Serum Sodium Levels In Patients Research Articles

Hyponatremia as a predictor of complicated appendicitis: a systematic review and meta-analysis.

Aim: To investigate the value of hyponatremia as a predictive marker for complicated appendicitis.Methods: PubMed, Embase, Web of Science and Scopus databases were searched for studies published up to 5 June 2024. Studies reporting serum sodium levels in patients with complicated and non-complicated appendicitis and studies reporting the association between baseline hyponatremia and complicated appendicitis were included. A random-effects meta-analysis was performed.Results: Twenty-two studies met the eligibility criteria. Serum sodium levels were measured at arrival or preoperatively in all included studies. Meta-analysis of data from 17 studies showed that preoperative sodium levels were significantly lower in patients with complicated appendicitis vs uncomplicated appendicitis [Mean Difference (MD): -2.58 95% confidence intervals (CI): -3.51, -1.66 I2=98%]. A pooled analysis of 18 studies demonstrated a statistically significant association between preoperative hyponatremia and complicated appendicitis [Odds Ratio (OR): 4.11 95% CI: 3.07, 5.51 I2=93%]. Results remained significant on subgroup analysis for adult and pediatric populations. However, the MD was higher and the OR was higher in the subgroup of pediatric patients.Conclusion: Hyponatremia was identified as a potential predictor for complicated appendicitis. The association between hyponatremia and complicated appendicitis seems to be stronger in pediatric patients as compared with adults.

STUDY OF SERUM SODIUM LEVELS AND ITS CLINICAL SIGNIFICANCE IN DECOMPENSATED CHRONIC LIVER DISEASE PATIENTS ADMITTED IN A TERTIARY CARE CENTRE OF NORTH EASTERN STATE, TRIPURA

Introduction: Chronic Liver Disease is a major source of death and morbidity globally. Hyponatremia is one of the most common electrolyte abnormalities in chronic liver disease patients. Various studies have established a correlation between serum sodium levels and survival in these patients. Hyponatremia is a marker of severity in CLD patients and studies have shown its relationship with MELD score and Child Pugh score. The complications of DCLD and mortality also increases with hyponatremia. The aim of this study was to study the serum sodium levels in patients with DCLD and to establish its significance. Materials And Methods: Data was collected from 100 patients admitted in medical wards. Patients were divided into 3 groups based on serum sodium levels and the relevant parameters analyzed among the groups. OBSERVATIONS: Among 100 patients, 45 had serum sodium levels ≥136 mEq/L, while 32 had serum sodium levels between 131 and 135 mEq/L and 23 patients had serum sodium level ≤130. No patients had serum sodium levels greater than 145. Serum sodium levels were associated strongly with the severity of liver disease as assessed by Child Pugh and MELD scores. Serum sodium ≤130 indicated the existence of Hepatic Encephalopathy, Hepatorenal Syndrome and Spontaneous Bacterial Peritonitis. Patients with serum sodium less than 130 mEq/L had increased frequency of complications than those with ≥136 mEq/L. Patient with serum sodium levels ≤130 had increased mortality. Conclusion: Hyponatremia is more common in DCLD and low serum sodium levels are associated with increased frequency of complications such as hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis and GI bleeding. Lower serum sodium levels were associated with increased MELD and Child Pugh score and mortality indicating the inverse relationship between serum sodium levels and severity of the disease.

Effect of fluoxetine on serum sodium levels in patients with depression

Background: One common selective serotonin reuptake inhibitor (SSRI) used to treat depression and other mood disorders is fluoxetine. Hyponatremia, or low serum sodium levels, is one of the side effects of fluoxetine and other selective serotonin reuptake inhibitors (SSRIs), despite their effectiveness in reducing depressed symptoms. Regular monitoring of serum sodium levels is essential to prevent and manage these side effects. Aim and Objectives: The objective of this study was to evaluate and compare the changes in serum sodium levels in patients with depression taking fluoxetine in different age groups (18–45, 46–70 years) and to evaluate the adverse effects between the two age groups. Materials and Methods: This prospective observational study involved 110 depressed patients who were divided into two age groups, 18–45 and 46–70 years old, and who attended a psychiatric outpatient department at a tertiary care hospital. Before starting fluoxetine therapy as well as in the first and third weeks afterward, serum sodium levels were tested, and adverse effects were noted. Between the two age groups, serum sodium level changes and other side effects were compared. Results: The serum sodium levels in the 46–70-year-old age group significantly dropped at the first and third weeks following therapy, whereas in the 18–45 year-old age group, the decrease in serum sodium levels occurred only after the 3rd week of therapy (P = 0.0005). At the 3rd week of therapy, 46–70-year-old serum sodium levels were substantially lower than those of 18–45-year-old patients (136.6 vs. 140.5, P = 0.0005), and only older patients had hyponatremia after the 1st and 3rd weeks of therapy. The P value is highly statistically significant (< 0.01). Conclusions: Fluoxetine can lower serum sodium levels, which are more common and clinically evident in the 46–70-year age group than in the 18–45-year age group. In the first few weeks of fluoxetine medication, monitoring serum sodium levels is advised, especially for patients in the 46–70 age group.

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.

Increased Serum Sodium at Acute Kidney Injury Onset Predicts In-Hospital Death.

Over the last decades, acute kidney injury (AKI) has been identified as a potentially fatal diagnosis which substantially increases in-hospital mortality in the short term and morbidity/mortality in the long term. However, reliable biomarkers for predicting AKI-associated outcomes are still missing. In this study, we assessed whether serum sodium, measured at different time points during the in-hospital treatment period, provided prognostic information in AKI. This was a retrospective, observational cohort study. AKI subjects were identified via the in-hospital AKI alert system. Serum sodium and potassium levels were documented at five pre-defined time points: hospital admission, AKI onset, minimum estimated glomerular filtration rate, minimum and maximum of the respective electrolyte during the treatment period. In-hospital death, the need for kidney replacement therapy (KRT) and recovery of kidney function were defined as endpoints. Patients who suffered in-hospital death (n = 37, 23.1%) showed significantly higher serum sodium levels at diagnosis of AKI (survivors: 145.7 ± 2.13 vs. non-survivors: 138.8 ± 0.636 mmol/L, P = 0.003). A logistic regression model was significant for serum sodium levels in patients with in-hospital death (X2, P = 0.003; odds ratio = 1.08 (1.022 - 1.141); R2 = 0.082; d = 0.089). This suggests an increase of the relative risk for in-hospital death by 8% with every unit of serum sodium increase. Patients with a sodium above the upper normal range at AKI diagnosis were also more likely to suffer in-hospital death (P = 0.001). In summary, we present evidence that serum sodium, measured at time of AKI diagnosis, potentially serves as a predictor for in-hospital death in patients with AKI.

Hypo-osmolarity induces apoptosis resistance via TRPV2-mediated AKT-Bcl-2 pathway.

In cirrhosis, several molecular alterations such as resistance to apoptosis could accelerate carcinogenesis. Recently, mechanotransduction has been attracting attention as one of the causes of these disturbances. In patients with cirrhosis, the serum sodium levels progressively decrease in the later stage of cirrhosis, and hyponatremia leads to serum hypo-osmolality. Since serum sodium levels in patients with cirrhosis with liver cancer are inversely related to cancer's number, size, stage, and cumulative survival, we hypothesized that hypo-osmolality-induced mechanotransduction under cirrhotic conditions might contribute to oncogenesis and/or progression of hepatocellular carcinoma (HCC). In this study, we adjusted osmosis of culture medium by changing the sodium chloride concentration and investigated the influence of hypotonic conditions on the apoptosis resistance of an HCC cell line, HepG2, using a serum-deprivation-induced apoptosis model. By culturing the cells in a serum-free medium, the levels of an antiapoptotic protein Bcl-2 were downregulated. In contrast, the hypotonic conditions caused apoptosis resistance by upregulation of Bcl-2. Next, we examined which pathway was involved in the apoptosis resistance. Hypotonic conditions enhanced AKT signaling, and constitutive activation of AKT in HepG2 cells led to upregulation of Bcl-2. Moreover, we revealed that the enhancement of AKT signaling was caused by intracellular calcium influx via a mechanosensor, TRPV2. Our findings suggested that hyponatremia-induced serum hypotonic in patients with cirrhosis promoted the progression of hepatocellular carcinoma.NEW & NOTEWORTHY Our study first revealed that hypo-osmolarity-induced mechanotransduction enhanced calcium-mediated AKT signaling via TRPV2 activation, resulting in contributing to apoptosis resistance. The finding indicates a possible view that liver cirrhosis-induced hyponatremia promotes hepatocellular carcinogenesis.

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.

Prognostic utility of the prognostic nutritional index combined with serum sodium level in patients with heart failure

Background and aimsBoth malnutrition and hyponatremia (serum sodium <135 mmol/L) can be induced by the impaired absorption function of the edematous intestinal wall caused by heart failure (HF) and are prognostic factors of mortality in HF. However, little is known about the interrelationship of nutritional status and hyponatremia in mortality risk prediction in HF. Methods and resultsThis study enrolled 2882 HF patients admitted to the HF care unit of Fuwai Hospital, Beijing, China from 2008 to 2018; 71.3% were male and the mean age was 56.64 ± 15.96 years. Nutritional status was assessed by prognostic nutritional index (PNI), calculated as serum albumin (g/L) + 5 × total lymphocyte count (109/L). Lower PNI indicates worse nutritional status. Patients were divided into 8 groups based on baseline PNI quartiles (Q1: <43.6, Q2: 43.6–48.55, Q3: 48.55–63.25, Q4: >63.25) and sodium level (normal sodium and hyponatremia). After adjustment, patients in the PNI Q1 associated with hyponatremia had a 2.12-fold higher risk of all-cause death (95% confidence interval [CI]: 1.67–2.70) compared with those in the PNI Q4 with normal sodium. A refinement in risk prediction was observed after adding PNI quartile and serum sodium category to the original model (ΔC-statistic = 0.018, 95% CI: 0.007–0.025; net re-classification index = 0.459, 95% CI: 0.371–0.548; integrated discrimination improvement = 0.025, 95% CI: 0.018–0.032). ConclusionHF patients with both the lowest PNI quartile and hyponatremia are at higher risk of all-cause mortality. The combination of PNI and serum sodium level enhanced the predictive value for all-cause mortality in hospitalized HF patients. Clinical trial registrationURL: ClinicalTrials.gov; Unique Identifier: NCT02664818.

HYPONATREMIA AS A PROGNOSTIC INDICATOR IN LOWER RESPIRATORY TRACT INFECTIONS IN CHILDREN ADMITTED IN PAEDIATRIC INTENSIVE CARE UNIT

Objective: To study the serum sodium levels in patients of lower respiratory tract infections admitted in the paediatric intensive care unit with their prognosis.&#x0D; Study Design: Prospective observational study.&#x0D; Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Jan to Jun 2018.&#x0D; Methodology: Eighty patients suffering from lower respiratory tract infections who were admitted to the paediatric intensive care unit were selected at consecutive sampling. The outcome was recorded in the form of discharge or mortality. Serum sodium was done at the time of admission and then periodically after every 24-48 hours. The Association of patients’ serum sodium with their prognosis was studied using chi-square test and p-value was calculated.&#x0D; Results: A total of 80 patients were enrolled in our study out of which 50 (62.50%) were males and 30 (37.50%) were females. Out of the total, 48 patients suffered from hyponatremia. These 48 patients had a mean serum sodium concentration of 131.24 ± 3.31 mEq/L. The mean age of patients suffering from hyponatremia was 5.78 ± 3.4 years. Mortality occurred in 5 (80.12%) of patients suffering from severe hyponatremia.&#x0D; Conclusion: There was a significant association of hyponatremia with mortality in children admitted in paediatric intensive care settings with lower respiratory tract infections. Therefore, proper management hence correction of serum sodium levels can improve survival in, particularly children admitted in a pediatric intensive care setting.

Relationship between Hyponatremia and Peripheral Neuropathy in Patients with Diabetes.

Objectives Hyponatremia is a common complication of diabetes. However, the relationship between serum sodium level and diabetic peripheral neuropathy (DPN) is unknown. This study was aimed at investigating the relationship between low serum sodium level and DPN in Chinese patients with type 2 diabetes mellitus. Methods A retrospective study was performed on 1928 patients with type 2 diabetes between 2010 and 2018. The multivariate test was used to analyze the relationship between the serum sodium level and the nerve conduction function. A restricted cubic spline was used to flexibly model and visualize the relationship between the serum sodium level and DPN, followed by logistic regression with adjustment. Results As the serum sodium level increased, the prevalence of DPN had a reverse J-curve distribution with the serum sodium levels (69.6%, 53.7%, 49.6%, 43.9%, and 49.7%; P = 0.001). Significant differences existed between the serum sodium level and the motor nerve conduction velocity, sensory nerve conduction velocity, part of compound muscle action potential, and sensory nerve action potential of the participants. Compared with hyponatremia, the higher serum sodium level was a relative lower risk factor for DPN after adjusting for several potential confounders (OR = 0.430, 95%CI = 0.220–0.841; OR = 0.386, 95%CI = 0.198–0.755; OR = 0.297, 95%CI = 0.152–0.580; OR = 0.376, 95%CI = 0.190–0.743; all P < 0.05). Compared with low-normal serum sodium groups, the high-normal serum sodium level was also a risk factor for DPN (OR = 0.690, 95%CI = 0.526–0.905, P = 0.007). This relationship was particularly apparent in male participants, those aged <65 years, those with a duration of diabetes of <10 years, and those with a urinary albumin − to − creatinine ratio (UACR) < 30 mg/g. Conclusions Low serum sodium levels were independently associated with DPN, even within the normal range of the serum sodium. We should pay more attention to avoid the low serum sodium level in patients with type 2 diabetes mellitus.

Desmopressin Administration and Impact on Hypertonic Saline Effectiveness in Intracranial Hemorrhage

Desmopressin improves hemostasis through the release of factor VIII, von Willebrand factor, and tissue plasminogen activator, and increases platelet adhesion. Neurocritical Care guidelines recommend consideration of desmopressin in antiplatelet-associated intracranial hemorrhage. Studies supporting its use have not evaluated the potential impact of desmopressin on serum sodium levels in patients receiving hypertonic saline therapy. The purpose of this study was to assess the impact of desmopressin on sodium levels and hypertonic saline effectiveness in intracranial hemorrhage. This was a single center retrospective observational chart review. Patients were included in the desmopressin group if they were diagnosed with intracranial hemorrhage, administered desmopressin, and received hypertonic saline infusion. Patients in the hypertonic saline alone group were then matched 1:1 to the patients in the desmopressin group. The primary end point was the effect of desmopressin on reaching a sodium goal of 145-155mEq/L. The secondary end points included intensive care unit and hospital length of stay, change in sodium, time to reach sodium goal, thrombotic events, mortality, and a composite of increased cerebral edema, hematoma expansion, midline shift, herniation, need for neurosurgical intervention, and neurologic decompensation. Of 112 patients screened, 25 patients met inclusion criteria for the desmopressin group, and 25 patients were matched with patients in the hypertonic saline alone group. The percentage of patients who reached goal sodium in the desmopressin group compared with hypertonic saline alone was similar (80% vs. 88%, respectively). There were no differences in the secondary end points. In the subgroup analysis, patients in the hypertonic saline group met the predefined sodium goal of 150-155mEq/L within 48h more often than those in the desmopressin group (82% vs. 60%, respectively, p = 0.042). The use of desmopressin in intracranial hemorrhage does not appear to negatively impact the ability for patients to reach goal sodium of 145-155mEq/L. However, in patients with higher sodium goals, desmopressin may decrease hypertonic saline effectiveness.

Serum sodium levels in patients with ST-segment elevation myocardial infarction: Its effects on in-hospital and long-term clinical outcomes

Serum sodium levels in patients with ST-segment elevation myocardial infarction: Its effects on in-hospital and long-term clinical outcomes

The Association Between Handgrip Strength and Predialysis Serum Sodium Level in Patients With Chronic Kidney Disease Stage 5D.

Purpose: Handgrip strength (HGS) is a useful tool for the systematic assessment of muscle function related to nutritional status. Reduced HGS has been associated with adverse clinical outcomes in chronic kidney disease (CKD) stage 5D patients. In the same patients, predialysis low serum sodium (sNa) has been associated with malnutrition and mortality. Here, we investigated the role of predialysis sNa on muscle function in CKD-5D patients.Methods: We evaluated 45 patients on hemodialysis (HD) and 28 patients on peritoneal dialysis (PD) with HGS measurement, bioimpedance analysis, anthropometric measures, and malnutrition inflammation score (MIS). According to established diagnostic criteria, reduced HGS was defined as strength below 30 and 20 Kg in men and women, respectively. Predialysis sNa values were defined as the mean of all predialysis measurements during the preceding 6 months. Data analysis was performed separately for each of the HD and PD groups.Results: The proportions of reduced HGS did not differ between the HD (66%) and PD (54%) groups, respectively. Patients in the HD group as compared to those in the PD group had higher serum albumin and potassium and mid-arm muscle circumference and lower residual renal function (RRF) and residual urine volume. Multivariate logistic analysis, after controlling for muscle mass, nutritional biomarkers, MIS, fluid overload and RRF, showed that for every 1 mmol/l increase of sNa the odds of reduced HGS was decreased by 60% (OR = 0.40, 95% CI: 0.16–0.99) and 42% (OR = 0.58, 95% CI: 0.36–0.93) in HD and PD patients, respectively. However, stratified analysis indicated that lower sNa levels predicted reduced HGS in individuals with a background of malnutrition, inflammation, overhydration and less preserved RRF, representing unfavorable conditions strongly related to muscle wasting in the dialysis setting.Conclusions: Predialysis sNa is a strong and independent determinant of HGS, a reliable nutritional marker in CKD-5D stage patients. However, according to our findings, lower sNa levels appear to be a marker of underlying unfavorable conditions that are heavily associated with reduced HGS, rather than a causal determinant of reduced HGS. Whether optimizing sNa levels improves patient muscle performance requires further investigations.

COMPARATIVE STUDY ON RAMIPRIL AND TELMISARTAN-ASSOCIATED HYPONATREMIA

Objectives: This study was planned to study the association of ramipril and telmisartan with hyponatremia and to compare the hyponatremia effect of ramipril and telmisartan.&#x0D; Methods: The study was conducted in a tertiary care hospital. Serum sodium levels were assayed in patients taking ramipril and telmisartan. Fifty-one patients were recruited. The patient’s age, gender, drug dosage, and frequency of drug administration were collected using a pro forma. Statistical analysis of data was performed using SPSS version 23.0.&#x0D; Results: About 35.3% (28 out of 51) of the study population administered with ramipril and telmisartan developed hyponatremia. Predisposition to develop hyponatremia was high in males compared to females. Incidence of hyponatremia was 43.8% (7 out of 16) in the age group of 50–60 years. Although, incidence of hyponatremia was 56.5% (13 out of 23) in ramipril group compared to 17.9% (5 out of 28) in telmisartan group, it was not statistically significant.&#x0D; Conclusion: The current study laid emphasis on the requisite for monitoring of serum sodium level in patients on ramipril and telmisartan administration to avoid morbidity and mortality due to unexpected adverse reactions.

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.

Hyponatremia as a predictor of perforated acute appendicitis in pediatric population: A prospective study

BackgroundThe aim of this study was to investigate hyponatremia as a new biochemical marker associated with complicated appendicitis in the pediatric population. MethodsPediatric patients (n = 184) with acute appendicitis confirmed by histopathology were enrolled in a prospective cohort study from January 2019 to May 2020. Medical history, demographic and clinical data were recorded in the study protocol. Blood samples for biochemical analysis, electrolytes and acute inflammatory markers were taken before surgery.Patients were further divided in two groups, those with non-perforated (n = 148; 79%) and perforated appendicitis (n = 38; 21%). ResultsThe mean serum sodium level in patients with complicated appendicitis was significantly lower compared to patients with non-complicated appendicitis (132.2 mmol/L vs. 139.2 mmol/L, p < 0.001). The receiver operating characteristic curve of plasma sodium concentration in patients who were diagnosed with perforated acute appendicitis showed an area under the curve of 0.983 (95% CI, 0.963–1.00). A cut-off-value of plasma sodium concentration of ≤135 mmol/L was shown to give the best possible sensitivity and specificity, 94.7% (95% CI: 82.2–99.3) and 88.5% (95% CI: 88.2–93.2) respectively (p < 0.001). Patients with complicated appendicitis were more likely to be younger than five years of age (10.5% vs. 1.4%, p = 0.005), have a duration of symptoms for >24 h (97.4% vs. 59.6%, p < 0.001), sodium serum concentration ≤135 mmol/L (89.5% vs. 5.5%, p < 0.001), body temperature >38.5 °C (47.4% vs. 11.0%, p < 0.001) and CRP serum concentration >62 mg/L (26% vs. 2%, p < 0.001). ConclusionHyponatremia is a novel and very discriminative marker of complicated appendicitis in the pediatric population, and is therefore recommended in appendicitis diagnostic and treatment planning. Type of studyProspective comparative study Level of evidenceII

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.

Assessment of serum sodium levels in patients of lower respiratory tract infections (LRTI) in children at tertiary care center

Introduction: Lower respiratory tract infection is an infection beneath the larynx which includes: Pneumonia, Wheeze associated Lower respiratory tract infection, Bronchiolitis and Empyema. The aim of this study was to find out the association among hyponatremia and LRTI in tertiary care center. Materials and Methods: The sample size was calculated to be a minimum of 50 subjects. Based on clinical signs and symptoms (as defined by WHO) and infiltrates present on chest X-ray diagnosis of LRTI such as Pneumonia, Bronchiolitis was made. Then patients were subjected to routine investigations such as: Complete blood count, Serum electrolyte (serum sodium) at the time of admission, on day 2 and day 3 by Ion selective electrodes. Results: Mild hyponatremia was found among 11 patients (16.92%), moderate among 9 (13.85%) and severe among 2 (3.08%) patients. Hyponatremia was found to be more common among 1 to 5 years age group as compared to ≥ 2months to 12 months and > 5 to 12 years age groups. Conclusion: Hyponatremia is a significantly common association among hospitalized children with lower respiratory tract infections and it is mainly due to syndrome of inappropriate antidiuretic hormone secretion (SIADH).

Impact of CYP3A5 genotype on tolvaptan pharmacokinetics and their relationships with endogenous markers of CYP3A activity and serum sodium level in heart failure patients.

Tolvaptan efficacy for heart failure has a large interindividual variation. This study aimed to evaluate the influence of CYP3A5 and ABCB1 genotypes on tolvaptan pharmacokinetics and their relationships with plasma markers of CYP3A activity and laboratory test values in heart failure patients. Fifty-eight heart failure patients receiving oral tolvaptan for volume overload were enrolled. Blood samples for determination of pre-dose plasma concentrations of tolvaptan and its metabolites were collected. CYP3A5 and ABCB1 genotypes, plasma 4β-hydroxycholesterol/total cholesterol ratio (4β-OHC/TC) and 25-hydroxyvitamin D (25-OHD), and serum laboratory test values were evaluated. The CYP3A5*3/*3 genotype was associated with a higher plasma concentration of tolvaptan but not with its metabolic ratios. The ABCB1 3435C>T, 2677G>T/A and 1236C>T polymorphisms affected neither tolvaptan pharmacokinetics nor its metabolism. Plasma 4β-OHC/TC and 25-OHD concentration were not correlated with plasma tolvaptan concentration. In a stratified analysis based on CYP3A5 genotype, plasma 4β-OHC/TC had a negative correlation with plasma tolvaptan concentration in the patients with the CYP3A5*1 allele, while the plasma concentration of 25-OHD did not. The CYP3A5*3/*3 genotype was associated with a higher serum sodium level in the patients with volume overload. The plasma concentration of 25-OHD had a positive correlation with the serum total bilirubin level. In conclusion, CYP3A5*3 but not ABCB1 genotypes elevated tolvaptan plasma exposure in heart failure patients. CYP3A5-deficient patients treated with tolvaptan had a higher serum sodium level. The CYP3A5 genotype altered the relationship between plasma tolvaptan and 4β-OHC.