Serum Sodium Levels In Patients Research Articles

Intranasal desmopressin reduces renal biopsy-related bleeding and serum sodium levels in patients with reduced renal function.

BackgroundThe use of desmopressin in preventing renal biopsy-related bleeding is not established and its effects on serum sodium levels are not well studied. The study aimed to compare the bleeding complication rates between the groups with and without desmopressin use prebiopsy and to observe the effect of desmopressin on postbiopsy serum sodium levels. MethodsIn this single-center, prospective and retrospective interventional study, from June 2018 onwards, patients with serum creatinine >132.6 μmol/L but not on dialysis and undergoing ultrasound-assisted needle-guided renal biopsy received 150 μg of desmopressin (D-amino D-arginine vasopressin (DDAVP)) (Group II). Data from patients from June 2017 to May 2018 were included in Group I in whom desmopressin was not used. Bleeding complications were monitored by clinical and ultrasound surveillance. Serum sodium levels were checked prior to and 24 h following desmopressin in Group II. ResultsA total of 194 patients were included in the study: 105 in Group I and 89 in Group II. Group II had lower overall minor bleeding complications and perinephric hematomas than Group I (15.7% versus 31.4%, 14% versus 27% and 7.8% versus 19% in Group II and Group I, respectively, with P < 0.05). Not using desmopressin and female sex were significant predictors for overall risk of bleeding on multivariate logistic regression. Serum sodium levels fell in 94% of patients in Group II. Lower prebiopsy serum sodium, higher estimated glomerular function rate and higher spot urine sodium values were associated with a greater decrease in serum sodium after desmopressin.ConclusionIntranasal desmopressin reduces bleeding complications during renal biopsies performed in patients with reduced renal function not requiring dialysis, albeit with a risk of developing hyponatremia.

Serum Sodium Level on the Recurrence of Febrile Seizure within the Same Febrile Illness-Experience in a District Level Hospital

Introduction: Febrile convulsion is the most common seizure disorder in the pediatric age group. It occurs in 2-5% of children. A febrile seizure is a seizure accompanied by fever (temperature 100.4°F or 38°C by any method), without central nervous system infection, that occurs in infants and children 6 through 60 months of age.&#x0D; Aim: The study was conducted to see the effect of serum sodium level on the recurrence of febrile seizure during the same febrile illness. Materials and Method: A cross-sectional descriptive study which enrolled 65 children admitted with febrile seizures at 100 bed district hospital, Naogaon. They were divided in to two groups, those with a single seizure and the rest were children with more than one seizures. Serum sodium levels were estimated after stabilization of patients. The probability of recurrent febrile seizures and serum sodium level was analyzed.&#x0D; Results: Hyponatremia (serum sodium &lt;135 mmol/l) was seen in 12(18.5%) of 65 children and the remaining 81.5% children had normal serum sodium level (serum sodium 135-145 mmol/l). Among the hyponatremia group all children developed more than one seizure during the same febrile episode. The mean serum sodium level in patients with single and recurrent seizure was 138.48±2.17mmol/l and 135.27±3.11mmol/(P&lt;0.001). The relationship between the probability of a recurrent seizure and serum sodium level is statistically highly significant.&#x0D; Conclusion: Estimation of the seum sodium in children with febrile seizures help in deciding for admission in hospital as well as to predict seizure recurrence within the same febrile episode.&#x0D; TAJ 2019; 32(1): 39-45

COMPARATIVE STUDY OF BIOCHEMICAL PARAMETERS AMONG ELDERLY PATIENTS WITH CATARACT

Background: Cataract is among the most common ocular morbidity seen among elderly patients, it incidence is related to the aging process. It is a ocular morbidity and result in decrease the eye sight. Incidence of cataract related to aging process is generally seen in patients who are aged above 45 years of age. In previous researches it was estimated that approximately seventy five percent of general population above the 70 years of age has reported to suffer from lens opacity or cataract.&#x0D; Material &amp; Methods: Patients who were presenting with nuclear or cortical or posterior sub-capsular cataracts along with healthy age and gender matched controls were enrolled from outdoor and from ward by simple random sampling. Clearance from Institutional Ethics Committee was taken before start of study. Written informed consent was taken from each study participant.&#x0D; Results: On the assessment of serum sodium levels it was found that mean serum sodium levels were 144.12 ± 2.43 meq/l in the cataract group and mean serum sodium levels were 139.37±3.4 meq/l in the age matched controls. This difference among both the groups was statistically significant (P value &lt;0.05). On the assessment of serum potassium levels, it was found that mean serum potassium levels were 4.32 ± 0.11 meq/l in the cataract group and mean serum potassium levels were 4.10 ± 0.16 meq/l in the age matched controls. This difference among both the groups was statistically non-significant (P value &gt;0.05).&#x0D; Conclusion: We concluded from the present study that the higher prevance of raised serum sodium levels in patients of senile cataract. We found that any alteration in serum electrolyte concentration leads to alterations in aqueous humor’s electrolyte concentration and responsible for risk factor for development of senile cataract.&#x0D; Key words: senile cataract, serum sodium, serum potassium.

Short- and long-term prognostic value of hyponatremia in patients with acute coronary syndrome: A systematic review and meta-analysis.

Hyponatremia is relevant to heart failure, liver cirrhosis and stroke, but the prognostic value of serum sodium levels in patients with acute coronary syndrome are still unclear. So we did a systematic review and meta-analysis to assess the prognostic value of hyponatremia on adverse events in patients after ACS. We systematically searched PubMed, Embase and Cochrane Library to find literatures which studied the prognostic value of hyponatremia in patients with ACS. Our main endpoints were the all-cause mortality and heart failure in the short- and long-term. Of 369 identified studies, 20 studies were included in our analysis. Compared with the normal natrium, hyponatremia was significantly associated with the increased risks of all-cause mortality within 30 days (RR: 2.18; 95%CI: 1.96–2.42) and during the follow-ups (HR: 1.74; 95%CI: 1.56–1.942). For the second endpoint of short- and long-term heart failure, the pooled effect sizes in hyponatremia patients were 1.72(95%CI: 1.38–2.14) and 1.69(95%CI: 1.12–2.55) respectively. In conclusion, hyponatremia has a significant prognostic value for short- and long-term adverse event in patients after ACS, the dynamic monitoring of serum sodium levels may could help physicians to identify high risk ACS patients and to stratify risk for optimal management.

Thiazide-associated hyponatremia in the elderly: what the clinician needs to know.

Thiazide-induced hyponatremia is one of the main causes of decreased sodium levels in elderly individuals. This review presents the current evidence regarding the thiazide-associated hyponatremia. Thiazide-associated hyponatremia is observed mainly in patients with certain risk factors such as those receiving large doses of thiazides, having much comorbidity, such as heart failure, liver disease or malignancy, and taking several medications, such as non-steroidal anti-inflammatory drugs, selective serotonin re-uptake inhibitors or tricyclic antidepressants. Sodium concentration should be monitored in patients with risk factors for developing thiazide-associated hyponatremia and clinicians should measure promptly serum sodium levels in patients with neurologic signs indicating reduced sodium levels. The clinical and biochemical profile of patients with thiazide-associated hyponatremia may be that of extracellular volume depletion or the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The investigation of possible thiazide-associated hyponatremia includes the exclusion of other causes of decreased sodium levels and the identification of the characteristics of hyponatremia due to thiazides (extracellular volume depletion-related or SIADH-like). Treatment should be carefully monitored to avoid serious neurologic complications due to overcorrection. Clinicians should discourage prescribing thiazides in patients with a history of diuretic-associated hyponatremia and should prefer low doses of thiazides in patients with risk factors for developing thiazide-associated hyponatremia.

Conivaptan prophylactically in transurethral resection of prostate surgeries

Background Transurethral resection of prostate (TURP) requires the use of irrigating fluids. The absorption of large volumes of these fluids may lead to hyponatremia and consequently TURP syndrome. If not treated promptly, the patient becomes cyanotic, hypotensive, and ultimately sustains cardiac arrest. Conivaptan is one of vaptans, a new group of vasopressin receptor antagonists that are increasingly being used for the treatment of euvolemic, hypervolemic forms of hyponatremia especially in the ICU. This study evaluates the efficacy of a single dose of conivaptan to prevent hyponatremia in TURP patients. Patients and methods In a prospective, randomized, double-blinded study, 50 male patients scheduled for elective TURP under central neuraxial block were included in this study. Patients were divided into two groups (A and B) (n=25 for each group). Group A patients received intravenous conivaptan 20 mg over 30 min, whereas group B was the control group who received the usual maintenance fluid. Preoperative serum sodium and potassium levels in patients were measured, followed by intraoperative levels, and these levels were recorded after 60 min by blood gas analyzer using venous blood samples. All patients were carefully observed for the early symptoms of TURP syndrome perioperatively. The serum levels of sodium and potassium of all patients were measured 1 h after surgery. Results The mean level of serum sodium showed statistically significant reduction (hyponatremia) intraoperatively and postoperatively in group B. There was a statistically insignificant increase in the mean level of serum potassium (hyperkalemia) intraoperatively and postoperatively in both groups. Electrolyte changes were asymptomatic clinically. Conclusion A single dose of conivaptan was found to be effective in preventing a marked decrease in the serum sodium levels in patients undergoing TURP with no effect on the serum potassium level.

Prognostic Role of Serum Chloride Levels in Acute Decompensated Heart Failure

BackgroundAcute decompensated heart failure (ADHF) can be complicated by electrolyte abnormalities, but the major focus has been concentrated on the clinical significance of serum sodium levels. ObjectivesThis study sought to determine the prognostic significance of serum chloride levels in relation to serum sodium levels in patients with ADHF. MethodsWe reviewed 1,318 consecutive patients with chronic heart failure admitted for ADHF to the Cleveland Clinic between July 2008 and December 2013. We also validated our findings in an independent ADHF cohort from the University of Pennsylvania (n = 876). ResultsAdmission serum chloride levels during hospitalization for ADHF were independently and inversely associated with long-term mortality (hazard ratio [HR] per unit change: 0.94; 95% confidence interval [CI]: 0.92 to 0.95; p < 0.001). After multivariable risk adjustment, admission chloride levels remained independently associated with mortality (HR per unit change: 0.93; 95% CI: 0.90 to 0.97; p < 0.001) in contrast to admission sodium levels, which were no longer significant (p > 0.05). Results were similar in the validation cohort in unadjusted (HR per unit change for mortality risk within 1 year: 0.93; 95% CI: 0.91 to 0.95; p < 0.001) and multivariable risk-adjusted analysis (HR per unit change for mortality risk within 1 year: 0.95; 95% CI: 0.92 to 0.99; p = 0.01). ConclusionsThese observations in a contemporary advanced ADHF cohort suggest that serum chloride levels at admission are independently and inversely associated with mortality. The prognostic value of serum sodium in ADHF was diminished compared with chloride.

Potential roles of vaptans in heart failure: experience from clinical trials and considerations for optimizing therapy in target patients.

Hyponatremia is a known complication in patients with heart failure (HF). HF patients with severe congestion, hyponatremia, and renal insufficiency are difficult to manage and may have worse outcomes. A main cause of hyponatremia is inappropriately elevated level of plasma arginine vasopressin (AVP), which causes water retention at the collecting duct. AVP antagonists have thus been developed to increase aquaresis and serum sodium levels in patients with euvolemic and hypervolemic hyponatremia. Although tolvaptan, an AVP-2 receptor antagonist, did not show outcomes benefit in patients with decompensated HF, prospective studies are ongoing to evaluate its optimal role in targeted HF patients.

The Relationship Between Serum Sodium Concentration and Atrial Fibrillation Among Adult Patients in Emergency Department Settings

3 , Ugur Lok 2 , Hakan Topacoglu 4 Abstract Objective: Alterations in serum levels of sodium may lead to cardiac arrhythmia by affecting the membrane potentials of cardiac cells. Previous studies have documented the association between postoperative atrial fibrillation and reduction in serum magnesium level after cardiovascular surgery well. However, there is no study assessing the relationship between serum sodium concentration and atrial fibrillation. Therefore, we aimed to investigate the relationship between serum sodium concentration and atrial fibrillation. Material and Methods: The present study had a cross-sectional design. The study population included 240 cases (120 patients with atrial fibrillation and 120 controls). Patients with atrial fibrillation were compared with the control group in terms of serum sodium level. Results: The mean serum sodium level in the atrial fibrillation group was 136.0±18.3 mEq/l, while it was found to be 142.0±23.9 mEq/l (p=0.04) in the control group. The mean serum sodium level in patients with permanent atrial fibrillation was 139±14 mEq/l, whereas it was 132.0±22.5 mEq/l in patients with parox - ysmal atrial fibrillation (p=0.03). Conclusion: This study indicates that low serum sodium level might be associated with atrial fibrillation. However, to obtain accurate results, new prospective studies with more patients are needed. (JAEM 2014; 13: 131-4)

Oral probiotic VSL#3 attenuates the circulatory disturbances of patients with cirrhosis and ascites

The modulation of gut flora constitutes a therapeutic tool in patients with liver disease, but some of its modalities require further investigation. Here, we evaluated the effects of probiotics on the hepatic and systemic haemodynamic alterations of advanced liver disease. Seventeen patients with cirrhosis and ascites were prospectively included, five of whom abandoned this study prematurely. Hepatic and systemic haemodynamic evaluations were performed at baseline and after 6 weeks of receiving an oral VSL#3 probiotic preparation. Peripheral blood analyses included the evaluation of cytokines (TNF-alpha, IL-1beta, IL-6), bacterial translocation [bacterial DNA and lipopolysaccharide-binding protein (LBP)] and nitric oxide end-products (NOx). In 12 patients completing this study, the oral administration of VSL#3 resulted in reductions of the hepatic venous pressure gradient (HVPG, P < 0.001), cardiac index and heart rate (both P < 0.01) and in increases of the systemic vascular resistance (P < 0.05) and mean arterial pressure (P = 0.06). HVPG decreased at least 10% from baseline in eight patients (67%). Serum sodium increased in most patients (P < 0.01). All these changes were unrelated to the detection of bacterial DNA or to the levels of LBP, pro-inflammatory cytokines or NOx. No significant adverse effects were observed. Administration of the probiotic mixture VSL#3 improved the hepatic and systemic haemodynamics and serum sodium levels in patients with cirrhosis. Our results identify major effects of probiotics in liver disease and provide the rationale for assessing their therapeutic potential against the progression of portal hypertension and its complications in future clinical trials.

Prognostic value of the model for end-stage liver disease combined with serum sodium levels in patients with decompensated cirrhosis

To investigate the ability of the model for end-stage liver disease (MELD) score combined with serum sodium measurements to effectively evaluate the prognosis of patients with decompensated liver cirrhosis. A total of 212 patients with decompensated cirrhosis were retrospectively analyzed. Each patient's MELD scores, and sodium-based MELD scores (MELD-Na, MELDNa, and MESO) were calculated at three-month intervals. The area under the receiver operating characteristic (ROC) curve (AUC) was used to compare the predictive abilities of the four scores for 3-, 6- and 12-month mortality. Kaplan-Meier survival curves were created using the best cut-off values for each score identified by the ROC. Among the 212 patients, 46 died within three months, 56 died within six months, and 87 died within 12 months. The MELD, MELD-Na, MELDNa and MESO scores were significantly different between patients who survived and those who died within three and 12 months (P less than 0.01). The AUCs for the four separate scores were all more than 0.8 at the 3- and 6-month time points; however, the AUCs of MELDNa (3-month: 0.846; 6-month: 0.869) and MESO (0.831; 0.850) were significantly better than those of MELD (0.812; 0.841) (P less than 0.05). At the 12-month time point, the AUCs of MELD, MELD-Na, MELDNa, and MESO were not significantly different (0.774, 0.775, 0.786, and 0.777, respectively). Survival curves showed that all the scores were able to clearly discriminate the patients who survived from those who died within 12 months (P=0.000). The MELD score and its sodium-based variants (MELD-Na, MELDNa, and MESO) can precisely predict mortality of patients with decompensated cirrhosis for short and intermediate periods. The MELDNa and MESO scores are superior for predicting 3- and 6-month survival.

Lixivaptan: a vasopressin receptor antagonist for the treatment of hyponatremia

Hyponatremia, the most common electrolyte disorder encountered in clinical practice, is associated with significant morbidity and mortality. The introduction of medications that specifically antagonize the vasopressin V2 receptor (vaptans) has provided a safe and effective means of therapy. Lixivaptan is the newest of these agents that reliably increase serum sodium levels in patients with euvolemic hyponatremia. However, significant questions remain regarding the specific indications for vaptans, and their potential impact on morbidity and mortality associated with hyponatremia.

V2 Receptor Antagonist; Tolvaptan

Hyponatremia is the most common electrolyte disorder in hospitalized patients. Many studies documented that it was related to increased morbidity and mortality in patients with congestive heart failure, liver cirrhosis, and neurologic diseases. Although knowledge of hyponatremia has been cumulated, the optimal management of hyponatremia remains incompletely established in clinical practice because of the diversity of underlying disease states, and its multiple causes with differing pathophysiologic mechanisms. Since vasopressin receptor antagonists have unique aquaretic effect to selectively increase electrolytes-free water excretion, clinicians could apply a more effective method to treat hyponatremia. Tolvaptan has significant evidence that it improves serum sodium levels in patients with euvolemic or hypervolemic hyponatremia related with heart failure, cirrhosis or syndrome of inappropriate anti-diuretic hormone. Tolvaptan has acceptable safety and tolerability for long-term usage in chronic hyponatremia, and the beneficial effects on serum Na+ occurred in patients with both mild and marked hyponatremia.

Burr Red Blood Cells (BC) In Patients with Disseminated Intravascular Coagulation (DIC)

AbstractAbstract 5141Burr red blood cells (BC) in patients with disseminated intravascular coagulation (DIC). Background:Angiopathic hemolysis with schistocytes occurs in a minority of DIC patients. Burr cells (BC), are morphologically homogeneous, with a serrated membrane resembling that of red cells (RBC) in a hypertonic medium. They are associated with acute renal insufficiency, and have been observed in DIC. Methods:Criteria for patient inclusion were sepsis, often with multi-organ failure and hypotension. Of the 39 patients studied, 20 had DIC, based on platelet counts <100,000, and an International Society of Hemostasis and Thrombosis score of ≥5, derived from D-dimer or fibrin split product levels, prothrombin time elevations, and fibrinogen levels. The percentages of BC and schistocytes were determined by 1000 RBC counts, without knowledge of data concerning DIC. Patients' [Hb]'s, serum creatinine and blood urea nitrogen (BUN), were recorded. Results:Five of the 20 DIC patients succumbed to their acute illness, while 15 recovered without developing renal insufficiency. The BC%'s of the 20 DIC patients ranged from 0–80%, with a median of 18% and a mean of 27%; in the 19 patients without DIC the range was 0–45%, the median 6.4% and the mean 11% (p=0.046). The schistocyte percentages in patients with and without DIC ranged from 0.20–17, and 0–78; the respective medians and means were 1.1% and 1.0%, and 3.0–5.8%. The median and mean [Hb]'s of the patients with and without DIC were 9.3 and 11, and 9.6 and 10.3, respectively. BC% did not correlate with the [Hb]. The median creatinine levels of patients with and without DIC were 0.92 and 0.93 mg/dl, though the DIC patients' BUN's were higher (medians 31 vs 15). The BC% correlated with neither the BUN nor the BUN/creatinine ratio. The median and mean serum sodium levels in patients with and without DIC were 137. Conclusion:BC's are significantly more frequent in septic patients with DIC than in those without it. BC% did not correlate with anemia, implying that BC do not cause significant hemolysis, though there was a trend to lower [Hb] in the DIC patients. BC% was much higher than that of schistocytes in both groups, and schistocyte percentages did not correlate with DIC or BC%. Because of the DIC patients' higher BUN's and BUN/creatinine ratio's, we cannot exclude a role for the factors, which caused pre-renal azotemia in BC formation. BC formation may prove to be a criterion for DIC. Disclosures:No relevant conflicts of interest to declare.

The relationship between arginine vasopressin levels and hyponatremia following a percutaneous renal biopsy in children receiving hypotonic or isotonic intravenous fluids

Post-operative hyponatremia is a common complication in children which results from hypotonic fluid administration in the presence of arginine vasopressin (AVP) excess. We evaluated the relationship between the change in serum sodium and AVP levels following percutaneous renal biopsy in children receiving either hypotonic or isotonic fluids. This study was prompted after we encountered a patient who developed near-fatal hyponatremic encephalopathy following a renal biopsy while receiving hypotonic fluids. The relationship between the change in serum sodium and AVP levels was evaluated prior to (T0) and at 5 h (T5) following a percutaneous renal biopsy in 60 children receiving either hypotonic (0.6% NaCl, 90 mEq/L) or isotonic fluids (0.9% NaCl, 154 mEq/L). The proportion of patients with elevated AVP levels post-procedure was similar between those receiving 0.6 or 0.9% NaCl (30 vs. 26%). Patients receiving 0.6% NaCl with elevated AVP levels experienced a fall in serum sodium of 1.9 ± 1.5 mEq/L, whereas those receiving 0.9% NaCl had a rise in serum sodium of 0.85 ± 0.34 mEq/L with no patients developing hyponatremia. There were no significant changes in serum sodium levels in patients with normal AVP concentrations post-procedure in either group. In conclusion, elevated AVP levels were common among our patients following a percutaneous renal biopsy. Isotonic fluids prevented a fall in serum sodium and hyponatremia, while hypotonic fluids did not.

Tolvaptan: a vasopressin antagonist for the management of euvolemic and hypervolemic hyponatremia

Tolvaptan is a new vasopressin antagonist developed for the treatment of hypervolemic or euvolemic hyponatremia. It has greater affinity for the V2 receptor than native vasopressin or any other vasopressin antagonist. Blockade of the V2 receptor induces solute-free water excretion without affecting normal electrolyte excretion. The pharmacokinetics and pharmacodynamics of tolvaptan are suitable for once-daily dosing. Throughout all phases of clinical studies, it was shown to be safe for short- and long-term use. Tolvaptan effectively increases serum sodium levels in patients with heart failure, cirrhosis and syndrome of inappropriate secretion of antidiuretic hormone. In patients hospitalized owing to heart failure, tolvaptan decreased bodyweight, increased urine output and improved dyspnea compared with placebo. However, tolvaptan has not proven to be beneficial for the long-term management of heart failure. Currently, tolvaptan is the only oral agent in its class available in the USA and Europe.

Does the Adrogue–Madias formula accurately predict serum sodium levels in patients with dysnatremias?

Does the Adrogue–Madias formula accurately predict serum sodium levels in patients with dysnatremias?

Serum Sodium Levels in Patients with Kawasaki Disease

The purpose of this study was to assess the hypothesis that lower serum sodium levels are associated with cardiovascular sequelae in patients with Kawasaki disease (KD). We used the database of the 16th nationwide survey of KD in Japan. We investigated the distribution of serum sodium levels and the relationship between serum sodium levels and cardiovascular sequelae. Of the reported cases, serum sodium levels were reported in 13,569 patients (89%). The proportion of patients with serum sodium levels 130 mEq/L or less, was greater in complete cases than in incomplete cases. The proportion of patients with serum sodium levels 130 mEq/L or less was increased with age. The largest proportion of patients with serum sodium levels 130 mEq/L or less was found in the category of 3-5 days since onset of illness. A serum sodium of level 135 mEq/L or less was an independent risk factor for cardiovascular sequelae (odds ratio, 1.79, 95% confidence interval, 1.42-2.26). Among patients with KD, there are significant differences in serum sodium levels between diagnostic categories, age, and days since the onset of illness. The sodium level may be a simple predictor of cardiovascular sequelae.

Treatment with conivaptan* increases serum sodium levels in patients with hyponatraemia,

Treatment with conivaptan* increases serum sodium levels in patients with hyponatraemia,

Prediction of postdexamethasone cortisol levels by serum sodium levels in patients with major depression.

The authors analyzed the dexamethasone suppression test (DST) results of 54 patients with major depressive disorder in relation to their pre-DST levels of cholesterol, sodium, potassium, and blood glucose, which are thought to have adrenocorticotrophic links. Discriminant analysis revealed that sodium alone was a significant predictor of nonsuppression. Validation of the predictive power of sodium could minimize the need for DST administration.