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Barajas Galindo DE, Ruiz-Sánchez JG, Fernández Martínez A, de la Vega IR, Ferrer García JC, Ropero-Luis G, Ortolá Buigues A, Serrano Gotarredona J, Gómez Hoyos E. Consensus document on the management of hyponatraemia of the Acqua Group of the Spanish Society of Endocrinology and Nutrition. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 1:7-26. [PMID: 36404266 DOI: 10.1016/j.endien.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/09/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hyponatremia is the most prevalent electrolyte disorder in the outpatient and inpatient settings. Despite this frequency, hyponatremia, including severe hyponatremia, is frequently underestimated and inadequately treated, thus highlighting the need to produce consensus documents and clinical practice guidelines geared towards improving the diagnostic and therapeutic approach to it in a structured fashion. MATERIAL AND METHODS Members of the Acqua Group of the Spanish Society of Endocrinology and Nutrition (SEEN) met using a networking methodology over a period of 20 months (between October 2019 and August 2021) with the aim of discussing and developing an updated guideline for the management of hyponatraemia. A literature search of the available scientific evidence for each section presented in this document was performed. RESULTS A document with 8 sections was produced, which sets out to provide updated guidance on the most clinically relevant questions in the management of hyponatraemia. The management of severe hyponatraemia is based on the i.v. administration of a 3% hypertonic solution. For the management of chronic euvolemic hyponatraemia, algorithms for the initiation of treatment with the two pharmacological therapeutic options currently available in Spain are presented: urea and tolvaptan. CONCLUSIONS This document sets out to simplify the approach to and the treatment of hyponatraemia, making it easier to learn and thus improve the clinical approach to hyponatremia.
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Affiliation(s)
- David E Barajas Galindo
- Sección de Endocrinología y Nutrición, Complejo Asistencial Universitario de León, León, Spain.
| | | | | | | | | | | | - Ana Ortolá Buigues
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Emilia Gómez Hoyos
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Poch E, Molina A, Piñeiro G. Syndrome of inappropriate antidiuretic hormone secretion. Med Clin (Barc) 2022; 159:139-146. [PMID: 35659417 DOI: 10.1016/j.medcli.2022.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 10/18/2022]
Abstract
Hyponatremia is the most frequent electrolytic disorder in hospitalized patients, and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), the most frequent cause of hiponatremia with clinically normal extracellular volume. It consists of a disorder of the regulation of body water that obeys to different causes, mainly cancer, pulmonary illnesses, disorders of the central nervous system and diverse drugs. As in any hiponatremia it a physiological knowledge of the regulation of body water and sodium is essential as well as the application of precise diagnostic criteria in order to manage the problem with an effective treatment. The available data until the moment show that the clinical diagnosis of SIADH made by professionals is mainly not supported on the established criteria drawn by experts and this lack of accuracy probably hits in the therapeutic result. The basis of the treatment of the SIADH is to correct its cause, water restriction, solutes (sodium chloride) and the use of vaptans in case of failure of the previous measures.
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Affiliation(s)
- Esteban Poch
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España; IDIBAPS; Departamento de Medicina, Universidad de Barcelona, Barcelona, España.
| | - Alicia Molina
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España
| | - Gastón Piñeiro
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España
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Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, Decaux G, Fenske W, Hoorn EJ, Ichai C, Joannidis M, Soupart A, Zietse R, Haller M, van der Veer S, van Biesen W, Nagler E, Gonzalez-Espinoza L, Ortiz A. Hyponatraemia diagnosis and treatment clinical practice guidelines. Nefrologia 2017; 37:370-380. [PMID: 28619670 DOI: 10.1016/j.nefro.2017.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 03/16/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022] Open
Abstract
Hyponatremia, defined as a serum sodium concentration <135mmol/l, is the most common water-electrolyte imbalance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from mild to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay. Despite this, the management of hyponatremia patients remains problematic. The prevalence of hyponatremia in a wide variety of conditions and the fact that hyponatremia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and specialty-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed clinical practice guidelines on the diagnostic approach and treatment of hyponatremia as a joint venture of 3societies representing specialists with a natural interest in hyponatremia. In addition to a rigorous approach to the methodology and evaluation of the evidence, the document focuses on patient-positive outcomes and on providing a useful tool for clinicians involved in everyday practice. In this article, we present an abridged version of the recommendations and suggestions for the diagnosis and treatment of hyponatremia extracted from the full guide.
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Affiliation(s)
| | | | | | - Djillali Annane
- Raymond Poincaré Hospital, University of Versailles Saint Quentin, París, Francia
| | - Steve Ball
- Newcastle Hospitals, Newcastle University, Newcastle, Reino Unido
| | - Daniel Bichet
- Sacré-Coeur Hospital, University of Montreal, Montreal (Quebec), Canadá
| | - Guy Decaux
- Erasmus University Hospital, Bruselas, Bélgica
| | | | | | | | | | | | | | | | | | | | - Evi Nagler
- Ghent University Hospital, Ghent, Bélgica
| | - Liliana Gonzalez-Espinoza
- IIS-Fundación Jiménez Díaz, Facultad de Medicina, Universidad Autónoma de Madrid; Fundación Renal Íñigo Álvarez de Toledo-IRSIN y REDINREN, Madrid, España
| | - Alberto Ortiz
- IIS-Fundación Jiménez Díaz, Facultad de Medicina, Universidad Autónoma de Madrid; Fundación Renal Íñigo Álvarez de Toledo-IRSIN y REDINREN, Madrid, España.
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