Sodium

Abnormalities in fluids, electrolytes, and metabolism of organ donors

Abnormal serum concentrations of electrolytes, hormones, and glucose are common throughout donor care. The organ procurement coordinator must properly interpret and plan treatment for these changes to prevent intracellular dysfunction in donor organs. This article describes abnormalities in magnesium, phosphorous, calcium, sodium, potassium, and glucose levels; polyuria; and thyroid and pituitary changes. Their potential consequences are discussed, and recommendations for treatment options are presented.

Hyponatremia in acute-phase response syndrome patients in general surgical wards

BACKGROUND

In surgical patients, hypoalbuminemia may occur as a component of acute-phase response (APR) syndrome, which we hypothesized could decrease serum sodium levels.

AIM

To compare the frequency of hyponatremia in adult surgical inpatients with or without APR syndrome.

METHODS

All the simultaneous plasma sodium and albumin results (n = 168), obtained from adults in surgical wards and corresponding to a 6-month period, were searched in the hospital mainframe. Other relevant laboratory and clinical data were also registered. APR was ascertained by the presence of major physical trauma, surgery or infection, plus hypoalbuminemia (serum albumin <3.5 g/dl) and neutrophil left shift (>/=7% of band count) associated with peripheral leukopenia (white blood cells <4, 000/mm(3)) or leukocytosis (WBC >9,000/mm(3)). Hyponatremia was defined by serum sodium concentration <135 mEq/l.

RESULTS

APR-positive patients (n = 113) had lower blood hemoglobin (10.92 +/- 2.18 vs. 13.53 +/- 2.30 g/dl), and serum albumin levels (median, range: 2.8, 1.9-3.4 vs. 3.7, 3.5-4.2 g/dl) than APR-negative (n = 55) ones, the same occurring in relation to antibiotics (54.8 vs. 10. 9%) and intravenous 5% dextrose in water (55.7 vs. 20.0%) or isotonic saline (46.0 vs. 9.1%) infusion. The hyponatremia frequency was higher among APR-positive patients (31.0 vs. 10.9%).

CONCLUSION

The higher percentage of hyponatremia among APR-positive patients could be attributed to decreased serum albumin levels associated with APR.

Hyposmolality stimulates apical membrane Na(+)/H(+) exchange and HCO(3)(-) absorption in renal thick ascending limb

The regulation of epithelial Na(+)/H(+) exchangers (NHEs) by hyposmolality is poorly understood. In the renal medullary thick ascending limb (MTAL), transepithelial bicarbonate (HCO(3)(-)) absorption is mediated by apical membrane Na(+)/H(+) exchange, attributable to NHE3. In the present study we examined the effects of hyposmolality on apical Na(+)/H(+) exchange activity and HCO(3)(-) absorption in the MTAL of the rat. In MTAL perfused in vitro with 25 mM HCO(3)(-) solutions, decreasing osmolality in the lumen and bath by removal of either mannitol or sodium chloride significantly increased HCO(3)(-) absorption. The responses to lumen addition of the inhibitors ethylisopropyl amiloride, amiloride, or HOE 694 are consistent with hyposmotic stimulation of apical NHE3 activity and provide no evidence for a role for apical NHE2 in HCO(3)(-) absorption. Hyposmolality increased apical Na(+)/H(+) exchange activity over the pH(i) range 6.5-7.5 due to an increase in V(max). Pretreatment with either tyrosine kinase inhibitors or with the tyrosine phosphatase inhibitor molybdate completely blocked stimulation of HCO(3)(-) absorption by hyposmolality. These results demonstrate that hyposmolality increases HCO(3)(-) absorption in the MTAL through a novel stimulation of apical membrane Na(+)/H(+) exchange and provide the first evidence that NHE3 is regulated by hyposmotic stress. Stimulation of apical Na(+)/H(+) exchange activity in renal cells by a decrease in osmolality may contribute to such pathophysiological processes as urine acidification by diuretics, diuretic resistance, and renal sodium retention in edematous states.

Treatment of sodium balance disorders. Water intoxication and salt toxicity

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

Diuretic-induced hyponatremia

Diuretics are one of the most common causes of severe hyponatremia. Yet, despite several relevant studies and years of clinical experience, the mechanism and optimal treatment of diuretic-induced hyponatremia remain unclear. What is clear is that most cases are caused by thiazide rather than loop diuretics and that severe hyponatremia can develop very rapidly in susceptible patients. In this review, I will discuss the pathogenesis, clinical features, prevention, and treatment of diuretic-induced hyponatremia in the hope that increased awareness and understanding will reduce the incidence and complications of this potentially life-threatening syndrome.

Endocrinologic and metabolic complications in the intensive care unit

Critical illness provides major stresses on all body systems, including those serving important regulatory functions. Endocrinologic and metabolic abnormalities are common on presentation and during hospitalization in the intensive care unit. Some of these abnormalities are the focus of this article. The authors review abnormalities of the adrenal and thyroid glands and in the metabolism of glucose, and include a brief review of abnormalities of sodium and calcium metabolism.

Sodium serum levels in hypoalbuminemic adults at general medical wards

Hypoalbuminemia may cause interstitial edema and hemodilution, which we hypothesized may influence serum sodium levels. Our purpose was to compare serum sodium levels of hospitalized adults with or without hypoalbuminemia. All sodium and albumin serum levels of 142 adults hospitalized at general medical wards over a six-month period were searched at a University Hospital mainframe computer. Relevant laboratory data and clinical details were also registered. Hypoalbuminemia was defined by serum albumin concentration < 3.3 g/dl Fisher, Mann-Whitney, and Student's t tests were applied to compare groups with or without hypoalbuminemia. Ninety-nine patients, classified as hypoalbuminemic, had lower blood hemoglobin (10.68 +/- 2.62 vs. 13.54 +/- 2.41), and sodium (135.1 +/- 6.44 vs. 139.9 +/- 4.76 mEq/l) and albumin (2.74 +/- 0.35 vs. 3.58 +/- 0.28 g/dl) serum levels than non-hypoalbuminemic (n = 43). Pearson's coefficient showed a significant direct correlation between albumin and sodium serum levels (r = 0.40) and between serum albumin and blood hemoglobin concentration (r = 0.46). Our results suggest that hypoalbuminemic adults have lower serum sodium levels than those without hypoalbuminemia, a phenomenon that may be at least partially attributed to body water retention associated with acute phase response syndrome.