum osmolality were evaluated. BUN/creatinine ratios were calculated. Mean serum sodium and serum osmolality levels were 142.53 ± 2.13 and 139.74 ± 2.16 mEq/L and 286.58 ± 4.40 and 280.57 ± 4.39 mOsmol/kg H2O in the RVO and control groups, respectively. Serum osmolality and serum sodium levels, and BUN/creatinine ratio were significantly higher in the RVO group than in controls (P < 0.05 for all). We found that serum osmolality, sodium levels, and the BUN/creatinine ratio increased significantly in the RVO group. The results suggest dehydration status may affect the genesis of vessel occlusion in RVO. [Ophthalmic Surg Lasers Imaging Retina 2024;55:130-135.].

Effect Of Sglt2 Inhibitor Dapagliflozin On Sodium, Potassium And Creatinine Levels In Patients With Acute Heart Failure.

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) is a new class of medication for the treatment of type 2 diabetes mellitus. Additionally, they have been found to have beneficial effects on heart failure outcomes, convincingly reducing the morbidity and mortality in heart failure. Although the medical data indicates SGLT2i to be safe and cardio-protective, very little attention has been given to the impact of these agents on electrolyte balance particularly in acute heart failure (AHF). We aimed to evaluate the effect of SGLT2i, and dapagliflozin on serum sodium, potassium and creatinine in AHF. Overall, 160 adult patients of either gender, admitted with AHF were selected for the study. Selected individuals were randomly assigned to receive dapagliflozin 10 mg orally added to standard medical treatment (n=80) or were in reception of standard medical therapy only (n=80). Serum electrolytes and serum creatinine were collected on admission and day 7 or on discharge whichever happened earlier. The mean level of serum electrolytes displayed insignificant differences among both groups on admission. The mean level of serum potassium was higher in the dapagliflozin group compared with the control group (p<0.001) on day 7/discharge. Mean serum sodium level was comparable and showed significant differences between the two groups following treatment (p-value=0.021). Significant higher levels of serum creatinine were observed following treatment in both groups. However, on intergroup comparison, they were statistically insignificant. Dapagliflozin is an effective treatment of heart failure and is not associated with deterioration of serum electrolyte levels and renal functioning when used as add-on therapy in AHF.

Association of Serum Electrolytes Level with Premenstrual Syndrome

Background: Premenstrual syndrome (PMS) is a significant health condition that affects a significant portion ofthe female population. Due to the ovarian hormone, changes in serum electrolyte levels can happen in the late lutealperiod of the menstrual cycle. Methods: A cross-sectional study was conducted to find out the association of serum electrolytes levels of 30 youngunmarried women with PMS from July 2016 to June 2017 in the Department of Physiology, Sir Salimullah MedicalCollege, Dhaka, Bangladesh. Results: The mean age of both groups of young unmarried women of was 20.30±1.15 years and 20.53±1.17 years. Themean serum sodium level was 139.97±1.30 and 140.93±1.68 mmol/L, and the serum potassium level was 4.20±0.32and 4.17±0.31 mmol/L. The mean serum sodium level was significantly higher in group B in comparison to groupA (p&lt;0.05). Premenstrual scores of irritability, abdominal bloating, backache, depression, fatigue, breast tenderness,headache, and anxiety were significantly higher in comparison to those of postmenstrual scores in the PMS group(p&lt;0.05). Conclusion: These study results acclaimed that serum sodium levels influence the physical and psychological symptoms of women with PMS.

Retrospective analysis of patients diagnosed with severe hyponatraemia in the emergency department.

Background . We investigated the demographic, aetiological and clinical characteristics of patients who presented to the emergency department and had severe hyponatraemia. Methods . We retrospectively evaluated 1171 patients who presented to the emergency department and were diagnosed with severe hyponatraemia. Results . Over half the patients studied were women (53.5%). The mean age of women was higher (p<0.0001). The most common complaint was dyspnoea (16.8%) and 42.5% of the patients had an oral intake disorder. In addition, 22.3% of the patients were on loop diuretics. About 76.3% of patients were conscious, and the mean sodium level of these patients was higher than the mean sodium level of those who responded to verbal and painful stimuli (p<0.001). Severe isolated hyponatraemia was observed in 61.8% of the patients. The mortality rate was 12.8%. There was no difference between the mean sodium levels of the deceased and discharged patients (p=1.0). The mortality rate was higher in patients who had a history of cirrhosis and cancer, but was lower in patients with a history of coronary artery disease (p=0.0002, p<0.0001 and p=0.04, respectively). Conclusion . Severe hyponatraemia was more prevalent in women, serum sodium levels were higher in conscious patients, and the mortality rate was higher in patients who had a history of cirrhosis and cancer. We found that the mean serum sodium levels did not help in distinguishing between the deceased and discharged patients.

Association of serum sodium and 24-hour urinary sodium level with the severity and complications of ascites in cirrhotic patients.

Hyponatremia is an independent predictor of mortality in cirrhotic patients but little is known regarding the relationship between the level of serum sodium and 24-hour urinary sodium with the development of severity and complications of cirrhotic ascites. To observe the association of serum sodium and 24-hour urinary sodium levels with different grades of ascites and its complications in cirrhotic patients. In the department of Gastroenterology in a tertiary care hospital, this cross-sectional study was conducted from April 2019 to September 2020. A total of 96 admitted cirrhotic patients with ascites were enrolled in this study by consecutive sampling. Out of 96 patients with cirrhotic ascites, 48 patients had mild, moderate, and severe ascites and 48 patients had complications of ascites like refractory ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome. The mean serum sodium level was 131.69 ± 4.90 and 124.88 ± 5.67 mmol/L and the 24-hour urinary sodium level was 76.82 ± 45.64 and 35.26 ± 22.57 mmol/L in uncomplicated and complicated ascites groups respectively with P value < .001. In grade 1, grade 2, and grade 3 ascites, there was a significant (P = .001), association between mean serum sodium (mmol/L) level (R -0.777) and 24-hour urine sodium (mmol/L) level (R -0.704) but no significant difference was seen when refractory ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome were considered. In our finding, low serum sodium and low 24-hour urinary sodium levels were associated with the development of severe complications of cirrhotic ascites. Hence, Serum sodium and 24-hour urinary sodium levels can be good predictors of grading and complications of cirrhotic ascites.

Correlation between estimated glomerular filtration rate and serum electrolytes in chronic kidney disease patients

Background: The occurrence of chronic kidney disease (CKD) a highly prevalent condition has been escalating in recent years. Electrolytes are the key to homeostasis and furthermore, their regulation is dependent upon renal function. CKD is associated with aberrations in the metabolism of electrolytes such as calcium, magnesium, sodium, and potassium. Aims and Objectives: The aim of this study is to study the correlation between estimated glomerular filtration rate (eGFR) and serum electrolytes in CKD patients. Materials and Methods: The present study was a cross-sectional study. One hundred patients with CKD aged 18 years or above were enrolled with inclusion and exclusion criteria. Complete blood investigations, urine analysis and ultrasonographic findings for detection of CKD were done and a semi-structured pro forma was used to record clinical profile in a cross-sectional study and patients were grouped into their respective CKD stages based on their eGFR. Results: The mean value of eGFR was 40.92±21.35 mL/min/1.73 m2. The mean value of serum sodium, calcium, magnesium, and potassium was 137.1±2.16 meq/L, 9.15±0.61 mg/dL, 3.16±0.93 mg/dL, and 4.65±0.96 meq/L, respectively. In the present study, we found that the mean serum magnesium levels in Stages 1, 2, 3, 4, and 5 of CKD were 2.10±0.20, 2.10±0.28, 2.74±0.50, 3.95±0.54, and 4.66±0.43 mg/dL, respectively. Mean serum magnesium levels were the mean serum potassium levels in Stages 1, 2, 3, 4, and 5 of CKD were 4.13±0.57, 4.15±0.68, 3.86±0.41, 5.55±0.39, and 6.25±0.08 meq/L, respectively. The mean serum calcium levels in Stages 1, 2, 3, 4, and 5 of CKD were 9.83±0.05, 9.79±0.20, 9.43±0.27, 8.72±0.38, and 7.8±0.10 mg/dL, respectively. The mean serum sodium levels in Stages 1, 2, 3, 4, and 5 of CKD were 137.33±0.57, 136.43±2.87, 136.92±2.15, 137.51±1.90, and 137.5±2.07 meq/L, respectively. Conclusion: There was significant rise in serum potassium and magnesium levels with decrease in eGFR in CKD patients. There was significant fall in serum calcium levels with decrease in eGFR in CKD patients. There was no significant correlation between serum sodium levels and eGFR in CKD patients.

Real-World Evaluation of Serum Sodium Levels in Patients With Focal Seizures Treated With Eslicarbazepine Acetate (P4-1.010)

<h3>Objective:</h3> Here we report serum sodium values in patients treated with adjunctive eslicarbazepine acetate (ESL) that were collected in an electronic health record database to assess the effect of ESL on sodium levels in a U.S. real world clinical setting. <h3>Background:</h3> ESL is approved for focal seizure treatment in patients ≥4 years in the US. ESL is a member of the dibenzazepine carboxamide class, a class associated with the development of hyponatremia. In a pooled analysis of 3 clinical trials, incidence of clinically meaningful post-dose sodium levels (≤125 mEq/L) was 1.0% (ESL 800mg), 1.5% (ESL 1200mg) vs 0% (placebo). <h3>Design/Methods:</h3> The electronic health record database was queried to identify patients with a diagnosis of epilepsy (ICD-10 G40*; N=99) or focal epilepsy (ICD-10 G40.0*-G40.2*; n=55), aged ≥4 years, currently treated with ESL, and sodium values available within 3 months prior to ESL initiation (baseline). Serum sodium levels obtained during baseline were compared to levels during ESL treatment (6 months, 1 year). These levels were summarized as the average of all lab values for all patients up to the date of interest and as the single lab value closest to the date of interest (max event) per individual patient. <h3>Results:</h3> Most patients started ESL at 400 or 800 mg/day. The mean serum sodium level for epilepsy patients during baseline was 138.9±8.6 mEq/L and remained stable through 12 months of ESL treatment (138.8±6.2 mEq/L), similar to focal epilepsy patients (baseline, 139.2±9.6 mEq/L; 12 months, 137.5±6.6 mEq/L). These results remained when assessing the max event. 4 focal epilepsy patients demonstrated serum sodium level ≤125 mEq/L at ≥1 timepoints during 12 months of ESL treatment. All observations were made in the context of routine delivery of care. <h3>Conclusions:</h3> Mean serum sodium values in patients treated with ESL did not change from baseline in a real-world clinical setting over 12 months. <b>Disclosure:</b> Mr. Mitchell has received personal compensation for serving as an employee of Sumitovant. Mr. Mitchell has received personal compensation for serving as an employee of Real Chemistry. Mr. Mitchell has stock in Citius Pharmaceuticals Inc. Mr. Mitchell has stock in Spectrum Pharmaceuticals. Mr. Mitchell has received publishing royalties from a publication relating to health care. Mr. Mitchell has received personal compensation in the range of $0-$499 for serving as a Chaplain Candidate with US Army Reserve. Dr. Cantu has received personal compensation for serving as an employee of Sunovion Pharmaceuticals Inc.. Darshan Mehta has received personal compensation for serving as an employee of Sunovion Pharmaceuticals Inc. . Todd Grinnell, PhD has received personal compensation for serving as an employee of Sunovion Pharmaceuticals Inc.. Mr. Smith has nothing to disclose.

Serum Electrolytes in Patients Presenting With Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) and Their Comparison With Stable COPD Patients.

Introduction Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, which may be further aggravated by episodes of acute exacerbationof COPD (AECOPD). Electrolyte imbalances during these episodes may add to the duration of hospitalization and disease outcome. Aims and objectives This study aims to compare the serum electrolyte levels of patients with AECOPD and stable COPD and correlate them with the severity of exacerbation and disease outcome. Materials and methods The study was conducted as a case-control study between January 2021 and December 2022. Patients with AECOPD and stable COPD were included as "cases" and "controls," respectively. The various serum electrolyte levels were defined as per recent guidelines. Statistical analysis was performed using SPSS 20.0 (IBM Corp., Armonk, NY). Results A total of 75 patients wereincludedwith 41 in the study group and 34 in the control group. The majority of people were between the ages of 61 and 70. The most frequent electrolyte abnormality found was hyponatremia.The mean serum sodium and calcium levels were lower in patients with AECOPD while the mean serum potassium levels were higher. A total of five deaths were recorded in patients with two or more electrolyte imbalances. The latter also had a requirement for home oxygen or non-invasive ventilation at the time of discharge. Conclusion Patients of AECOPD with multiple electrolyte imbalances need scrutinized treatment as they are more prone to develop complications, have poorer outcomes, and prolonged hospital stays.

CLINICAL PROFILE AND OUTCOME OF NEONATES WITH HYPERNATREMIC DEHYDRATION - A TERTIARY CARE HOSPITAL BASED STUDY

Objectives: Materials And Methods: Clinical prole and outcome of neonates with hypernatremic dehydration. Cross sectional study conducted in a tertiary care centre in central India, includes sick neonates aged less than 28 days admitted in hospital for a period from April 2022 to March 2023, who found to have hypernatremic dehydration on admission with serum soidum &gt;150 mEq/L. Clinical and demographic information in relation to mother and baby were recorded. Out of total 2076 neonates admitted during t Results: he study period, 25 babies were diagnosed as a hypernatremic dehydration, showing an institute prevalence of 1.2%. Median age of presentation was 9 days, with female to male ratio 1.03. 92% of the babies were exclusively breast fed.76 % were born via normal delivery. Maximum presented with not accepting feed (96%), along with fever (64%), decreased urine output (52%), convulsions (28%). Admitted babies had a mean serum sodium level of 173.9 mEq/L, with as high as 200 mEq/L. 9 babies (36%) presented with shock,19 (76%) presented with evidence of kidney injury. Statistically signicant correlation was found between percentage of weight loss to mortality and serum sodium levels to mortality. Hypernatremic dehydration is a common Conclusion: medical emergency encountered in neonatal ICU and can be caused by poor feeding. Early diagnosis and appropriate treatment are crucial for survival and better prognosis.

Hyperfibrinogenemia and hyponatremia as predictors of perforated appendicitis in children: A retrospective cohort study

The aim of this study was to investigate the predictive value of hyperfibrinogenemia and hyponatremia for perforated appendicitis in children. A retrospective review of 521 pediatric patients (≤ 15years) with acute appendicitis confirmed by histopathology from January 2017 to December 2020 was performed. Patients were divided in two groups, those with non-perforated (n = 379; 73%) and perforated appendicitis (n = 142; 27%). The serum values of sodium and fibrinogen were taken before surgery. We performed the receiver operating characteristic analysis for the two biochemical markers. The sensitivity, specificity, positive and negative predictive values for perforated appendicitis in the presence of hyponatremia and hyperfibrinogenemia were calculated. Hyperfibrinogenemia (≥ 4.0g/L) was found in 58.45% of perforated appendicitis and 104 of 142 (73.34%) children with perforated appendicitis had hyponatremia (≤ 135mmol/L). The perforated appendicitis group had a higher mean fibrinogen concentration (P = 0.001). There was a statistically significant difference in mean serum sodium levels between the perforated appendicitis and non-perforated appendicitis groups (P = 0.016). Receiver operating characteristic curve analysis for fibrinogen, sodium and combination of the both markers shown the combination had the largest area under the curve in identifying children with perforated acute appendicitis (0.858) (95% CI, 0.82-0.90) compared with fibrinogen (0.815) (95% CI, 0.77-0.86) and sodium 0.818 (95% CI, 0.78-0.86) alone. Furthermore, the combination of both markers had the best positive and negative predictive value for appendix perforation compared to fibrinogen and sodium. Hyponatremia and/or hyperfibrinogenemia are excellent markers for predicting perforated appendicitis in children. We propose that plasma sodium and/or fibrinogen concentrations be utilized as a supplementary to guide individual treatment decisions in children with appendicitis, such as surgery timing and nonoperative management options.

Postoperative Assessment of Cognitive Dysfunction in Patients Undergoing Transurethral resection of the Prostate under Spinal Anaesthesia: A Prospective Cohort Study

Introduction: Postoperative Cognitive Dysfunction (POCD) is a common disorder following surgery that threatens the quality of patients’ lives. POCD is closely associated with perioperative factors such as age, physical state, surgery duration, anaesthesia method, intraoperative hypotension, and infection. Among these factors, age is the only long-term risk factor for POCD. The relationship between anaesthesia depth and the incidence of POCD is debatable. Aim: To assess POCD in patients undergoing Transurethral Resection of the Prostate (TURP) and to examine the association between the duration of surgery and serum sodium levels with cognitive dysfunction. Materials and Methods: A prospective observational study was conducted at the Department of Anesthesiology, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India, from January 2020 to June 2021. The study included 100 patients aged over 60 years who were scheduled for TURP surgery under Spinal Anaesthesia. The Mini-Mental State Examination (MMSE) test was performed in the preoperative holding area, and the results were recorded. A decline in cognitive function was defined as a loss of 2 or more points on the MMSE test compared to the preoperative value. Serum sodium levels and MMSE scores were measured before surgery. Serum sodium levels and MMSE scores were also recorded after the 1st hour and 6th hour postoperatively. The data were entered into MS Excel 2007 and analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Results: In the present study, out of 100 subjects, the majority of patients (33%) belonged to the age group of 66-70 years, and most of the study subjects (79%) were classified as American Society of Anesthesiologists (ASA) II status, followed by ASA III status. The mean age of the study participants was 69.3 years. The mean duration of surgery was 45.6 minutes. A statistically significant difference (p&lt;0.05) was observed when comparing the mean serum sodium levels before surgery (138.1±1.5 mmol/L) with those at the 1st hour postoperatively (135.9±1.6 mmol/L) and 6th hour postoperatively (134.4±1.4 mmol/L). The mean MMSE score before surgery and at the 1st hour and 6th hour postoperatively was the same (27.6±0.8), and there was no statistically significant difference between them. The MMSE score did not vary with the serum sodium levels, and this difference was not statistically significant (p&gt;0.05). Conclusion: In the present study, patients undergoing TURP procedures under spinal anaesthesia did not exhibit any POCD, despite a considerable drop in serum sodium levels. It is worth noting that all patients were asymptomatic.

Severity of Hyponatremia and its Influence on Various Complications of Decompensated Chronic Liver Disease

Objective The study quantified the occurrence and intensity of hyponatremia in decompensated chronic liver disease patients Study design: Descriptive Cross sectional study Place and Duration: Department of Gastroenterology, Centre for Liver Diseases, Holy Family Hospital (CLD, HFH) for a total 6 months duration Methodology: Patients aged 13-75 years, both male and female presenting with Clinical, biochemical, and Ultrasonographic findings of cirrhosis were included in this study. Patients' ages, genders, levels of serum hyponatremia, rates of complications, Child-Pugh scores, and other contextual data were recorded in a standardized proforma. The tests were conducted in the hospital's lab, and a pathologist looked over the results. Results: Among 120 study cases, 72 (60 %) patients were male and 48 (40 %) were female patients. The mean age was 50.83 ± 10.50 years; ranging from 30 years to 70 years. Of these 120 study cases, 32 (26.7 %) were from rural areas while 88 (73.3 %) were from urban areas, 35 (29.2%) were poor, 69 (57.5%) were middle income and 16 (13.3%) were having rich socioeconomic status. Child-Pugh class B was noted in 77 (64.2 %) and Child-Pugh class C was noted in 43 (35.8%) of our study cases. The mean serum sodium level was 131.25 ± 4.34 mmol/L ranging from 118 mmol/L to 141 mmol/L and hyponatremia was noted in 64 (53.3%) of our study cases. Mild hyponatremia was noted in 12 (10%), moderate hyponatremia in 28 (23.3%) and severe hyponatremia in 24 (20%) of our study cases. Hepatic encephalopathy was noted in 16 (13.3%), spontaneous bacterial peritonitis in 36 (30%), variceal bleeding in 44 (36.7%) and Hepatorenal syndrome in 24 (20%). Conclusion: Our study found that people with liver cirrhosis were more likely to be hyponatremic than those without the condition. Hyponatremia was associated with being older age, having problems, and being labelled as a Child-Pugh class C. It was also revealed that the number of problems was strongly correlated with the degree to which the hyponatremia had progressed. Nurses, doctors, and anybody else providing care for cirrhotic patients should all keep a close check on their patients' sodium levels. Keywords: Hyponatremia, liver cirrhosis, Serum Sodium, Child-Pugh

Effect of diuretics on sodium, potassium and chloride levels- a cross sectional study

Background: Diuretics are one of the widely used class of drugs used in various cardiovascular and other disorders. However, they can cause various metabolic adverse effects, electrolyte imbalance being among important changes.Methods: A cross sectional study was conducted in which patients diagnosed with hypertension for at least one month were included. Over a period of 6 months patients were enrolled irrespective of whether they were taking diuretics or not. Demographic details, drug therapy and electrolyte levels were recorded in a proforma. Data was analyzed for difference in serum electrolyte levels between diuretic and nondiuretic groups as well as between different diuretic groups.Results: Out of total 177 participants, 71 were on diuretic therapy. There was significant difference in mean serum sodium (S. Na), potassium (S. K) and chlorine (S. Cl) levels between diuretic and nondiuretic groups (P&lt;0.05). Hyponatremia, hypokalemia and hyperkalemia were observed. Thiazide diuretic group showed significantly greater hyponatremia compared to other diuretics (P=0.028). Hyperkalemia was observed in participants receiving K sparing diuretic or combination of loop and K sparing diuretics. Old age and number of comorbidities showed negative association with S. Na. Females had significantly more hyponatremia than male participants.Conclusions: The study confirms that diuretics cause various abnormalities in electrolytes namely Na and K levels. Old age, comorbidities and female sex are risk factors for hyponatremia.

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

Traumatic brain injurySodiumClinical outcomes.

Low Serum Sodium Level and Prediction of Febrile Seizure Recurrence

Background: Febrile seizure (FS) is one of the most common neurologic disorders in children. Electrolyte imbalance especially hyponatremia may have an important role in triggering the febrile seizure. The measure of serum electrolytes will be useful in predicting further seizures. This study aimed to investigate the effect of relative hyponatremia on the risk of recurrent febrile seizures. Methods: This prospective study was performed on 115 children (6-60 months) with convulsions, at the pediatric department of Ibrahim malik teaching hospital. the serum sodium was measured immediately after abortion of seizures and each patient was followed for 24 hours for assessment of recurrence. Of the 115 children, 47 (40.9 %) develop recurrent febrile seizures. Of those the majority were males 36 (76.6%) (P=0.01), 52(45.2%) age less than 12 months(P=0.001), 26 (68.4%) have parents’ consanguinity(P=0.000), and were first born child25 (53.2%). The mean serum sodium levels in patients with one and recurrent attacks, were 132.1, 136.1 meq/l, respectively (P=0.00). Conclusions: The serum sodium level was ominously lower in the recurrence group compared to the non-recurrent group. Measurements of serum sodium levels and hyponatremia diagnosis have a key role in predicting the FC recurrence. Therefore, doctors should be careful during fluid administration to febrile seizure patients.

Hyperbilirubinemia and Hyponatremia as Predictors of Complicated Appendicitis.

Several studies have reported elevated serum bilirubin or reduced serum sodium levels in patients with complicated appendicitis (CA). This study examined the efficacy of hyperbilirubinemia, hyponatremia, and both combined in the preoperative diagnosis of CA. Patients who underwent surgery for acute appendicitis were included in this retrospective review. In total, 247 patients were included in the final analysis. Of these, 36 (14.2%) had early appendicitis, 177 (72.0%) had acute suppurative appendicitis, 32 (13.0%) had necrotizing/gangrenous acute appendicitis, and 2 (0.8%) had other types of appendicitis. The mean total bilirubin (TBIL) level was significantly higher in patients with CA than in those with uncomplicated appendicitis. Conversely, the mean serum sodium level was significantly lower in patients with CA than in those with uncomplicated appendicitis. The levels of TBIL (odds ratio: 1.098, 95% CI: 1.052–1.147) and serum sodium (odds ratio: 0.743, 95% CI: 0.646–0.855) were associated with CA. Hyponatremia combined with hyperbilirubinemia yielded significant discriminatory value for the diagnosis of CA. TBIL and serum sodium levels can be considered as adjuvant parameters in the diagnosis of perforated/necrotizing appendicitis. Although hyperbilirubinemia and hyponatremia together were better able to determine the risk of CA than either marker alone, other markers are required to definitively predict CA. Furthermore, large-scale studies are needed to confirm these findings.

Risk factors for overcorrection of severe hyponatremia: a post hoc analysis of the SALSA trial.

BackgroundHyponatremia overcorrection can result in irreversible neurologic impairment such as osmotic demyelination syndrome. Few prospective studies have identified patients undergoing hypertonic saline treatment with a high risk of hyponatremia overcorrection.MethodsWe conducted a post hoc analysis of a multicenter, prospective randomized controlled study, the SALSA trial, in 178 patients aged above 18 years with symptomatic hyponatremia (mean age, 73.1 years; mean serum sodium level, 118.2 mEq/L). Overcorrection was defined as an increase in serum sodium levels by >12 or 18 mEq/L within 24 or 48 hours, respectively.ResultsAmong the 178 patients, 37 experienced hyponatremia overcorrection (20.8%), which was independently associated with initial serum sodium level (≤110, 110–115, 115–120, and 120–125 mEq/L with 7, 4, 2, and 0 points, respectively), chronic alcoholism (7 points), severe symptoms of hyponatremia (3 points), and initial potassium level (<3.0 mEq/L, 3 points). The NASK (hypoNatremia, Alcoholism, Severe symptoms, and hypoKalemia) score was derived from four risk factors for hyponatremia overcorrection and was significantly associated with overcorrection (odds ratio, 1.41; 95% confidence interval, 1.24–1.61; p < 0.01) with good discrimination (area under the receiver-operating characteristic [AUROC] curve, 0.76; 95% CI, 0.66–0.85; p < 0.01). The AUROC curve of the NASK score was statistically better compared with those of each risk factor. ConclusionIn treating patients with symptomatic hyponatremia, individuals with high hyponatremia overcorrection risks were predictable using a novel risk score summarizing baseline information.

Frequency and Severity of Hyponatremia in Children Seeking Emergency Care

Objective: To determine the frequency and severity of hyponatremia in children seeking emergency care at tertiary care Hospital. Methodology: This cross-sectional study was done at Pediatric emergency civil Hospital Karachi from May 2012 to November 2012. All patients of either sex coming to pediatric emergency, ages from 2 months to 12 years who did not receive any treatment during this illness were included. All patients who met the inclusion criteria were evaluated for sodium concentration through serum sodium concentration. Informed consent was obtained from the parents or attendant. Data was analyzed using SPSS version 26. Results: The mean age of enrolled participants was 4.1±2.7 year. Of 188 enrolled participants, 144 (76.6%) were male and 44 (23.4%) were female with a male to female ratio of 2.3:1, mean weight 12.87±3.5 kg and mean serum sodium level of 134.64±3.7mEq/L. The frequency of hyponatremia was in 61(32.4%) cases and out of these 61 patients, 18.9% had severe hyponatremia. The frequency of hyponatremia was statistically insignificant according to age and gender (p-&gt;0.05). Conclusion: It was concluded that the frequency of hyponatremia in sick children presented to emergency department was 32.4%. Key words: Hyponatremia, Children, Emergency department