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Yalta K, Palabıyık O, Gurdogan M, Yetkın E. Hyponatremia and takotsubo syndrome: a review of pathogenetic and clinical implications. Heart Fail Rev 2024; 29:27-44. [PMID: 37698728 DOI: 10.1007/s10741-023-10344-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Abstract
Hyponatremia is a common electrolyte abnormality with important prognostic and therapeutic implications. It might exert detrimental effects on various organ systems including the central nervous system (CNS), bone, and heart along with its potential association with poor quality of life. These adverse effects might be largely mediated through a variety of mechanisms including osmotic stress, dysfunctional transmembrane exchangers, and enhanced oxidative stress.Interestingly, hyponatremia might also have an important association with takotsubo syndrome (TTS) that has been universally considered as a reversible form of cardiomyopathy usually emerging in response to various stressors. In this context, severe hyponatremia was previously reported to serve as a direct trigger of TTS evolution largely through its potential impact on CNS and heart. However, pathogenetic and clinical implications of hyponatremia still need to be thoroughly evaluated in patients with TTS. This paper aims to analyze the clinical features of published cases with TTS primarily triggered by hyponatremia and also aims to discuss the association between hyponatremia and TTS from a broader perspective.
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Affiliation(s)
- Kenan Yalta
- Cardiology Department, School of Medicine, TrakyaUniversity, Balkan Yerleşkesi, 22030, Edirne, Turkey.
| | - Orkide Palabıyık
- Trakya University, Vocational Collage of Health Services, Edirne, Turkey
| | - Muhammet Gurdogan
- Cardiology Department, School of Medicine, TrakyaUniversity, Balkan Yerleşkesi, 22030, Edirne, Turkey
| | - Ertan Yetkın
- Türkiye Hastanesi, Cardiology Department, Istanbul, Turkey
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2
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Nasir AZ, Jorgensen D. Third-degree atrioventricular block associated with severe acute hyponatraemia. BMJ Case Rep 2023; 16:e254907. [PMID: 36963765 PMCID: PMC10040035 DOI: 10.1136/bcr-2023-254907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
Severe acute hyponatraemia, defined as a sodium concentration of less than 120 mEq/L, typically manifests with neurological manifestations, resulting in obtundation, coma, seizures, respiratory arrest and death. It very rarely is arrhythmogenic, with a literature review revealing seven cases of hyponatraemia-associated atrioventricular (AV) block of various degrees, of which only three were described as having third-degree AV block. The higher-degree AV blocks typically occurred at sodium levels closer to 115 mEq/L. We present a case of severe acute hypo-osmolar hyponatraemia-induced third-degree AV block in a patient without any other risk factors or aetiologies who initially presented with subdural haematoma and developed refractory bradycardia during his admission. The patient's third-degree AV block completely resolved after correction of his sodium. This case highlights the importance of working up the cause of new-onset third-degree AV block and the consideration of rarer electrolyte derangements such as hyponatraemia as a potential cause.
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Affiliation(s)
- Ali Zagham Nasir
- Internal Medicine Residency, Trinity Health Grand Rapids, Grand Rapids, Michigan, USA
| | - Drew Jorgensen
- Critical Care, Trinity Health Grand Rapids, Grand Rapids, Michigan, USA
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3
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Takotsubo syndrome presenting with left bundle branch block in an octogenarian. Is hyponatremia a pathogenic "common ground"? J Geriatr Cardiol 2022; 19:622-625. [PMID: 36339469 PMCID: PMC9630005 DOI: 10.11909/j.issn.1671-5411.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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4
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Amir M, Renata A, Ratana LT. Symptomatic sinus bradycardia due to electrolyte imbalances in syndrome of inappropriate antidiuretic hormone (SIADH) related covid-19: a case report. BMC Infect Dis 2021; 21:465. [PMID: 34020617 PMCID: PMC8139541 DOI: 10.1186/s12879-021-06143-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background Coronavirus Disease-2019 (COVID-19) has been declared a global pandemic since March 11th, 2020. Despite emerging reports and literature covering a broad spectrum of COVID-19 clinical manifestations, facets of COVID-19 have not been fully elucidated. To the authors’ concern, sinus bradycardia as a manifestation of COVID-19-induced syndrome of inappropriate antidiuretic hormone (SIADH) has never been reported before. Case presentation In this paper, we report a case of a 59-year-old male patient with confirmed COVID-19 initially presented with presyncope. Further investigations reveal sinus bradycardia related to COVID-19-induced SIADH. This case highlights the possibility of immuno-neuroendocrino-cardiovascular crosstalk resulting in an atypical manifestation of COVID-19: near syncope due to sinus bradycardia. Conclusions Another possible cause of sinus bradycardia in COVID-19 is electrolyte imbalance due to COVID-19-related SIADH.
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Affiliation(s)
- Muzakkir Amir
- Departement of Cardiology and Vascular Medicine, Hasanuddin University, Makassar, Indonesia. .,Dr. Wahidin Sudirohusodo National General Hospital, Makassar, Indonesia.
| | - Andi Renata
- Departement of Cardiology and Vascular Medicine, Hasanuddin University, Makassar, Indonesia.,Dr. Wahidin Sudirohusodo National General Hospital, Makassar, Indonesia
| | - Levina Tri Ratana
- Departement of Cardiology and Vascular Medicine, Hasanuddin University, Makassar, Indonesia.,Dr. Wahidin Sudirohusodo National General Hospital, Makassar, Indonesia
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Benzon HA, Bobrowski A, Suresh S, Wasson NR, Cheon EC. Impact of preoperative hyponatraemia on paediatric perioperative mortality. Br J Anaesth 2019; 123:618-626. [DOI: 10.1016/j.bja.2019.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/28/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022] Open
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Lu HT, Loo HC, Ng KS, Wong YO, Nordin R. Cardiac arrhythmia triggered by diuretic-induced hyponatremia. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2019; 14:39-43. [PMID: 31827736 PMCID: PMC6818697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Diuretics have a long and distinguished history in the treatment of hypertension and heart failure. Clinical practice guidelines recommend that diuretics should be considered to be as suitable as other antihypertensive agents for the initiation and maintenance of antihypertensive treatment. However, diuretics may potentially cause electrolyte disturbances and metabolic side effects. Diuretic-induced hyponatremia is probably more prevalent than generally acknowledged. We present an unusual case of indapamide-induced hyponatremia and hypokalemia complicated by cardiac arrhythmia. The adverse drug reaction was reversible and non-life-threatening, but this case serves as a reminder that careful evaluation and constant monitoring are necessary when prescribing diuretics.
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Affiliation(s)
- H T Lu
- MD (USM), FRCP (EDINBURGH) Department of Cardiology, Sultanah Aminah Hospital, 8 Jalan Masjid Abu Bakar, 80100 Johor Bahru Johor, Malaysia.
| | - H C Loo
- MD (UKM), FRACGP (Australia] MRCP (London) Ledang Specialist Clinic, 141 Jalan Muar, 84900 Tangkak Johor, Malaysia
| | - K S Ng
- MBBS (Singapore), MASTER OF MEDICINCE IM (Singapore], FAFPM (Malaysia), Klinik Malaysia, 118, Jalan, Mersing, 86000 Kluang, Johor Malaysia
| | - Y O Wong
- MBBS (UM), AM (MAL), FRCP, (Glasgow), Klinik Pakar Perubatan Century 14A, Jalan Harimau, Century Garden 80250 Johor Bahru, Johor Malaysia
| | - R Nordin
- MD (Monash, Australia), MPH, PhD (Japan), Clinical School Johor Bahru Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 8 Jalan Masjid Abu Bakar, 80100 Johor Bahru Johor, Malaysia
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Karabag T, Kalayci B, Sayin MR, Erten T. Atrioventricular conduction defect associated with severe hyponatremia. ACTA ACUST UNITED AC 2018; 91:342-345. [PMID: 30093815 PMCID: PMC6082612 DOI: 10.15386/cjmed-846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/25/2017] [Accepted: 12/06/2017] [Indexed: 11/26/2022]
Abstract
Hyponatremia is the most common electrolyte disorder among hospitalized patients and in the clinical setting. Patients with hyponatremia may develop a variety of symptoms, primarily neurological and gastrointestinal. Hyponatremia is more frequently encountered in patients with an underlying heart disease, particularly in the elderly. We hereby present a case of complete atrioventricular block in an elderly patient who had undergone aortic valve replacement and had been using thiazide. Complete atrioventricular block improved after sodium replacement therapy and no other cause of electrolyte disorder was documented.
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Affiliation(s)
- Turgut Karabag
- Department of Cardiology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Belma Kalayci
- Department of Cardiology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Muhammet Rasit Sayin
- Department of Cardiology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Turgay Erten
- Department of Cardiology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
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Plakht Y, Gilutz H, Shiyovich A. Sodium levels during hospitalization with acute myocardial infarction are markers of in-hospital mortality: Soroka acute myocardial infarction II (SAMI-II) project. Clin Res Cardiol 2018; 107:956-964. [PMID: 29766284 DOI: 10.1007/s00392-018-1268-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 05/02/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Abnormalities in sodium homeostasis are common in hospitalized patients. Hyponatremia upon admission is a poor prognostic marker in acute myocardial infarction (AMI) patients. However, little is known about the association between changes in sodium levels and in-hospital mortality. We delineated changes in sodium levels and studied the association of such changes with in-hospital mortality of AMI patients. METHODS Retrospective analysis of AMI patients hospitalized for > 6 days. Sodium levels throughout the 6-day post-admission were divided into five equally sized groups (quintiles = Q) and thereafter categorized as follows: Q1 (< 135 mEq/L), Q2-Q4 (135-140 mEq/L, reference group), and Q5 (≥141 mEq/L). PRIMARY OUTCOME in-hospital mortality. RESULTS A total of 8306 patients (10,416 admissions) were included (mean age 67.8 ± 14.0 years, 33.4% women, 45.5% STEMI). In-hospital mortality was 6.6%. Q1 and Q5 upon admission were both related to higher risk for in-hospital mortality, compared with the reference group (OR 1.47 and OR 1.33, respectively, p < 0.001 each). Q1 was more frequent in non-survivors throughout the entire study period, while the prevalence of Q5 levels was similar in survivors and non-survivors upon admission carrying increasing mortality risk thereafter: for Q1 consistent OR 1.50, while for Q5 it, increased from OR 1.32 upon admission to OR 1.90 on the sixth day, p < 0.001. CONCLUSIONS Low and high sodium levels are associated with increased risk for in-hospital mortality in patients with AMI. The risk is unchanged for hyponatremia, while it consistently increases for increased sodium levels.
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Affiliation(s)
- Ygal Plakht
- Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. .,Department of Nursing, Leon and Matilda Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, Israel.
| | - Harel Gilutz
- Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Arthur Shiyovich
- Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mifsud S, Schembri EL, Mercieca Balbi M, Gruppetta M, Clark J. Beer, hyponatraemia and cardiac conduction defects. BMJ Case Rep 2018. [DOI: 10.1136/bcr-2018-224260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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10
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Selmer C, Madsen JC, Torp-Pedersen C, Gislason GH, Faber J. Hyponatremia, all-cause mortality, and risk of cancer diagnoses in the primary care setting: A large population study. Eur J Intern Med 2016; 36:36-43. [PMID: 27527754 DOI: 10.1016/j.ejim.2016.07.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 07/05/2016] [Accepted: 07/27/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hyponatremia has been associated with increased all-cause mortality in hospitalized individuals. In this study we examine the risk of all-cause mortality in primary care subjects with hyponatremia, while also exploring the association with subsequent diagnosis of cancer. METHODS Retrospective cohort study on subjects who underwent blood tests, consulting their general practitioner 2000-2012 in Copenhagen, Denmark. Reference range for sodium was 135-145mmol/L, and mild, moderate, and severe hyponatremia were defined as 130-135, 125-129, and <125mmol/L, respectively. Primary outcome was all-cause mortality, and secondary outcomes overall and specific types of cancer diagnoses. RESULTS Among 625,114 included subjects (mean age 49.9 [SD±18.4] years; 43.5% males), 90,926 (14.5%) deaths occurred. All-cause mortality was increased in mild, moderate, and severe hyponatremia (age-adjusted mortality rates [IRs, incidence rates] 26, 30, and 36 per 1000 person-years (py), respectively and incidence rate ratios [IRRs] 1.81 [95% CI: 1.76-1.85], 2.11 [2.00-2.21], and 2.52 [2.26-2.82], respectively) compared with individuals with normonatremia (IR 14 per 1000 py). For the secondary endpoint an increased level-dependent risk was found with lower sodium levels in relation to cancer overall, head and neck cancers, and pulmonary cancer, with severe hyponatremia associated with the highest IRRs (1.77 [1.39-2.24], 5.24 [2.17-12.63]), and 4.99 [3.49-7.15], respectively). CONCLUSIONS All levels of hyponatremia are associated with all-cause mortality in primary care patients and hyponatremia is linked to an increased risk of being diagnosed with any cancer, particularly pulmonary and head and neck cancers.
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Affiliation(s)
- Christian Selmer
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark; Department of Endocrinology, Amager and Hvidovre University Hospital, Copenhagen, Denmark.
| | | | | | - Gunnar Hilmar Gislason
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jens Faber
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Endocrinology, Herlev University Hospital, Herlev, Denmark
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Virk HUH, Inayat F, Rahman ZU. Complete Heart Block in Association with Dengue Hemorrhagic Fever. Korean Circ J 2016; 46:866-869. [PMID: 27826348 PMCID: PMC5099345 DOI: 10.4070/kcj.2016.46.6.866] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 11/02/2015] [Accepted: 12/17/2015] [Indexed: 12/20/2022] Open
Abstract
Dengue virus infection affects the heart structurally and functionally. Clinical manifestations of cardiac complications secondary to dengue virus infection vary from self-limiting arrhythmias to severe myocardial infarction, leading to hypotension, pulmonary edema, and cardiogenic shock. However, we report a case of dengue hemorrhagic fever (DHF) complicated by a complete heart block. A female with DHF due to dengue virus serotype 2, presented to the emergency department with fever, headache, rash, and fatigue followed by an episode of syncope. She was found to have a third-degree atrioventricular block, with pulseless polymorphic ventricular tachycardia. Patient was resuscitated and a temporary trans-venous pacemaker was placed. She reverted back to normal sinus rhythm after 4 days of syncope and was subsequently discharged from the hospital after complete resolution of symptoms, without the need for a permanent pacemaker. Physicians are warranted to have high index of suspicion for dengue virus infection as an etiology in patients with acute cardiovascular compromise, especially in tropical areas.
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Affiliation(s)
- Hafeez Ul Hassan Virk
- Department of Medicine, Mount Sinai St. Luke's and Mount Sinai Roosevelt Hospitals, Icahn School of Medicine, New York, NY, USA
| | - Faisal Inayat
- Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Zia Ur Rahman
- Department of Medicine, Johnson City Medical Center, Quillen College of Medicine, Johnson City, TN, USA
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Kottwitz J, Akdis D, Duru F, Heidecker B. Severe Hyponatremia Leading to Complete Atrioventricular Block. Am J Med 2016; 129:e243-4. [PMID: 27321971 DOI: 10.1016/j.amjmed.2016.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 05/31/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Jan Kottwitz
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Deniz Akdis
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Bettina Heidecker
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
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Das S, Bandyopadhyay S, Ramasamy A, Prabhu VV, Pachiappan S. A case of losartan-induced severe hyponatremia. J Pharmacol Pharmacother 2016; 6:219-21. [PMID: 26816476 PMCID: PMC4714391 DOI: 10.4103/0976-500x.171880] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This case report outlines a very rare case of losartan-induced severe hyponatremia in a 73-year-old type 2 diabetic patient. The patient was initiated with 50 mg daily oral losartan monotherapy for newly diagnosed moderate hypertension. After 3.5 months of taking the drug, he presented to the emergency department in a drowsy state with severe generalized weakness and occasional palpitations. He was a known diabetic for the last 3 years and well controlled by oral metformin alone. On examination, his serum sodium level was found to be 123 meq/L. There were no evidences of any other possible metabolic, infective, organic or other pathologic causes giving rise to that condition, except losartan itself. De-challenge was done and he was treated vigorously resulting in reversal of the diseased state. Naranjo adverse drug reaction probability scale suggested that it was "probable" that oral losartan was responsible for the development of severe hyponatremia in this patient.
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Affiliation(s)
- Saibal Das
- Nalmuri Block Primary Health Centre, South 24 Parganas, West Bengal, India
| | - Sanjib Bandyopadhyay
- Department of Community Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Anand Ramasamy
- Department of Pharmacology, Swamy Vivekanandha College of Pharmacy, Namakkal, Tamil Nadu, India
| | - V Vinoth Prabhu
- Department of Pharmacology, Swamy Vivekanandha College of Pharmacy, Namakkal, Tamil Nadu, India
| | - Sudhakar Pachiappan
- Department of Pharmacology, Swamy Vivekanandha College of Pharmacy, Namakkal, Tamil Nadu, India
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Barber J, McKeever TM, McDowell SE, Clayton JA, Ferner RE, Gordon RD, Stowasser M, O'Shaughnessy KM, Hall IP, Glover M. A systematic review and meta-analysis of thiazide-induced hyponatraemia: time to reconsider electrolyte monitoring regimens after thiazide initiation? Br J Clin Pharmacol 2015; 79:566-77. [PMID: 25139696 PMCID: PMC4386942 DOI: 10.1111/bcp.12499] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/13/2014] [Indexed: 12/13/2022] Open
Abstract
AIMS Hyponatraemia is one of the major adverse effects of thiazide and thiazide-like diuretics and the leading cause of drug-induced hyponatraemia requiring hospital admission. We sought to review and analyze all published cases of this important condition. METHODS Ovid Medline, Embase, Web of Science and PubMed electronic databases were searched to identify all relevant articles published before October 2013. A proportions meta-analysis was undertaken. RESULTS One hundred and two articles were identified of which 49 were single patient case reports. Meta-analysis showed that mean age was 75 (95% CI 73, 77) years, 79% were women (95% CI 74, 82) and mean body mass index was 25 (95% CI 20, 30) kg m(-2) . Presentation with thiazide-induced hyponatraemia occurred a mean of 19 (95% CI 8, 30) days after starting treatment, with mean trough serum sodium concentration of 116 (95% CI 113, 120) mm and serum potassium of 3.3 (95% CI 3.0, 3.5) mm. Mean urinary sodium concentration was 64 mm (95% CI 47, 81). The most frequently reported drugs were hydrochlorothiazide, indapamide and bendroflumethiazide. CONCLUSIONS Patients with thiazide-induced hyponatraemia were characterized by advanced age, female gender, inappropriate saliuresis and mild hypokalaemia. Low BMI was not found to be a significant risk factor, despite previous suggestions. The time from thiazide initiation to presentation with hyponatraemia suggests that the recommended practice of performing a single investigation of serum biochemistry 7-14 days after thiazide initiation may be insufficient or suboptimal. Further larger and more systematic studies of thiazide-induced hyponatraemia are required.
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Affiliation(s)
- Jennifer Barber
- Division of Therapeutics and Molecular Medicine, University of NottinghamNottingham, NG7 2UH, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of NottinghamNottingham, NG5 1PB, UK
| | - Sarah E McDowell
- West Midlands Centre for Adverse Drug Reactions, City HospitalBirmingham, B18 7QH, UK
| | - Jennifer A Clayton
- Department of Diabetes and Endocrinology, Nottingham University Hospitals NHS TrustNottingham, NG7 2UH, UK
| | - Robin E Ferner
- West Midlands Centre for Adverse Drug Reactions, City HospitalBirmingham, B18 7QH, UK
| | - Richard D Gordon
- Endocrine Hypertension Research Centre, University of Queensland School of MedicineBrisbane, Australia
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland School of MedicineBrisbane, Australia
| | - Kevin M O'Shaughnessy
- Clinical Pharmacology Unit, Department of Medicine, University of CambridgeCambridge, CB2 2QQ, UK
| | - Ian P Hall
- Division of Therapeutics and Molecular Medicine, University of NottinghamNottingham, NG7 2UH, UK
| | - Mark Glover
- Division of Therapeutics and Molecular Medicine, University of NottinghamNottingham, NG7 2UH, UK
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Navinan MR, Yudhishdran J, Herath S, Liyanage I, Kugadas T, Kumara D, Kulatunga A. Complete heart block in dengue complicating management of shock due to both bleeding and leakage: a case report. BMC Res Notes 2015; 8:68. [PMID: 25884693 PMCID: PMC4351841 DOI: 10.1186/s13104-015-1036-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 02/24/2015] [Indexed: 12/20/2022] Open
Abstract
Background The spread of Dengue virus infection is reaching pandemic proportions. Dengue is usually dreaded for causing shock due to capillary leakage. However the clinical spectrum of dengue is vast and the newly incorporated expanded dengue syndrome introduces a wide range of presentations that are rarely observed and appreciated but nevertheless have the potential to cause significant morbidity and even mortality. Cardiac involvement in dengue is one such example. Case presentation A 26 year old South-Asian female presented in a state of haemodynamic shock with a history of fever and use of non-steroidal anti inflammatory drugs. Dengue was suspected clinically and later confirmed. Following stabilization and while still in the febrile phase the patient developed bradycardia with dynamic electrocardiogram changes which evolved into complete heart block. However there was no circulatory compromise. Clinical picture was further complicated by the development of dengue haemorhaghic fever and cautious fluid resuscitation was carried out in correlation to clinical and haematological parameters. Impaired coagulation profile necessitated administration of activated factor seven on the backdrop of low platelets and bleeding. Cardiac pacing could be avoided due to maintenance of vitals within acceptable parameters. Conclusion Expanded dengue syndrome should be given greater appreciation as not all may be benign. Cardiovascular system involvement in dengue has the potential to cause significant morbidity and mortality. Careful interpretation of clinical parameters will help in the institution of the appropriate management and help avoid unnecessary invasive interventions. Screening of dengue patients with timely electrocardiographs would be useful to detect cardiac involvement. Guidance on managing atypical manifestations of dengue expanded syndrome should available to help clinicians dictate treatment.
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Qureshi W, Hassan S, Khalid F, Almahmoud MF, Shah B, Tashman R, Ambulgekar N, El-Refai M, Mittal C, Alirhayim Z. Outcomes of correcting hyponatremia in patients with myocardial infarction. Clin Res Cardiol 2013; 102:637-44. [PMID: 23653254 DOI: 10.1007/s00392-013-0576-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 04/26/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hyponatremia has significant prognostic implications in patients with heart, failure. However, little data are available regarding its significance in patients presenting with myocardial infarction. In addition, it is not known if correction of hyponatremia impacts outcomes in these patients. The aim of this study was to evaluate the prognostic value of hyponatremia in patients with myocardial infarction and the effect of its correction on all-cause mortality. METHODS Patients with the discharge diagnosis of myocardial infarction at our institution between 2000 and 2010 with serum sodium levels measured within 24 h of admission were included in this retrospective analysis. Multivariate analysis was used to determine the predictors of all-cause mortality. Cox proportional hazard model was applied to determine the adjusted survival. RESULTS A total of 11,562 patients (67.15 ± 14.6 years, males 56.3 %) were included in the analysis. There were a total of 1,535 (13.3 %) deaths within mean follow-up duration of 5.5 ± 3.3 years. There were 425 (27.9 %) deaths in patients with corrected hyponatremia and 155 (55.3 %) deaths in persistent hyponatremia patients. Multivariate analysis indicated that corrected hyponatremia and persistent hyponatremia were independent predictors of all cause mortality (p < 0.0001). When analyzing short-term (30 days) and long-term mortality, corrected hyponatremia group did not have associated long term mortality. Various methods to correct hyponatremia were also analyzed and use of vaptans was associated with decrease in mortality in patients with hyponatremia from 115 to 125 (HR 0.45; 95 % CI 0.26-0.78, p = 0.005). CONCLUSION Our analysis showed that corrected and persistent hyponatremia in patients presenting with myocardial infarction is a predictor of all-cause mortality, major adverse cardiac events and heart failure related 30 day rehospitalization. In certain cases, correction of hyponatremia may actually improve survival of the patients.
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Affiliation(s)
- Waqas Qureshi
- Department of Internal Medicine, Henry Ford Health Systems/Wayne State University School of Medicine, 2799 W Grand Blvd, CFP-1, Detroit, MI 48202, USA
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Haga HA, Risberg Å, Strand E. Resuscitation of an anaesthetised foal with uroperitoneum and ventricular asystole. EQUINE VET EDUC 2011. [DOI: 10.1111/j.2042-3292.2011.00233.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Walsh SR, Oates JE, Anderson JA, Blair SD, Makin CA, Walsh CJ. Postoperative arrhythmias in colorectal surgical patients: incidence and clinical correlates. Colorectal Dis 2006; 8:212-6. [PMID: 16466562 DOI: 10.1111/j.1463-1318.2005.00881.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To determine the incidence and clinical correlates of postoperative cardiac arrhythmias in patients undergoing elective large bowel resection. METHODS Fifty-one consecutive patients undergoing elective open colorectal resection were recruited for this prospective observational study. Participating patients underwent daily three-lead electrocardiograms postoperatively. Data regarding potential risk factors for arrhythmias were recorded. Post-operative complications were recorded. RESULTS Thirteen (26%) patients developed a postoperative arrhythmia, most commonly atrial fibrillation. Significant univariate correlates with postoperative arrhythmias were: age (P<0.01), hypertension (P<0.01), pre-operative serum potassium levels (P<0.01), postoperative pulmonary oedema (P=0.03), postoperative serum potassium (P=0.03) and sodium (P<0.01). Arrhythmia patients were more likely to have other complications (P=0.02). Thirty-one percent of arrhythmia patients had underlying sepsis compared with 18% of controls (P=0.38). CONCLUSION Arrhythmias are common following elective large bowel resection. They occur in older patients and are associated with the development of other complications.
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Affiliation(s)
- S R Walsh
- Department of General Surgery, Arrowe Park Hospital, Upton, UK
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Moritz ML, Ayus JC. Preventing neurological complications from dysnatremias in children. Pediatr Nephrol 2005; 20:1687-700. [PMID: 16079988 DOI: 10.1007/s00467-005-1933-6] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Revised: 02/28/2005] [Accepted: 03/02/2005] [Indexed: 12/15/2022]
Abstract
Dysnatremias are among the most common electrolyte abnormalities encountered in hospitalized patients. In most cases, a dysnatremia results from improper fluid management. Dysnatremias can occasionally result in death or permanent neurological damage, a tragic complication that is usually preventable. In this manuscript, we discuss the epidemiology, pathogenesis and prevention and treatment of dysnatremias in children. We report on over 50 patients who have suffered death or neurological injury from hospital-acquired hyponatremia. The main factor contributing to hyponatremic encephalopathy in children is the routine use of hypotonic fluids in patients who have an impaired ability to excrete free-water, due to such causes as the postoperative state, volume depletion and pulmonary and central nervous system diseases. The appropriate use of 0.9% sodium chloride in parenteral fluids would likely prevent most cases of hospital-acquired hyponatremic encephalopathy. We report on 15 prospective studies in over 500 surgical patients that demonstrate that normal saline effectively prevents postoperative hyponatremia, and hypotonic fluids consistently result in a fall in serum sodium. Hyponatremic encephalopathy is a medical emergency that should be treated with hypertonic saline, and should never be managed with fluid restriction alone. Hospital-acquired hypernatremia occurs in patients who have restricted access to fluids in combination with ongoing free-water losses. Hypernatremia could largely be prevented by providing adequate free-water to patients who have ongoing free-water losses or when mild hypernatremia (Na>145 mE/l) develops. A group at high-risk for neurological damage from hypernatremia in the outpatient setting is that of the breastfed infant. Breastfed infants must be monitored closely for insufficient lactation and receive lactation support. Judicious use of infant formula supplementation may be called for until problems with lactation can be corrected.
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Affiliation(s)
- Michael L Moritz
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Pittsburgh, The University of Pittsburgh School of Medicine, PA 15213-2538, USA.
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Schrier RW, Martin PY. Recent advances in the understanding of water metabolism in heart failure. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1999; 449:415-26. [PMID: 10026833 DOI: 10.1007/978-1-4615-4871-3_53] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Hyponatremia is common in advanced heart failure and relates to the severity of the disease. Non-osmotic arginine vasopressin (AVP) release and biosynthesis have been shown to be increased during chronic cardiac failure (CHF) and baroreceptors pathways have been demonstrated to play a major role in this non-osmotic stimulation of AVP. Decreased cardiac output unloads the baroreceptors and activates the sympathetic nervous system, thus stimulating AVP through a separate pathway which overrides the osmotic pathway. Besides sympathetic nervous system activation, neurohumoral peptides, such as angiotensin II, endothelins, natriuretic peptides and prostaglandins, could also participate in the non-osmotic AVP activation. The vasoconstrictor effect of AVP has been supported by the decrease systemic vascular resistance during the administration of V1 receptor AVP antagonist in CHF patients. Administration of V2 receptor AVP antagonists corrects the hyponatremia and has been demonstrated to improve survival in animal models of heart failure. Preliminary data in humans with CHF also demonstrate urinary dilution and correction of hyponatremia with orally active non-peptide V2 receptor antagonists. Finally, upregulation of the AVP-regulated water channels, aquaporin-2 (AQP2), located in the collecting duct cells has been shown in experimental heart failure. This AQP2 upregulation can be entirely suppressed by V2 receptor AVP antagonists paralleling the correction of the hyponatremia. Thus, non-osmotic release of AVP in CHF upregulates AQP2 water channels, enhances water reabsorption and causes hyponatremia. The V1, and perhaps the V2, receptor activation may also diminish cardiac function.
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Affiliation(s)
- R W Schrier
- Department of Medicine, University of Colorado Health Sciences Center, Denver 80262, USA
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