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Gao J, Wang Y, Zhang A, Pang H, Wang F. Old woman with Sheehan's syndrome suffered severe hyponatremia following percutaneous coronary intervention: a case report and review of literature. Front Cardiovasc Med 2024; 11:1353392. [PMID: 38742176 PMCID: PMC11089169 DOI: 10.3389/fcvm.2024.1353392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/17/2024] [Indexed: 05/16/2024] Open
Abstract
Glucocorticoid deficiency can lead to hypoglycemia, hypotension, and electrolyte disorders. Acute glucocorticoid deficiency under stress is very dangerous. Here, we present a case study of an elderly patient diagnosed with Sheehan's syndrome, manifesting secondary adrenal insufficiency and secondary hypothyroidism, managed with daily prednisone and levothyroxine therapy. She was admitted to our hospital due to acute non-ST segment elevation myocardial infarction. The patient developed nausea and limb twitching post-percutaneous coronary intervention, with subsequent diagnosis of hyponatremia. Despite initial intravenous sodium supplementation failed to rectify the condition, and consciousness disturbances ensued. However, administration of 50 mg hydrocortisone alongside 6.25 mg sodium chloride rapidly ameliorated symptoms and elevated blood sodium levels. Glucocorticoid deficiency emerged as the primary etiology of hyponatremia in this context, exacerbated by procedural stress during percutaneous coronary intervention. Contrast agent contributed to blood sodium dilution. Consequently, glucocorticoid supplementation emerges as imperative, emphasizing the necessity of stress-dose administration of glucocorticoid before the procedure. Consideration of shorter intervention durations and reduced contrast agent dosages may mitigate severe hyponatremia risks. Moreover, it is crucial for this patient to receive interdisciplinary endocrinologist management. In addition, Sheehan's syndrome may pose a risk for coronary atherosclerotic disease.
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Affiliation(s)
- Jie Gao
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong, China
| | - Yuehai Wang
- Cardiology Department and Experimental Animal Center, Liaocheng People’s Hospital of Shandong University and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, Shandong, China
| | - Anqi Zhang
- Department of Central Laboratory, Liaocheng People’s Hospital, Liaocheng, Shandong, China
| | - Huihui Pang
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong, China
| | - Fei Wang
- Department of Cardiology, Shandong Corps Hospital of Chinese People’s Armed Police Forces, Jinan, China
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Li XJ, Meng HH. Clinical study on the relationship between liver cirrhosis, ascites, and hyponatremia. World J Gastrointest Surg 2024; 16:751-758. [PMID: 38577083 PMCID: PMC10989326 DOI: 10.4240/wjgs.v16.i3.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/12/2024] [Accepted: 01/31/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Cirrhosis is a common liver disease, and ascites is one of the common clinical conditions. However, the clinical manifestations of ascites combined with hyponatremia as a high-risk condition and its relationship to patient prognosis have not been fully studied. AIM To explore the clinical manifestations, prognostic factors, and relationships of ascites with hyponatremia in patients with cirrhosis to provide better diagnostic and treatment strategies. METHODS In this study, we retrospectively analyzed the clinical data of 150 patients diagnosed with cirrhosis and ascites between 2017 and 2022. Patients were divided into two groups: ascites combined with hyponatremia group and ascites group. We compared the general characteristics, degree of hyponatremia, complications, treatment, and prognosis between the two groups. RESULTS In the study results, patients in the ascites combined with hyponatremia group showed an older average age (58.2 ± 8.9 years), 64.4% were male, and had a significantly longer hospitalization time (12.7 ± 5.3 d). Hyponatremia was more severe in this group, with a mean serum sodium concentration of 128.5 ± 4.3 mmol/L, which was significantly different from the ascites group of 137.6 ± 2.1 mmol/L. Patients with ascites and hyponatremia were more likely to develop hepatic encephalopathy (56.2% vs 39.0%), renal impairment (45.2% vs 28.6%) and infection (37.0% vs 23.4%). Regarding treatment, this group more frequently used diuretics (80.8% vs 62.3%) and salt supplements (60.3% vs 38.9%). Multiple logistic regression analysis identified older age [Odds ratio (OR) = 1.06, P = 0.025] and male gender (OR = 1.72, P = 0.020) as risk factors for hyponatremia combined with ascites. Overall, patients with ascites and hyponatremia present a clear high-risk status, accompanied by severe complications and poor prognosis. CONCLUSION In patients with cirrhosis, ascites with hyponatremia is a high-risk condition that is often associated with severe complications.
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Affiliation(s)
- Xuan-Ji Li
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Hui-Hui Meng
- Department of Hepatology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan 430065, Hubei Province, China
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Netto AB, Chandrahasa N, Koshy SS, Taly AB. Hyponatremia in Guillain-Barre Syndrome: A Review of Its Pathophysiology and Management. Can J Neurol Sci 2024:1-11. [PMID: 38361453 DOI: 10.1017/cjn.2024.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Guillain-Barre syndrome (GBS) is the commonest cause of acute polyradiculoneuropathy that requires hospitalization. Many of these patients experience systemic and disease-related complications during its course. Notable among them is hyponatremia. Though recognized for decades, the precise incidence, prevalence, and mechanism of hyponatremia in GBS are not well known. Hyponatremia in GBS patients is associated with more severe in-hospital disease course, prolonged hospitalization, higher mortality, increased costs, and a greater number of other complications in the hospital and worse functional status at 6 months and at 1 year. Though there are several reports of low sodium associated with GBS, many have not included the exact temporal relationship of sodium or its serial values during GBS thereby underestimating the exact incidence, prevalence, and magnitude of the problem. Early detection, close monitoring, and better understanding of the pathophysiology of hyponatremia have therapeutic implications. We review the complexities of the relationship between hyponatremia and GBS with regard to its pathophysiology and treatment.
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Affiliation(s)
- Archana B Netto
- Departments of Neurology, Bangalore Medical College & Research Institute, Bangalore, India
| | - Niveditha Chandrahasa
- Departments of Neurology, Bangalore Medical College & Research Institute, Bangalore, India
| | - Sheril S Koshy
- Departments of Neurology, Bangalore Medical College & Research Institute, Bangalore, India
| | - Arun B Taly
- Departments of Neurology, Bangalore Medical College & Research Institute, Bangalore, India
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Shamim J. Letter to the Editor for "Hypertonic Saline Versus Other Intracranial-Pressure-Lowering Agents for Patients with Acute Traumatic Brain Injury: A Systematic Review and Meta-analysis". Neurocrit Care 2024; 40:375-376. [PMID: 37957416 DOI: 10.1007/s12028-023-01864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Javeria Shamim
- Department of Pediatrics, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-0354, USA.
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Schwarz C, Lindner G, Windpessl M, Knechtelsdorfer M, Saemann MD. [Consensus recommendations on the diagnosis and treatment of hyponatremia from the Austrian Society for Nephrology 2024]. Wien Klin Wochenschr 2024; 136:1-33. [PMID: 38421476 PMCID: PMC10904443 DOI: 10.1007/s00508-024-02325-5] [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] [Accepted: 01/03/2024] [Indexed: 03/02/2024]
Abstract
Hyponatremia is a disorder of water homeostasis. Water balance is maintained by the collaboration of renal function and cerebral structures, which regulate thirst mechanisms and secretion of the antidiuretic hormone. Measurement of serum-osmolality, urine osmolality and urine-sodium concentration help to diagnose the different reasons for hyponatremia. Hyponatremia induces cerebral edema and might lead to severe neurological symptoms, which need acute therapy. Also, mild forms of hyponatremia should be treated causally, or at least symptomatically. An inadequate fast increase of the serum sodium level should be avoided, because it raises the risk of cerebral osmotic demyelination. Basic pathophysiological knowledge is necessary to identify the different reasons for hyponatremia which need different therapeutic procedures.
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Affiliation(s)
- Christoph Schwarz
- Innere Medizin 1, Pyhrn-Eisenwurzenklinikum, Sierningerstr. 170, 4400, Steyr, Österreich.
| | - Gregor Lindner
- Zentrale Notaufnahme, Kepler Universitätsklinikum GmbH, Johannes-Kepler-Universität, Linz, Österreich
| | | | | | - Marcus D Saemann
- 6.Medizinische Abteilung mit Nephrologie und Dialyse, Klinik Ottakring, Wien, Österreich
- Medizinische Fakultät, Sigmund-Freud Universität, Wien, Österreich
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Han Y, Duan J, Chen M, Huang S, Zhang B, Wang Y, Liu J, Li X, Yu W. Relationship between serum sodium level and sepsis-induced coagulopathy. Front Med (Lausanne) 2024; 10:1324369. [PMID: 38298508 PMCID: PMC10828971 DOI: 10.3389/fmed.2023.1324369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/21/2023] [Indexed: 02/02/2024] Open
Abstract
Purpose A discussion about the correlation between the level of serum sodium and sepsis-induced coagulopathy (SIC). Materials and methods A retrospective analysis was conducted on sepsis patients who were admitted to the Intensive Care Unit (ICU) of Nanjing Drum Tower Hospital from January 2021 to December 2022. Based on the presence of coagulation disorders, the patients were divided into two groups: sepsis-induced coagulopathy (SIC) and non-sepsis-induced coagulopathy (non-SIC) groups. We recorded demographic characteristics and laboratory indicators at the time of ICU admission, and analyzed relationship between serum sodium level and SIC. Results One hundred and twenty-five patients with sepsis were enrolled, among which, the SIC and the non-SIC groups included 62 and 63 patients, respectively. Compared to patients in the non-SIC group, the level of serum sodium of those in the SIC was significantly higher (p < 0.001). Multi-factor logistic regression showed serum sodium level was independently associated with SIC (or = 1.127, p = 0.001). Pearson's correlation analysis indicated that the higher the serum sodium level, the significantly higher the SIC score was (r = 0.373, p < 0.001). Additionally, the mortality rate of patients with sepsis in the ICU were significantly correlated with increased serum sodium levels (p = 0.014). Conclusion An increase in serum sodium level was independently associated with an increased occurrence of SIC and also associated with the poor prognosis for patients with sepsis.
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Affiliation(s)
- Yanyu Han
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Drum Tower Clinical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianfeng Duan
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ming Chen
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Shijie Huang
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Drum Tower Clinical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Beiyuan Zhang
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yan Wang
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jiali Liu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiaoyao Li
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Wenkui Yu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Drum Tower Clinical College, Nanjing University of Chinese Medicine, Nanjing, China
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Farah R, Asha N, Mezher F, Maaitah S, Abu Al-Samen F, Abu Abboud F, Ajarmeh S. Prevalence, Risk Factors, and Mortality of Patients Presenting with Moderate and Severe Hyponatremia in Emergency Departments. Emerg Med Int 2023; 2023:9946578. [PMID: 38187818 PMCID: PMC10771923 DOI: 10.1155/2023/9946578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/11/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024] Open
Abstract
Background Hyponatremia is among the most common electrolyte disturbances encountered in clinical practice and is associated with a high rate of morbidity and mortality. However, there are very limited data on adult cases presenting to emergency departments with hyponatremia. Objectives This study aimed to evaluate the frequency, clinical characteristics, and outcomes in hyponatremic patients presenting to emergency departments. Methods This retrospective study analyzed all patients older than 18 years who visited our institution's emergency department between October 2018 and October 2019 and has a serum sodium (Na) level <130 mmol/L. Results Among 24,982 patients who visited the emergency department and had a documented serum sodium level, 284 were included. Patients' median age was 67.13 ± 14.8 years. Younger patients are less likely to develop severe hyponatremia compared to older patients (adjusted odds ratio (AOR): 0.415; 95% confidence interval (CI): 0.231-0.743; p=0.003). Asymptomatic hyponatremia and gastrointestinal manifestations were the most common presenting hyponatremia symptoms (33.7% and 24.2%, respectively). Proton pump inhibitor (PPI) use, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACE/ARB) use, and spironolactone use (OR = 2.6 and 3.9, 2.3 with a p=0.02, 0.03, and 0.05, respectively) were associated with increased odds of severe hyponatremia. There is no difference in the overall mortality rate within 6 months of presentation between severe and moderate hyponatremia groups (11.1% versus 16.2%, p=0.163). Conclusion Moderate and severe hyponatremia are not uncommon among patients presenting to emergency departments. Moderate hyponatremia can be asymptomatic with clinical significance. Older patients, use of PPI, use of ACEi/ARBs, and spironolactone use were associated with an increased risk of severe hyponatremia compared to moderate. Further prospective analysis of a larger population is needed to confirm our findings.
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Affiliation(s)
- Randa Farah
- Nephrology Division, Internal Medicine Department, School of Medicine, The University of Jordan, Queen Rania Street, Amman 11942, Jordan
| | - Nisreen Asha
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Farah Mezher
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Saja Maaitah
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | | | - Salma Ajarmeh
- Paediatric Departments, School of Medicine, Mutah University, Karak, Jordan
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8
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Perschinka F, Köglberger P, Klein SJ, Joannidis M. [Hyponatremia : Etiology, diagnosis and acute therapy]. Med Klin Intensivmed Notfmed 2023; 118:505-517. [PMID: 37646802 PMCID: PMC10501960 DOI: 10.1007/s00063-023-01049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 09/01/2023]
Abstract
Hyponatremia is one of the most common electrolyte disorders in emergency departments and hospitalized patients. Serum sodium concentration is controlled by osmoregulation and volume regulation. Both pathways are regulated via the release of antidiuretic hormone (ADH). Syndrome of inappropriate release of ADH (SIADH) may be caused by neoplasms or pneumonia but may also be triggered by drug use or drug abuse. Excessive fluid intake may also result in a decrease in serum sodium concentration. Rapid alteration in serum sodium concentration leads to cell swelling or cell shrinkage, which primarily causes neurological symptoms. The dynamics of development of hyponatremia and its duration are crucial. In addition to blood testing, a clinical examination and urine analysis are essential in the differential diagnosis of hyponatremia.
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Affiliation(s)
- Fabian Perschinka
- Gemeinsame Einrichtung Internistische Intensiv- und Notfallmedizin, Department für Innere Medizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Paul Köglberger
- Gemeinsame Einrichtung Internistische Intensiv- und Notfallmedizin, Department für Innere Medizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
- Institut für Anästhesiologie und Intensivmedizin, Klinikum Wels, Grieskirchnerstraße 42, 4600, Wels, Österreich
| | - Sebastian J Klein
- Gemeinsame Einrichtung Internistische Intensiv- und Notfallmedizin, Department für Innere Medizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Michael Joannidis
- Gemeinsame Einrichtung Internistische Intensiv- und Notfallmedizin, Department für Innere Medizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
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Wiest NE, Nasir A, Bui A, Karime C, Chase RC, Barrios MS, Hunter R, Jones SM, Moktan VP, Creager JG, Shirazi E, Mohseni MM, Dawson NL. Improving management of hyponatraemia by increasing urine testing in the emergency department. BMJ Open Qual 2023; 12:e002326. [PMID: 37758666 PMCID: PMC10537979 DOI: 10.1136/bmjoq-2023-002326] [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] [Received: 02/21/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Hyponatraemia on hospital admission is associated with increased length of stay, healthcare expenditures and mortality. Urine studies collected before fluid or diuretic administration are essential to diagnose the underlying cause of hyponatraemia, thereby empowering admitting teams to employ the appropriate treatment. A multidisciplinary quality improvement (QI) team led by internal medicine residents performed a QI project from July 2020 through June 2021 to increase the rate of urine studies collected before fluid or diuretic administration in the emergency department (ED) in patients admitted with moderate to severe hyponatraemia. We implemented two plan-do-study-act (PDSA) cycles to address this goal. In PDSA Cycle #1, we displayed an educational poster in employee areas of the ED and met with nursing staff at their monthly meetings to communicate the project and answer questions. We also obtained agreement from ED attending physicians and nursing leaders to support the project. In PDSA Cycle #2, we implemented a structural change in the nursing triage process to issue every patient who qualified for bloodwork with a urine specimen container labelled with a medical record number on registration so that the patient could provide a sample at any point, including while in the waiting area. After PDSA Cycle #1, urine specimen collection increased from 34.5% to 57.5%. After PDSA Cycle #2, this increased further to 59%. We conclude that a combination of educational and structural changes led to a significant increase in urine specimen collection before fluid or diuretic administration among patients presenting with moderate-to-severe hyponatraemia in the ED.
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Affiliation(s)
- Nathaniel E Wiest
- Internal Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Ayan Nasir
- Department of Internal Medicine, South Lake Medical Center, Clermont, Florida, USA
| | - Albert Bui
- Department of Internal Medicine, South Lake Medical Center, Clermont, Florida, USA
| | - Christian Karime
- Department of Internal Medicine, South Lake Medical Center, Clermont, Florida, USA
| | - R Christopher Chase
- Department of Internal Medicine, South Lake Medical Center, Clermont, Florida, USA
| | - Maria S Barrios
- Department of Neurology, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Ryan Hunter
- Department of Neurology, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Samuel M Jones
- Department of Neurology, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Varun P Moktan
- Internal Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Jessica G Creager
- Department of Neurology, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Ehsan Shirazi
- Department of Emergency Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Michael M Mohseni
- Department of Emergency Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Nancy L Dawson
- Internal Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
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Zhu DD, Tan YR, Zheng LW, Lao JZ, Liu JY, Yu J, Chen P. Microneedle-Coupled Epidermal Sensors for In-Situ-Multiplexed Ion Detection in Interstitial Fluids. ACS APPLIED MATERIALS & INTERFACES 2023. [PMID: 36916026 DOI: 10.1021/acsami.3c00573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Maintaining the concentrations of various ions in body fluids is critical to all living organisms. In this contribution, we designed a flexible microneedle patch coupled electrode array (MNP-EA) for the in situ multiplexed detection of ion species (Na+, K+, Ca2+, and H+) in tissue interstitial fluid (ISF). The microneedles (MNs) are mechanically robust for skin or cuticle penetration (0.21 N/needle) and highly swellable to quickly extract sufficient ISF onto the ion-selective electrochemical electrodes (∼6.87 μL/needle in 5 min). The potentiometric sensor can simultaneously detect these ion species with nearly Nernstian response in the ranges wider enough for diagnosis purposes (Na+: 0.75-200 mM, K+: 1-128 mM, Ca2+: 0.25-4.25 mM, pH: 5.5-8.5). The in vivo experiments on mice, humans, and plants demonstrate the feasibility of MNP-EA for timely and convenient diagnosis of ion imbalances with minimal invasiveness. This transdermal sensing platform shall be instrumental to home-based diagnosis and health monitoring of chronic diseases and is also promising for smart agriculture and the study of plant biology.
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Affiliation(s)
- Dan Dan Zhu
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore 637457, Singapore
| | - Yu Rong Tan
- School of Materials Science and Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Le Wen Zheng
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore 637457, Singapore
| | - Jia Zheng Lao
- School of Materials Science and Engineering, Nanyang Technological University, Singapore 639798, Singapore
- Institute of Flexible Electronics Technology of THU, Jiaxing, Zhejiang 314000, China
| | - Ji Yang Liu
- Key Laboratory of Surface & Interface Science of Polymer Materials of Zhejiang Province, Department of Chemistry, Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Jing Yu
- School of Materials Science and Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Peng Chen
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore 637457, Singapore
- Skin Research Institute of Singapore, Singapore 308232, Singapore
- Lee Kong Chian School of Medicine, Institute for Digital Molecular Analytics and Science, Nanyang Technological University, Singapore 636921, Singapore
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11
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Senanayake J, Haji Rahman R, Boucher B, Ali MZ, Madanat S, Hammell C, Chuy F. Multi-Etiological Hyponatremia in Association With Suspected Beer Potomania. Cureus 2023; 15:e36407. [PMID: 37090390 PMCID: PMC10115209 DOI: 10.7759/cureus.36407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Beer potomania is a unique condition characterized by hyponatremia secondary to excessive beer drinking and low daily solute intake. We report a case of a 41-year-old African American female with multiple comorbidities, notably alcohol use disorder, who was initially treated for hypertensive emergency and was subsequently found to be hyponatremic during the same visit. Beer potomania was suspected as a leading etiology of hyponatremia. This report emphasizes the importance of the proper diagnosis and appropriate management of beer potomania in the setting of concomitant comorbidities. Clinician awareness is crucial in implementing immediate treatment and in the prevention of potentially fatal sequelae such as severe malnutrition and osmotic demyelination syndrome.
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Affiliation(s)
| | | | - Benoit Boucher
- Medicine, Saint James School of Medicine, St. Vincent, VCT
| | | | - Sally Madanat
- Medicine, Washington University of Health and Science, Cleveland, USA
| | - Carly Hammell
- Medicine, Washington University of Health and Science, Cleveland, USA
| | - Francisco Chuy
- Internal Medicine, Weiss Memorial Hospital, Chicago, USA
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12
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Xiao M, Wang X, Wang H, Du F, Yao Y, Wang X, Wang J, Yang J, Xiong W, Wang Q, Ren X, Zhu T. Risk factors for hyponatremia in acute exacerbation chronic obstructive pulmonary disease (AECOPD): a multicenter cross-sectional study. BMC Pulm Med 2023; 23:39. [PMID: 36709254 PMCID: PMC9884134 DOI: 10.1186/s12890-023-02328-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/16/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Hyponatremia is an independent predictor of poor prognosis, including increased mortality and readmission, in COPD patients. Identifying modifiable etiologies of hyponatremia may help reduce adverse events in patients with AECOPD. Therefore, the aim of this study was to explore the risk factors and underlying etiologies of hyponatremia in AECOPD patients. METHODS A total of 586 AECOPD patients were enrolled in this multicenter cross-sectional study. Finally, 323 had normonatremia, and 90 had hyponatremia. Demographics, underlying diseases, comorbidities, symptoms, and laboratory data were collected. The least absolute shrinkage and selection operator (LASSO) regression was used to select potential risk factors, which were substituted into binary logistic regression to identify independent risk factors. Nomogram was built to visualize and validate binary logistics regression model. RESULTS Nine potential hyponatremia-associated variables were selected by LASSO regression. Subsequently, a binary logistic regression model identified that smoking status, rate of community-acquired pneumonia (CAP), anion gap (AG), erythrocyte sedimentation rate (ESR), and serum magnesium (Mg2+) were independent variables of hyponatremia in AECOPD patients. The AUC of ROC curve of nomogram was 0.756. The DCA curve revealed that the nomogram could yielded more clinical benefits if the threshold was between 10% and 52%. CONCLUSIONS Collectively, our results showed that smoking status, CAP, AG, ESR, and serum Mg2+ were independently associated with hyponatremia in AECOPD patients. Then, these findings indicate that pneumonia, metabolic acidosis, and hypomagnesemia were the underlying etiologies of hyponatremia in AECOPD patients. However, their internal connections need further exploration.
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Affiliation(s)
- Min Xiao
- grid.412901.f0000 0004 1770 1022Respiratory Medicine and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041 China
| | - Xiaoyu Wang
- grid.412901.f0000 0004 1770 1022Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, 610041 China
| | - Hanchao Wang
- Respiratory Medicine and Critical Care Medicine, and Preclinical Research Center, Suining Central Hospital, Suining, 629000 Sichuan China
| | - Fawang Du
- Respiratory Medicine and Critical Care Medicine, and Preclinical Research Center, Suining Central Hospital, Suining, 629000 Sichuan China
| | - Yu Yao
- Respiratory Medicine and Critical Care Medicine, and Preclinical Research Center, Suining Central Hospital, Suining, 629000 Sichuan China
| | - Xiaochuan Wang
- Respiratory Medicine and Critical Care Medicine, and Preclinical Research Center, Suining Central Hospital, Suining, 629000 Sichuan China
| | - Jiajia Wang
- grid.412461.40000 0004 9334 6536Rheumatology Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010 China
| | - Juan Yang
- grid.66875.3a0000 0004 0459 167XDivision of General Internal Medicine, Mayo Clinic, Rochester, MN 55905 USA
| | - Wei Xiong
- grid.412461.40000 0004 9334 6536Respiratory Medicine and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010 China
| | - Qin Wang
- grid.412461.40000 0004 9334 6536Respiratory Medicine and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010 China
| | - Xubin Ren
- Respiratory Medicine and Critical Care Medicine, Chengdu First People’s Hospital, Chengdu, 610041 Sichuan China
| | - Tao Zhu
- Respiratory Medicine and Critical Care Medicine, and Preclinical Research Center, Suining Central Hospital, Suining, 629000 Sichuan China
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Muacevic A, Adler JR. The Association Between Hyponatremia and Optic Nerve Sheath Diameter: A Prospective Study. Cureus 2023; 15:e34084. [PMID: 36843796 PMCID: PMC9945814 DOI: 10.7759/cureus.34084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/25/2023] Open
Abstract
Background Hyponatremia is a common electrolyte balance disorder. It may result in brain edema and increased intracranial pressure (ICP). Optic nerve sheath diameter (ONSD) measurement remains an increasingly sought-after method in many situations associated with ICP elevations. The aim of our study was to investigate the relationship between the change of ONSD before and after hypertonic saline (3% sodium chloride) treatment and the clinical improvement with increased sodium levels in patients with symptomatic hyponatremia who presented to the emergency department. Methodology This study was conducted in the emergency department of a tertiary hospital, according to the design of a prospective, self-controlled, non-randomized trial study. Determined by power analysis, 60 patients were included in the study. The statistical analysis of the continuous data was performed using the means, standard deviations, and minimum and maximum values of the feature values. The frequency and percentage values were used to define categorical variables. The mean difference comparison of pre-and post-treatment measurements was evaluated by paired t-test. P<0.05 was considered to be significant. Results The measurement parameters' differences before and after hypertonic saline treatment were evaluated. While the mean of the right eye ONSD was 5.27±0.22 mm before treatment, it declined substantially to 4.52±0.24 mm after treatment (p<0.001). It was also found that the left eye ONSD was 5.26±0.23 mm before the treatment and declined to 4.53±0.24 mm after the treatment (p<0.001). In addition, the mean of the overall ONSD was 5.26±0.23 mm before treatment and 4.52±0.24 mm after treatment (p<0.001). Conclusions Ultrasonic measurement of ONSD can be used to monitor the clinical improvement of patients receiving hypertonic saline therapy for symptomatic hyponatremia.
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