1
|
Arora I, Juneja H, Bhandekar H, Chandankhede M. Neonatal hypernatremic dehydration in breastfed neonates: a prospective study unmasking the influences of breastfeeding practices and early weight monitoring. J Matern Fetal Neonatal Med 2024; 37:2299568. [PMID: 38151267 DOI: 10.1080/14767058.2023.2299568] [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] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/21/2023] [Indexed: 12/29/2023]
Abstract
Introduction: Hypernatremic dehydration in neonates is an uncommon but serious reason for re-hospitalization, especially in exclusively breastfed neonates. The aim was to study the incidence, associated maternal and neonatal characteristics and risk factors, and presenting features of neonatal hypernatremic dehydration (NHD). Methods: A prospective study design was employed to enroll full-term newborns admitted with serum sodium concentrations of ≥145 mEq/L from April 2022 to March 2023 at a tertiary care rural hospital. Maternal and neonatal characteristics and breastfeeding practices of these mother-baby pairs were recorded and observed. Healthy control for every mother-baby pair was taken. Ethical clearance and informed consent were obtained from mothers. Result: 34 newborns out of total 672 NICU admissions were admitted due to NHD, with an incidence of 4.7%. Primiparous mothers were 23 (67.6%) in the cases and 10 (29.4%) in the control group (p = 0.0017). Disparity in maternal breastfeeding practices of cases, such as delayed initiation time 2.3 h vs. 1.27 h (p < 0.0001), less frequency of breastfeeding 6.5 times vs. 9.3 times (p < 0.0001), and duration of breastfeeding sessions 23.3 min vs. 32 min (p = 0.0014) respectively in cases and controls were found to be potential contributing factors. 61.7% of mothers had breast issues in the cases and 17.6% in the control group (p = 0.0002) with average LATCH score of 4.29 in cases as compared to 8.08 in controls (p < 0.0001) at time of baby's admission to NICU. The average neonatal age at presentation was six days and average weight loss was 11.4% in cases vs. 2.8% in controls (p < 0.0001). The main presenting features were excessive weight loss 30 (88.2%), lethargy 20 (58.8%), jaundice 18 (52.9%) and fever 14 (41.1%). Conclusion: Neonatal hypernatremic dehydration (NHD) poses a significant clinical challenge, particularly in full-term, exclusively breastfed healthy neonates. We found an incidence of 4.7%. Delayed initiation of breastfeeding, inadequate breastfeeding techniques, and maternal breast-related issues were significant contributors to NHD. Primiparous mothers were found to be at higher risk, emphasizing the need for targeted breastfeeding education and support for primiparous mothers. The study reaffirmed the critical role of frequent and effective duration of breastfeeding and daily weight monitoring for preventing NHD.
Collapse
Affiliation(s)
- Ishani Arora
- Department of Pediatrics, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Wardha, India
| | - Hemant Juneja
- Department of Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Wardha, India
| | - Heena Bhandekar
- Department of Pediatrics, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Wardha, India
| | - Manju Chandankhede
- Department of Biochemistry, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Wardha, India
| |
Collapse
|
2
|
Saba L, Hanna C, Creo AL. Updates in hyponatremia and hypernatremia. Curr Opin Pediatr 2024; 36:219-227. [PMID: 38174733 DOI: 10.1097/mop.0000000000001324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Hyponatremia and hypernatremia are commonly encountered electrolyte abnormalities that require timely and careful intervention, as they can be associated with significant morbidity and mortality. RECENT FINDINGS This review article addresses the etiology, presentation, diagnosis, and management of both hyponatremia and hypernatremia, emphasizing the latest advancements and emerging trends in pediatric care. SUMMARY A methodical approach is needed to accurately assess and treat hyponatremia and hypernatremia. Both conditions continue to rely on serum and urine testing, however newer tests such as copeptin and stimulated testing may hold promise to further refine testing in the future.
Collapse
Affiliation(s)
- Leslie Saba
- Department of Pediatric and Adolescent Medicine, Mayo Clinic
| | - Christian Hanna
- Division of Pediatric Nephrology and Hypertension, Department of Pediatric and Adolescent Medicine, Mayo Clinic
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic
| | - Ana L Creo
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
3
|
Kathpal E, Boehm E, Nguyen CS, Vogrin S, Hamblin PS. Systemic and iatrogenic factors contribute to the development of severe hypernatraemia in vulnerable inpatients. Clin Endocrinol (Oxf) 2024; 100:350-357. [PMID: 37807424 DOI: 10.1111/cen.14978] [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: 05/10/2023] [Revised: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES To determine all-cause in-hospital mortality associated with severe hypernatraemia and the causes, comorbidities, time to treatment, discharge destination and postdischarge mortality. DESIGN Retrospective observational cohort study. PATIENTS Severe hypernatraemia, (sodium concentration ≥ 155 mmol/L), at any time during a tertiary hospital admission in Melbourne, Australia, 1 January 2019 to 31 December 2019 (pre-COVID19). MEASUREMENTS Deaths, Charlson Comorbidity Index (CCI), hypernatraemia causes, time to treatment, discharge destination. RESULTS One hundred and one inpatients: 64 community-acquired, 37 hospital-acquired. In-hospital mortality was 38%, but cumulative mortality was 65% by 1 month after discharge, with only a minor further increase at 6 and 12 months. After adjusting for peak sodium concentration, the community acquired group had significantly reduced odds of in-hospital mortality (odds ratio 0.15, 95% confidence interval [0.04-0.54], p = .003). Iatrogenic factors were present in 57% (21/37) of the hospital-acquired group. Only 55% of all cases received active sodium directed treatment. Time to start treatment did not affect outcomes. High levels of comorbidity were present, median CCI (IQR) was 6 (5-8) in the community and 5 (4-7) in the hospital group. Dementia prevalence was higher in the community group, 66% (42/64) versus 19% (7/37) (p = .001). Infection was the most common precipitant with 52% (33/64) in the community and 32% (12/37) in the hospital group. Of the survivors, 32% who had been living independently required residential care after discharge. CONCLUSIONS Mortality was high and loss of independence in survivors common. To potentially improve outcomes, hypernatraemia-specific guidelines should be formulated and efforts made to reduce system and iatrogenic factors.
Collapse
Affiliation(s)
- Esha Kathpal
- Department of Endocrinology & Diabetes, Western Health, Victoria, Australia
| | - Emma Boehm
- Department of Endocrinology & Diabetes, Western Health, Victoria, Australia
| | | | - Sara Vogrin
- Department of Medicine, Western Health, University of Melbourne, Victoria, Australia
| | - Peter S Hamblin
- Department of Endocrinology & Diabetes, Western Health, Victoria, Australia
- Department of Medicine, Western Health, University of Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Miao Y, Fan K, Peng X, Li S, Chen J, Wei Y, Deng Y, Zhao C, Wu Q, Ge M, Gong J, Wu D. Serum sodium level fluctuations following the resection of childhood-onset craniopharyngioma. Brain Behav 2024; 14:e3430. [PMID: 38433103 PMCID: PMC10909694 DOI: 10.1002/brb3.3430] [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: 04/14/2023] [Revised: 12/27/2023] [Accepted: 01/28/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Craniopharyngiomas are low-grade malignancies (WHO I) in the sellar region. Most cases of childhood-onset craniopharyngioma are adamantinomatous craniopharyngioma, and neurosurgery is the treatment of choice. Affected patients have postoperative complications, including water and electrolyte disturbances, because these malignancies develop near the hypothalamus and pituitary gland. Determining postoperative serum sodium fluctuation patterns in these patients can reduce postoperative mortality and improve prognosis. OBJECTIVE To measure changes in serum sodium levels in pediatric patients who underwent craniopharyngioma surgery and identify influencing factors. METHODS This retrospective study measured the serum sodium levels of 202 patients aged 0-18 years who underwent craniopharyngioma resection in Beijing Tiantan Hospital and Beijing Children's Hospital and identified predictors of severe hyponatremia and hypernatremia. RESULTS The mean age of the cohort was 8.35 ± 4.35 years. The prevalence of hypernatremia, hyponatremia, and their severe forms (serum Na+ > 150 mmol/L and serum Na+ < 130 mmol/L) within 14 days after surgery was 66.3%, 72.8%, 37.1%, and 40.6%, respectively. The mean postoperative serum sodium level showed a triphasic pattern, characterized by two peaks separated by a nadir. Sodium levels peaked on days 2 (143.6 ± 7.6 mmol/L) and 14 (143.2 ± 6.7 mmol/L) and reached their lowest on day 6 (135.5 ± 7.5 mmol/L). A total of 31 (15.3%) patients met the diagnostic threshold for hyponatremia and hypernatremia of the triphase response, whereas 116 (57.4%) patients presented this pattern, regardless of met the diagnostic criteria or not. The prevalence of severe hyponatremia varied depending on preoperative endocrine hormone deficiency, tumor status (primary or recurrent), and surgical approach. CONCLUSIONS Serum sodium levels after craniopharyngioma resection in children showed a triphasic pattern in most cases. The risk of postoperative hyponatremia varied depending on preoperative endocrine hormone deficiency, tumor status (primary or recurrent), and surgical approach.
Collapse
Affiliation(s)
- Yuqi Miao
- Department of Endocrinology, Genetics and MetabolismBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
| | - Kaiyu Fan
- Department of Pediatric NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Xiaojiao Peng
- Department of NeurosurgeryBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
| | - Si Li
- State Key Laboratory of Molecular Development BiologyInstitute of Genetics and Developmental Biology, Chinese Academy of SciencesBeijingChina
| | - Jiahui Chen
- Department of Endocrinology, Genetics and MetabolismBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
| | - Yu Wei
- Department of Endocrinology, Genetics and MetabolismBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
| | - Yaxian Deng
- Department of PediatricBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Chengsong Zhao
- Beijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
| | - Qingfeng Wu
- State Key Laboratory of Molecular Development BiologyInstitute of Genetics and Developmental Biology, Chinese Academy of SciencesBeijingChina
- Beijing Key Laboratory for Genetics of Birth DefectsBeijingChina
| | - Ming Ge
- Department of NeurosurgeryBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
| | - Jian Gong
- Department of Pediatric NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Di Wu
- Department of Endocrinology, Genetics and MetabolismBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
- Beijing Key Laboratory for Genetics of Birth DefectsBeijingChina
| |
Collapse
|
5
|
Ye SC, Cheung CC, Lauder E, Grunau B, Moghaddam N, van Diepen S, Holmes DT, Sekhon MS, Christenson J, Tallon JM, Fordyce CB. Association of admission serum sodium and outcomes following out-of-hospital cardiac arrest. Am Heart J 2024; 268:29-36. [PMID: 37992794 DOI: 10.1016/j.ahj.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND The prognostic association between dysnatremia and outcomes in out-of-hospital cardiac arrest (OHCA) is not well understood. Given hypernatremia is associated with poor outcomes in critical illness and hyponatremia may exacerbate cerebral edema, we hypothesized that dysnatremia on OHCA hospital admission would be associated with worse neurological outcomes. METHODS We studied adults (≥19 years) with non-traumatic OHCA between 2009 and 2016 who were enrolled in the British Columbia Cardiac Arrest Registry and survived to hospital admission at 2 quaternary urban hospitals. We stratified cases by admission serum sodium into hyponatremic (<135 mmol/L), normonatremic (135-145 mmol/L), and hypernatremic (>145 mmol/L) groups. We used logistic regression models, adjusted for age, sex, shockable rhythm, admission serum lactate, and witnessed arrest, to estimate the association between admission sodium and favorable neurological outcome (cerebral performance category 1-2 or modified Rankin scale 0-3). RESULTS Of 414 included patients, 63 were hyponatremic, 330 normonatremic, and 21 hypernatremic. In each respective group, 21 (33.3%), 159 (48.2%), and 3 (14.3%) experienced good neurological outcomes. In univariable models, hyponatremia (OR 0.53, 95% CI 0.30-0.93) and hypernatremia (OR 0.19, 95% CI 0.05-0.65) were associated with lower odds of good neurological outcomes compared to the normonatremia group. After adjustment, only hypernatremia was associated with lower odds of good neurological outcomes (OR 0.22, 95% CI 0.05-0.98). CONCLUSIONS Hypernatremia at admission was independently associated with decreased probability of good neurological outcomes at discharge post-OHCA. Future studies should focus on elucidating the pathophysiology of dysnatremia following OHCA.
Collapse
Affiliation(s)
- Si Cong Ye
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher C Cheung
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erik Lauder
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Grunau
- BC Resuscitation Research Collaborative, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; BC Emergency Health Services, Vancouver, British Columbia, Canada
| | - Nima Moghaddam
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean van Diepen
- BC Resuscitation Research Collaborative, British Columbia, Canada; Department of Critical Care and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel T Holmes
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mypinder S Sekhon
- BC Resuscitation Research Collaborative, British Columbia, Canada; Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jim Christenson
- BC Resuscitation Research Collaborative, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John M Tallon
- BC Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; BC Emergency Health Services, Vancouver, British Columbia, Canada
| | - Christopher B Fordyce
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.
| |
Collapse
|
6
|
Yang T, Wu W, Liu X, Xiang B, Sun Q, Zhang S, Zhuang Y, Yin Z, Zhang Q, Cao Y, Ye H. Clinical Characteristics of Adipsic Diabetes Insipidus. Endocr Pract 2024; 30:141-145. [PMID: 38029928 DOI: 10.1016/j.eprac.2023.11.012] [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: 10/05/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE Adipsic diabetes insipidus (ADI) is a life-threatening disease. It is characterized by arginine vasopressin deficiency and thirst absence. Data about clinical characteristics of ADI were scarce. This study investigated the clinical features of hospitalized ADI patients. METHODS A retrospective study was conducted of hospitalized ADI patients admitted to the Endocrinology Department of Huashan Hospital between January 2014 and December 2021, and compared with central diabetes insipidus (CDI) patients with normal thirst. RESULTS During the study period, there were a total of 507 hospitalized CDI patients, among which 50 cases were ADI, accounting for 9.9%. Forty percent of ADI patients were admitted due to hypernatremia, but there were no admissions due to hypernatremia in the control group. The lesions of ADI patients were more likely to be located in the suprasellar area (100% vs 66%, P < .05). Higher prevalence of hypothalamic dysfunction (76% vs 8%, P < .001), central hypothyroidism (100% vs 90%, P = .031), hyperglycemia (66% vs 32%, P < .001), dyslipidemia (92% vs 71%, P = .006), and hyperuricemia (64% vs 37%, P = .003) was found in the ADI group than in the control group. The proportions of hypernatremia were higher in the ADI group both at admission and at discharge (90% vs 8%, 68% vs 8%, respectively, both with P < .001), contributing to higher prevalence of complications, such as renal insufficiency, venous thrombosis, and infection. CONCLUSION ADI patients were found with higher prevalence of hypernatremia, hypopituitarism, hypothalamic dysfunction, metabolic disorders, and complications, posing a great challenge for comprehensive management.
Collapse
Affiliation(s)
- Tingjun Yang
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China; School of Nursing, Fudan University, Shanghai, China
| | - Wei Wu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoyu Liu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China; School of Life Sciences, Fudan University, Shanghai, China; College of Life Science, Inner Mongolia University, Inner Mongolia, China
| | - Boni Xiang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Quanya Sun
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuo Zhang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuan Zhuang
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhiwen Yin
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiongyue Zhang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China.
| | - Yanpei Cao
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China.
| | - Hongying Ye
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
7
|
Chia TM, O'Neill H, Sohail HM, Nagi D. The impact of hyponatraemia and hypernatremia on severity and clinical outcomes of acute acquired pneumonia. Ir Med J 2024; 117:899. [PMID: 38260969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
|
8
|
Tudor RM, Sherlock M, Thompson C. Recurrent severe hypernatraemia in a young patient: a disconnect between osmoreceptor function and drinking behaviour. BMJ Case Rep 2024; 17:e255377. [PMID: 38191224 PMCID: PMC10806951 DOI: 10.1136/bcr-2023-255377] [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] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
Chronic hypernatraemia is a rare clinical entity. In the younger population, hypernatraemia is often a consequence of failure to generate thirst in response to osmotic stimuli.We report the case of a male patient admitted with severe hypernatraemia (plasma sodium 175 mmol/L) on return from holidays. His urine was maximally concentrated at 894 mOsm/kg-suggestive of normal vasopressin reserve. MRI of the brain showed a large extra-axial cyst, with preservation of the posterior pituitary bright spot. Formal osmoregulatory studies demonstrated normal osmoregulated vasopressin secretion and normal thirst, but no appropriate drinking behaviour.This patient illustrates a unique pathophysiological disconnect between thirst appreciation and the central drive to drink, in the context of normal osmoregulatory function. It is likely that this disconnect is related to the patient's large intracranial cyst.The management challenge is to maintain appropriate fluid intake in order to prevent recurrent severe hypernatraemia.
Collapse
Affiliation(s)
- Roxana Maria Tudor
- Academic Department of Endocrinology and Diabetes, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mark Sherlock
- Academic Department of Endocrinology and Diabetes, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chris Thompson
- Academic Department of Endocrinology and Diabetes, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
9
|
Shenoy S, Bockenhauer D. Challenges in using fractional excretion of sodium in the assessment of salt poisoning. Acta Paediatr 2024; 113:150-154. [PMID: 36853022 DOI: 10.1111/apa.16734] [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: 12/22/2022] [Revised: 02/02/2023] [Accepted: 02/27/2023] [Indexed: 03/01/2023]
Abstract
AIM Hypernatraemia typically reflects dehydration, yet in rare instances may be caused by salt poisoning. Identifying these rare cases is a difficult challenge. Making the diagnosis of salt poisoning can have severe consequences, such as the removal of the child from its home or even prison sentences for the implicated carer. It is therefore imperative to get the diagnosis right. Guidelines for the assessment of hypernatraemia emphasise the importance of the fractional excretion of sodium to distinguish between dehydration and salt poisoning, but no generally accepted cut-off value exists. Opinions about the diagnosis of salt poisoning in some cases consequently may differ. Here, we aim to highlight the challenges and stimulate discussion on how to improve the tools for the assessment of hypernatraemia. METHODS Report of a case of unexplained hypernatraemia in which the treating paediatrician raised the suspicion of salt poisoning. RESULTS Two consulted experts made opposing judgements about the aetiology of the observed hypernatraemia. CONCLUSION Clear diagnostic criteria for the diagnosis of salt poisoning are lacking and more data are needed for their establishment. Without this, victims may experience further harm and carers are at risk of devastating, yet potentially erroneous accusations.
Collapse
Affiliation(s)
- Savitha Shenoy
- Department of General Paediatrics and Endocrinology, Leicester Children's Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Detlef Bockenhauer
- UCL Department of Renal Medicine, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| |
Collapse
|
10
|
Tagan G, Benmachiche M. [Hypernatremia in hospital]. Rev Med Suisse 2023; 19:2189-2192. [PMID: 37994597 DOI: 10.53738/revmed.2023.19.851.2189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Hypernatremia, defined as a serum sodium concentration greater than 145 mmol/l, is an electrolyte disorder associated with increased in-hospital morbidity and mortality. Its prevalence is estimated between 1 to 3% in hospitalized patients and up to 11% in intensive care. It most often results from an impaired thirst mechanism or the inability to access water to drink. The clinical presentation varies depending on the severity of the hypernatremia. Patients may be pauci-symptomatic to comatose. Correcting too quickly the hypernatremia can lead to serious consequences (cerebral hemorrhage, demyelination). Prevention of the onset of hypernatremia is essential in the hospital. Its management consists of treating the underlying cause and correcting the hyperosmolarity by ensuring close monitoring of the sodium level.
Collapse
Affiliation(s)
- Géraldine Tagan
- Service de médecine interne, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Malik Benmachiche
- Service de médecine interne, Centre hospitalier universitaire vaudois, 1011 Lausanne
| |
Collapse
|
11
|
de Haan L, Ten Wolde M, Beudel M, Olde Engberink RHG, Appelman B, Haspels-Hogervorst EK, Rusch D, Gritters van den Oever NC, Simsek S, Paternotte N, van den Bergh JP, Wyers CE, de Kruif MD, Dormans T, Moeniralam H, Bokhizzou N, Brinkman K, Douma R. What is the aetiology of dysnatraemia in COVID-19 and how is this related to outcomes in patients admitted during earlier and later COVID-19 waves? A multicentre, retrospective observational study in 11 Dutch hospitals. BMJ Open 2023; 13:e075232. [PMID: 37963704 PMCID: PMC10649520 DOI: 10.1136/bmjopen-2023-075232] [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: 05/08/2023] [Accepted: 09/15/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES To evaluate the relationship among dysnatraemia at hospital presentation and duration of admission, risk of intensive care unit (ICU) admission and all-cause mortality and to assess the underlying pathophysiological mechanism of hyponatraemia in patients with COVID-19. Our hypothesis is that both hyponatraemia and hypernatraemia at presentation are associated with adverse outcomes. DESIGN Observational study. SETTING Secondary care; 11 Dutch hospitals (2 university and 9 general hospitals). PARTICIPANTS An analysis was performed within the retrospective multicentre cohort study COVIDPredict. 7811 patients were included (60% men, 40% women) between 24 February 2020 and 9 August 2022. Patients who were ≥18 years with PCR-confirmed COVID-19 or CT with COVID-19 reporting and data system score≥4 and alternative diagnosis were included. Patients were excluded when serum sodium levels at presentation were not registered in the database or when they had been transferred from another participating hospital. OUTCOME MEASURES We studied demographics, medical history, symptoms and outcomes. Patients were stratified according to serum sodium concentration and urinary sodium excretion. RESULTS Hyponatraemia was present in 2677 (34.2%) patients and hypernatraemia in 126 (1.6%) patients. Patients with hyponatraemia presented more frequently with diarrhoea, lower blood pressure and tachycardia. Hyponatraemia was, despite a higher risk for ICU admission (OR 1.27 (1.11-1.46; p<0.001)), not associated with mortality or the risk for intubation. Patients with hypernatraemia had higher mortality rates (OR 2.25 (1.49-3.41; p<0.001)) and were at risk for ICU admission (OR 2.89 (1.83-4.58)) and intubation (OR 2.95 (1.83-4.74)). CONCLUSIONS Hypernatraemia at presentation was associated with adverse outcomes in patients with COVID-19. Hypovolaemic hyponatraemia was found to be the most common aetiology of hyponatraemia. Hyponatraemia of unknown aetiology was associated with a higher risk for ICU admission and intubation and longer duration of admission.
Collapse
Affiliation(s)
- Lianne de Haan
- Department of Internal Medicine, Flevo Hospital, Almere, The Netherlands
- Department of Internal Medicine, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - Marije Ten Wolde
- Department of Internal Medicine, Flevo Hospital, Almere, The Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Rik H G Olde Engberink
- Center of Experimental and Molecular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Brent Appelman
- Center of Experimental and Molecular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | - Daisy Rusch
- Department of Intensive Care, Martini Hospital, Groningen, The Netherlands
| | | | - Suat Simsek
- Department of Internal Medicine, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - Nienke Paternotte
- Department of Pulmonology, Northwest Hospital Group, Alkmaar, The Netherlands
| | | | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Martijn D de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Tom Dormans
- Department of Intensive Care, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Hazra Moeniralam
- Department of Internal Medicine, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Neyma Bokhizzou
- Department of Internal Medicine, Bovenij Hospital, Amsterdam, The Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
| | - Renee Douma
- Department of Internal Medicine, Flevo Hospital, Almere, The Netherlands
| |
Collapse
|
12
|
Miller NE, Rushlow D, Stacey SK. Diagnosis and Management of Sodium Disorders: Hyponatremia and Hypernatremia. Am Fam Physician 2023; 108:476-486. [PMID: 37983699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Hyponatremia and hypernatremia are electrolyte disorders that can be associated with poor outcomes. Hyponatremia is considered mild when the sodium concentration is 130 to 134 mEq per L, moderate when 125 to 129 mEq per L, and severe when less than 125 mEq per L. Mild symptoms include nausea, vomiting, weakness, headache, and mild neurocognitive deficits. Severe symptoms of hyponatremia include delirium, confusion, impaired consciousness, ataxia, seizures, and, rarely, brain herniation and death. Patients with a sodium concentration of less than 125 mEq per L and severe symptoms require emergency infusions with 3% hypertonic saline. Using calculators to guide fluid replacement helps avoid overly rapid correction of sodium concentration, which can cause osmotic demyelination syndrome. Physicians should identify the cause of a patient's hyponatremia, if possible; however, treatment should not be delayed while a diagnosis is pursued. Common causes include certain medications, excessive alcohol consumption, very low-salt diets, and excessive free water intake during exercise. Management to correct sodium concentration is based on whether the patient is hypovolemic, euvolemic, or hypervolemic. Hypovolemic hyponatremia is treated with normal saline infusions. Treating euvolemic hyponatremia includes restricting free water consumption or using salt tablets or intravenous vaptans. Hypervolemic hyponatremia is treated primarily by managing the underlying cause (e.g., heart failure, cirrhosis) and free water restriction. Hypernatremia is less common than hyponatremia. Mild hypernatremia is often caused by dehydration resulting from an impaired thirst mechanism or lack of access to water; however, other causes, such as diabetes insipidus, are possible. Treatment starts with addressing the underlying etiology and correcting the fluid deficit. When sodium is severely elevated, patients are symptomatic, or intravenous fluids are required, hypotonic fluid replacement is necessary.
Collapse
Affiliation(s)
| | | | - Stephen K Stacey
- La Crosse-Mayo Family Medicine Residency, Mayo Clinic Health System, La Crosse, Wisconsin
| |
Collapse
|
13
|
Abstract
Sodium imbalances are a common occurrence in the emergency department. Although recognition and diagnosis are relatively straightforward, discovering the cause and management should be approached systematically. The most important history items to ascertain is if the patient has symptoms and how long this imbalance has taken to develop. Treatment rapidity depends on severity of symptoms with the most rapid treatment occurring in only the severely symptomatic. Overcorrection has dire consequences and must be approached in a careful and systematic fashion in order to prevent these devastating consequences.
Collapse
Affiliation(s)
- Aaron Alindogan
- Department of Emergency Medicine, UTHSCSA, Floyd Curl Drive, MC 7736, San Antonio, TX 78229, USA
| | - Ryan Joseph
- Department of Emergency Medicine, UTHSCSA, Floyd Curl Drive, MC 7736, San Antonio, TX 78229, USA.
| |
Collapse
|
14
|
Diller N, Osborn DA, Birch P. Higher versus lower sodium intake for preterm infants. Cochrane Database Syst Rev 2023; 10:CD012642. [PMID: 37824273 PMCID: PMC10569379 DOI: 10.1002/14651858.cd012642.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Infants born preterm are at increased risk of early hypernatraemia (above-normal blood sodium levels) and late hyponatraemia (below-normal blood sodium levels). There are concerns that imbalances of sodium intake may impact neonatal morbidities, growth and developmental outcomes. OBJECTIVES To determine the effects of higher versus lower sodium supplementation in preterm infants. SEARCH METHODS We searched CENTRAL in February 2023; and MEDLINE, Embase and trials registries in March and April 2022. We checked reference lists of included studies and systematic reviews where subject matter related to the intervention or population examined in this review. We compared early (< 7 days following birth), late (≥ 7 days following birth), and early and late sodium supplementation, separately. SELECTION CRITERIA We included randomised, quasi-randomised or cluster-randomised controlled trials that compared nutritional supplementation that included higher versus lower sodium supplementation in parenteral or enteral intake, or both. Eligible participants were preterm infants born before 37 weeks' gestational age or with a birth weight less than 2500 grams, or both. We excluded studies that had prespecified differential water intakes between groups. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility and risk of bias, and extracted data. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included nine studies in total. However, we were unable to extract data from one study (20 infants); some studies contributed to more than one comparison. Eight studies (241 infants) were available for quantitative meta-analysis. Four studies (103 infants) compared early higher versus lower sodium intake, and four studies (138 infants) compared late higher versus lower sodium intake. Two studies (103 infants) compared intermediate sodium supplementation (≥ 3 mmol/kg/day to < 5 mmol/kg/day) versus no supplementation, and two studies (52 infants) compared higher sodium supplementation (≥ 5 mmol/kg/day) versus no supplementation. We assessed only two studies (63 infants) as low risk of bias. Early (less than seven days following birth) higher versus lower sodium intake Early higher versus lower sodium intake may not affect mortality (risk ratio (RR) 1.02, 95% confidence interval (CI) 0.38 to 2.72; I2 = 0%; 3 studies, 83 infants; low-certainty evidence). Neurodevelopmental follow-up was not reported. Early higher versus lower sodium intake may lead to a similar incidence of hyponatraemia < 130 mmol/L (RR 0.68, 95% CI 0.40 to 1.13; I2 = 0%; 3 studies, 83 infants; low-certainty evidence) but an increased incidence of hypernatraemia ≥ 150 mmol/L (RR 1.62, 95% CI 1.00 to 2.65; I2 = 0%; 4 studies, 103 infants; risk difference (RD) 0.17, 95% CI 0.01 to 0.34; number needed to treat for an additional harmful outcome 6, 95% CI 3 to 100; low-certainty evidence). Postnatal growth failure was not reported. The evidence is uncertain for an effect on necrotising enterocolitis (RR 4.60, 95% CI 0.23 to 90.84; 1 study, 46 infants; very low-certainty evidence). Chronic lung disease at 36 weeks was not reported. Late (seven days or more following birth) higher versus lower sodium intake Late higher versus lower sodium intake may not affect mortality (RR 0.13, 95% CI 0.01 to 2.20; 1 study, 49 infants; very low-certainty evidence). Neurodevelopmental follow-up was not reported. Late higher versus lower sodium intake may reduce the incidence of hyponatraemia < 130 mmol/L (RR 0.13, 95% CI 0.03 to 0.50; I2 = 0%; 2 studies, 69 infants; RD -0.42, 95% CI -0.59 to -0.24; number needed to treat for an additional beneficial outcome 2, 95% CI 2 to 4; low-certainty evidence). The evidence is uncertain for an effect on hypernatraemia ≥ 150 mmol/L (RR 7.88, 95% CI 0.43 to 144.81; I2 = 0%; 2 studies, 69 infants; very low-certainty evidence). A single small study reported that later higher versus lower sodium intake may reduce the incidence of postnatal growth failure (RR 0.25, 95% CI 0.09 to 0.69; 1 study; 29 infants; low-certainty evidence). The evidence is uncertain for an effect on necrotising enterocolitis (RR 0.07, 95% CI 0.00 to 1.25; 1 study, 49 infants; very low-certainty evidence) and chronic lung disease (RR 2.03, 95% CI 0.80 to 5.20; 1 study, 49 infants; very low-certainty evidence). Early and late (day 1 to 28 after birth) higher versus lower sodium intake for preterm infants Early and late higher versus lower sodium intake may not have an effect on hypernatraemia ≥ 150 mmol/L (RR 2.50, 95% CI 0.63 to 10.00; 1 study, 20 infants; very low-certainty evidence). No other outcomes were reported. AUTHORS' CONCLUSIONS Early (< 7 days following birth) higher sodium supplementation may result in an increased incidence of hypernatraemia and may result in a similar incidence of hyponatraemia compared to lower supplementation. We are uncertain if there are any effects on mortality or neonatal morbidity. Growth and longer-term development outcomes were largely unreported in trials of early sodium supplementation. Late (≥ 7 days following birth) higher sodium supplementation may reduce the incidence of hyponatraemia. We are uncertain if late higher intake affects the incidence of hypernatraemia compared to lower supplementation. Late higher sodium intake may reduce postnatal growth failure. We are uncertain if late higher sodium intake affects mortality, other neonatal morbidities or longer-term development. We are uncertain if early and late higher versus lower sodium supplementation affects outcomes.
Collapse
Affiliation(s)
- Natasha Diller
- Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia
| | - David A Osborn
- Central Clinical School, School of Medicine, The University of Sydney, Sydney, Australia
| | - Pita Birch
- Department of Neonatology, Mater Mother's Hospitals South Brisbane, Brisbane, Australia
| |
Collapse
|
15
|
Kruse SM, Fine AL, Gregory SW. Abnormal Eye Movements and Hypernatremia in a 4-month-old Girl. Pediatr Rev 2023; 44:S44-S47. [PMID: 37777236 DOI: 10.1542/pir.2021-005012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Sarah M Kruse
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | | | - Seth W Gregory
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
16
|
Abstract
BACKGROUND Dysnatremia occurs commonly in patients with aneurysmal subarachnoid hemorrhage (aSAH). The mechanisms for development of sodium dyshomeostasis are complex, including the cerebral salt-wasting syndrome, the syndrome of inappropriate secretion of antidiuretic hormone, diabetes insipidus. Iatrogenic occurrence of altered sodium levels plays a role, as sodium homeostasis is tightly linked to fluid and volume management. METHODS Narrative review of the literature. RESULTS Many studies have aimed to identify factors predictive of the development of dysnatremia, but data on associations between dysnatremia and demographic and clinical variables are variable. Furthermore, although a clear relationship between serum sodium serum concentrations and outcomes has not been established-poor outcomes have been associated with both hyponatremia and hypernatremia in the immediate period following aSAH and set the basis for seeking interventions to correct dysnatremia. While sodium supplementation and mineralocorticoids are frequently administered to prevent or counter natriuresis and hyponatremia, evidence to date is insufficient to gauge the effect of such treatment on outcomes. CONCLUSIONS In this article, we reviewed available data and provide a practical interpretation of these data as a complement to the newly issued guidelines for management of aSAH. Gaps in knowledge and future directions are discussed.
Collapse
Affiliation(s)
- Katharina M Busl
- Departments of Neurology and Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA.
| | | |
Collapse
|
17
|
Kronborg JR, Lindhardt RB, Vejlstrup N, Holst LM, Juul K, Smerup MH, Gjedsted J, Ravn HB. Postoperative free water administration is associated with dysnatremia after congenital heart disease surgery in infants. Acta Anaesthesiol Scand 2023; 67:730-737. [PMID: 36866603 DOI: 10.1111/aas.14223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 03/04/2023]
Abstract
Dysnatremia after congenital heart disease (CHD) surgery is common. European guidelines on intraoperative fluid therapy in children recommend isotonic solutions to avoid hyponatremia, but prolonged cardiopulmonary bypass and administration of high sodium-containing solutions (i.e., blood products and sodium bicarbonate) are associated with postoperative hypernatremia. The aim of the study was to describe fluid composition prior to and during the development of postoperative dysnatremia. A retrospective observational, single-center study including infants undergoing CHD surgery. Demographics and clinical characteristics were registered. Highest and lowest plasma sodium values were recorded and associations with perioperative fluid administration, blood products, crystalloids, and colloids were explored in relation to three perioperative periods. Postoperative dysnatremia occurred in nearly 50% of infants within 48 h after surgery. Hypernatremia was mainly associated with administration of blood products (median [IQR]: 50.5 [28.4-95.5] vs. 34.5 [18.5-61.1] mL/kg; p = 0.001), and lower free water load (1.6 [1.1-2.2] mL/kg/h; p = 0.01). Hyponatremia was associated with a higher free water load (2.3 [1.7-3.3] vs. 1.8 [1.4-2.5] mL/kg/h; p = 0.001) and positive fluid balance. On postoperative day 1, hyponatremia was associated with higher volumes of free water (2.0 [1.5-2.8] vs. 1.3 [1.1-1.8] mL/kg/h; p < 0.001) and human albumin, despite a larger diuresis and more negative daily fluid balance. Postoperative hyponatremia occurred in 30% of infants despite restrictive volumes of hypotonic maintenance fluid, whereas hypernatremia was mainly associated with blood product transfusion. Individualized fluid therapy, with continuous reassessment to reduce the occurrence of postoperative dysnatremia is mandatory in pediatric cardiac surgery. Prospective studies to evaluate fluid therapy in pediatric cardiac surgery patients are warranted.
Collapse
Affiliation(s)
- Jonas Rønne Kronborg
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Bo Lindhardt
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Line Marie Holst
- Department of Pediatrics, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Klaus Juul
- Department of Pediatric Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Holdgaard Smerup
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Gjedsted
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Berg Ravn
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
18
|
Abstract
BACKGROUND In children with hypernatremia, current clinical guidelines recommend a reduction in serum sodium of 0.5 mmol/L per hour or less to avoid complications of cerebral edema. However, no large-scale studies have been conducted in the pediatric setting to inform this recommendation. Therefore, this study aimed to report the association between the rate of correction of hypernatremia, neurological outcomes, and all-cause mortality in children. METHODS A retrospective cohort study was conducted from 2016 to 2019 at a quaternary pediatric center in Melbourne, Victoria, Australia. All children with at least one serum sodium level ≥150 mmol/L were identified through interrogation of the hospital's electronic medical record. Medical notes, neuroimaging reports, and electroencephalogram results were reviewed for evidence of seizures and/or cerebral edema. The peak serum sodium level was identified and correction rates over the first 24 hours and overall were calculated. Unadjusted and multivariable analyses were used to examine the association between the rate of sodium correction and neurological complications, the requirement for neurological investigation, and death. RESULTS There were 402 episodes of hypernatremia among 358 children over the 3-year study period. Of these, 179 were community-acquired and 223 developed during admission. A total of 28 patients (7%) died during admission. Mortality was higher in children with hospital-acquired hypernatremia, as was the frequency of intensive care unit admission and hospital length of stay. Rapid correction (>0.5 mmol/L per hour) occurred in 200 children and was not associated with greater neurological investigation or mortality. Length of stay was longer in children who received slow correction (<0.5 mmol/L per hour). CONCLUSIONS Our study did not find any evidence that rapid sodium correction was associated with greater neurological investigation, cerebral edema, seizures, or mortality; however, slow correction was associated with a longer hospital length of stay.
Collapse
Affiliation(s)
- Madeleine Didsbury
- Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Centre for Health Analytics The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Emily J. See
- Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Centre for Health Analytics The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia
- School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Daryl R. Cheng
- Centre for Health Analytics The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of General Medicine and EMR Team, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Joshua Kausman
- Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Centre for Health Analytics The Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Catherine Quinlan
- Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Centre for Health Analytics The Royal Children's Hospital, Melbourne, Victoria, Australia
- School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
19
|
Association of hypernatremia with outcomes of COVID-19 patients: A systematic review and meta-analysis: Erratum. Medicine (Baltimore) 2023; 102:e32723. [PMID: 36701740 DOI: 10.1097/MD.0000000000032723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
|
20
|
Lee MS. The authors reply: hypernatremia as a risk factor in OHCA neurological prognostification. Am J Emerg Med 2023; 63:163. [PMID: 36266212 DOI: 10.1016/j.ajem.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 12/05/2022] Open
Affiliation(s)
- Min Sung Lee
- Artificial Intelligence and Big Data Research Center, Sejong Medical Research Institute; Medical AI, Inc., Seoul, Republic of Korea; Mediplex Sejong Hospital, Republic of Korea.
| |
Collapse
|
21
|
del Rio J, Buess M. Outcome of Hospitalized Cancer Patients with Hypernatremia: A Retrospective Case-Control Study. Curr Oncol 2022; 29:8814-8824. [PMID: 36421346 PMCID: PMC9689174 DOI: 10.3390/curroncol29110693] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/08/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
Hypernatremia (>145 mmol/L) is a relatively rare event, and the data regarding its role in the outcome of inpatients on an oncology ward are weak. The aim of this study was to describe the prevalence, prognosis, and outcome of hospitalized cancer patients with hypernatremia. We performed a retrospective case-control study of data obtained from inpatients with a solid tumor at the St. Claraspital, Basel, Switzerland, who were admitted between 2017 and 2020. The primary endpoint was overall survival. Hypernatremia was found in 93 (3.16%) of 2945 inpatients bearing cancer or lymphoma. From 991 eligible normonatremic control patients, 93 were matched according to diagnosis, age, and sex. The median overall survival time (OS) of patients with hypernatremia was 1.5 months compared to 11.7 months of the normonatremic controls (HR 2.69, 95% CI 1.85-3.90, p < 0.0001). OS of patients with irreversible compared to reversible hypernatremia was significantly shorter (23 versus 88 days, HR 4.0, 95% CI 2.04-7.70, p < 0.0001). The length of hospital stay was significantly longer for the hypernatremic than for the normonatremic group (p < 0.0001). Significantly more patients with hypernatremia died in the hospital (30.1% versus 8.6%, p < 0.001). These results suggest hypernatremia to be associated with an unfavorable outcome and a very short OS.
Collapse
Affiliation(s)
- Jessica del Rio
- Faculty of Medicine, Basel University, 4001 Basel, Switzerland
| | - Martin Buess
- Faculty of Medicine, Medical Oncology, St. Claraspital and Basel University, 4001 Basel, Switzerland
- Correspondence:
| |
Collapse
|
22
|
Ravioli S, Rohn V, Lindner G. Hypernatremia at presentation to the emergency department: a case series. Intern Emerg Med 2022; 17:2323-2328. [PMID: 36114318 PMCID: PMC9483287 DOI: 10.1007/s11739-022-03097-4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 09/02/2022] [Indexed: 11/20/2022]
Abstract
Disorders of serum sodium are common findings in patients presenting to the emergency department (ED). The aim of this study was to systematically investigate the prevalence, symptoms, etiology, treatment as well as the course of hypernatremia present on admission to the ED. All adult patients with measurements of serum sodium presenting to the ED between 01 January 2017 and 31 December 2020 were included in this retrospective cohort study. Chart reviews were performed for all patients with hypernatremia defined as serum sodium > 147 mmol/L. 376 patients (0.7%) had a serum sodium > 145 mmol/L on admission and 109 patients (0.2%) had clinically relevant hypernatremia > 147 mmol/L. Main symptoms included somnolence (42%) followed by disorientation (30%) and recent falls (17%). An impaired sense of thirst was the main cause of hypernatremia as present in 76 patients (70%), followed by a lack of free access to water in 50 patients (46%). Regarding treatment, only one patient received targeted oral hydration and 38 patients (35%) experienced inadequate correction of hypernatremia as defined as either a correction of < 2 mmol/L or further increasing sodium during the first 24 h. 25% of patients with hypernatremia died during the course of their hospital stay. Patients who died had significantly lower correction rates of serum sodium (0 mmol/L (-3 - 1.5) versus - 6 mmol/L (-10 - 0), p < 0.001). Hypernatremia is regularly encountered in the ED and patients present with unspecific neurologic symptoms. Initial treatment and correction of hypernatremia are frequently inadequate with no decrease or even increase in serum sodium during the first 24 h.
Collapse
Affiliation(s)
- Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Schoengruenstrasse 42, 4500, Solothurn, Switzerland.
| | - Vanessa Rohn
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Schoengruenstrasse 42, 4500, Solothurn, Switzerland
| | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Schoengruenstrasse 42, 4500, Solothurn, Switzerland
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| |
Collapse
|
23
|
Abraham VM, Booth G, Geiger P, Balazs GC, Goldman A. Machine-learning Models Predict 30-Day Mortality, Cardiovascular Complications, and Respiratory Complications After Aseptic Revision Total Joint Arthroplasty. Clin Orthop Relat Res 2022; 480:2137-2145. [PMID: 35767804 PMCID: PMC9555902 DOI: 10.1097/corr.0000000000002276] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/20/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Aseptic revision THA and TKA are associated with an increased risk of adverse outcomes compared with primary THA and TKA. Understanding the risk profiles for patients undergoing aseptic revision THA or TKA may provide an opportunity to decrease the risk of postsurgical complications. There are risk stratification tools for postoperative complications after aseptic revision TKA or THA; however, current tools only include nonmodifiable risk factors, such as medical comorbidities, and do not include modifiable risk factors. QUESTIONS/PURPOSES (1) Can machine learning predict 30-day mortality and complications for patients undergoing aseptic revision THA or TKA using a cohort from the American College of Surgeons National Surgical Quality Improvement Program database? (2) Which patient variables are the most relevant in predicting complications? METHODS This was a temporally validated, retrospective study analyzing the 2014 to 2019 National Surgical Quality Improvement Program database, as this database captures a large cohort of aseptic revision THA and TKA patients across a broad range of clinical settings and includes preoperative laboratory values. The training data set was 2014 to 2018, and 2019 was the validation data set. Given that predictive models learn expected prevalence of outcomes, this split allows assessment of model performance in contemporary patients. Between 2014 and 2019, a total of 24,682 patients underwent aseptic revision TKA and 17,871 patients underwent aseptic revision THA. Of those, patients with CPT codes corresponding to aseptic revision TKA or THA were considered as potentially eligible. Based on excluding procedures involving unclean wounds, 78% (19,345 of 24,682) of aseptic revision TKA procedures and 82% (14,711 of 17,871) of aseptic revision THA procedures were eligible. Ten percent of patients in each of the training and validation cohorts had missing predictor variables. Most of these missing data were preoperative sodium or hematocrit (8% in both the training and validation cohorts). No patients had missing outcome data. No patients were excluded due to missing data. The mean patient was age 66 ± 12 years, the mean BMI was 32 ± 7 kg/m 2 , and the mean American Society of Anesthesiologists (ASA) Physical Score was 3 (56%). XGBoost was then used to create a scoring tool for 30-day adverse outcomes. XGBoost was chosen because it can handle missing data, it is nonlinear, it can assess nuanced relationships between variables, it incorporates techniques to reduce model complexity, and it has a demonstrated record of producing highly accurate machine-learning models. Performance metrics included discrimination and calibration. Discrimination was assessed by c-statistics, which describe the area under the receiver operating characteristic curve. This quantifies how well a predictive model discriminates between patients who have the outcome of interest versus those who do not. Relevant ranges for c-statistics include good (0.70 to 0.79), excellent (0.80 to 0.89), and outstanding (> 0.90). We estimated 95% confidence intervals (CIs) for c-statistics by 500-sample bootstrapping. Calibration curves quantify reliability of model predictions. Reliable models produce prediction probabilities for outcomes that are similar to observed probabilities of those outcomes, so a well-calibrated model should demonstrate a calibration curve that does not deviate substantially from a line of slope 1 and intercept 0. Calibration curves were generated on the 2019 validation data. Shapley Additive Explanations (SHAP) visualizations were used to investigate feature importance to gain insight into how models made predictions. The models were built into an online calculator for ongoing testing and validation. The risk calculator, which is freely available ( http://nb-group.org/rev2/ ), allows a user to input patient data to calculate postoperative risk of 30-day mortality, cardiac, and respiratory complications after aseptic revision TKA or THA. A post hoc analysis was performed to assess whether using data from 2020 would improve calibration on 2019 data. RESULTS The model accurately predicted mortality, cardiac complications, and respiratory complications after aseptic revision THA or TKA, with c-statistics of 0.88 (95% CI 0.83 to 0.93), 0.80 (95% CI 0.75 to 0.84), and 0.78 (95% CI 0.74 to 0.82), respectively, on internal validation and 0.87 (95% CI 0.77 to 0.96), 0.70 (95% CI 0.61 to 0.78), and 0.82 (95% CI 0.75 to 0.88), respectively, on temporal validation. Calibration curves demonstrated slight over-confidence in predictions (most predicted probabilities were higher than observed probabilities). Post hoc analysis of 2020 data did not yield improved calibration on the 2019 validation set. Important risk factors for all models included increased age and higher ASA, BMI, hematocrit level, and sodium level. Hematocrit and ASA were in the top three most important features for all models. The factor with the strongest association for mortality and cardiac complication models was age, and for the respiratory model, chronic obstructive pulmonary disease. Risk related to sodium followed a U-shaped curve. Preoperative hyponatremia and hypernatremia predicted an increased risk of mortality and respiratory complications, with a nadir of 138 mmol/L; hyponatremia was more strongly associated with mortality than hypernatremia. A hematocrit level less than 36% predicted an increased risk of all three adverse outcomes. A BMI less than 24 kg/m 2 -and especially less than 20 kg/m 2 -predicted an increased risk of all three adverse outcomes, with little to no effect for higher BMI. CONCLUSION This temporally validated model predicted 30-day mortality, cardiac complications, and respiratory complications after aseptic revision THA or TKA with c-statistics ranging from 0.78 to 0.88. This freely available risk calculator can be used preoperatively by surgeons to educate patients on their individual postoperative risk of these specific adverse outcomes. Unanswered questions that remain include whether altering the studied preoperative patient variables, such as sodium or hematocrit, would affect postoperative risk of adverse outcomes; however, a prospective cohort study is needed to answer this question. LEVEL OF EVIDENCE Level III, therapeutic study.
Collapse
Affiliation(s)
- Vivek Mathew Abraham
- Department of Orthopaedic Surgery, Bone and Joint Sports Medicine Center, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Greg Booth
- Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, USA
- Naval Biotechnology Group, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Phillip Geiger
- Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, USA
- Naval Biotechnology Group, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - George Christian Balazs
- Department of Orthopaedic Surgery, Bone and Joint Sports Medicine Center, Naval Medical Center Portsmouth, Portsmouth, VA, USA
- Uniformed University of the Health Sciences, Bethesda, MD, USA
| | - Ashton Goldman
- Department of Orthopaedic Surgery, Bone and Joint Sports Medicine Center, Naval Medical Center Portsmouth, Portsmouth, VA, USA
- Uniformed University of the Health Sciences, Bethesda, MD, USA
| |
Collapse
|
24
|
Nakamura-Utsunomiya A. Autoimmunity Related to Adipsic Hypernatremia and ROHHAD Syndrome. Int J Mol Sci 2022; 23:ijms23136899. [PMID: 35805903 PMCID: PMC9266522 DOI: 10.3390/ijms23136899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Specific antibody responses to subfornical organs, including Nax antibody, have been reported in patients with adipsic hypernatremia of unknown etiology who do not have structural lesions in the hypothalamic–pituitary gland. The subfornical organ, also referred to as the window of the brain, is a sensing site that monitors sodium and osmotic pressure levels. On the other hand, ROHHAD syndrome is a rare disease for which the etiology of the hypothalamic disorder is unknown, and there have been some reports in recent years describing its association with autoimmune mechanisms. In addition, abnormal Na levels, including hypernatremia, are likely to occur in this syndrome. When comparing the clinical features of adipsic hypernatremia due to autoimmune mechanisms and ROHHAD syndrome, there are similar hypothalamic–pituitary dysfunction symptoms in addition to abnormal Na levels. Since clinical diagnoses of autoimmunological adipsic hypernatremia and ROHAD syndrome might overlap, we need to understand the essential etiology and carry out precise assessments to accurately diagnose patients and provide effective treatment. In this review, I review the literature on the autoimmune mechanism reported in recent years and describe the findings obtained so far and future directions.
Collapse
Affiliation(s)
- Akari Nakamura-Utsunomiya
- Department of Genetic Medicine, Hiroshima University Graduate School, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8511, Japan;
- Department of Pediatrics, Hiroshima University Graduate School, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8511, Japan
- Division of Neonatal Screening, National Center for Child Health and Development, 2 Chome-10-1 Okura, Setagaya, Tokyo 157-8535, Japan
| |
Collapse
|
25
|
Affiliation(s)
- Kamel S Kamel
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Martin Schreiber
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ziv Harel
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
26
|
Sasidharan Pillai S, Boxerman JL, Topor LS. Septopreoptic Holoprosencephaly in an Adolescent Presenting with Hypodipsia and Hypernatremia. J Pediatr 2022; 240:307-308. [PMID: 34487769 DOI: 10.1016/j.jpeds.2021.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Sabitha Sasidharan Pillai
- Division of Pediatric Endocrinology, Hasbro Children's Hospital, Providence, Rhode Island; Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jerrold L Boxerman
- Division of Neuroradiology, Rhode Island Hospital, Providence, Rhode Island; Department of Radiology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lisa Swartz Topor
- Division of Pediatric Endocrinology, Hasbro Children's Hospital, Providence, Rhode Island; Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
27
|
Du C, Leng Y, Zhou Q, Xiao JX, Yuan XR, Yuan J. Relationship between postoperative hypothalamic injury and water and sodium disturbance in patients with craniopharyngioma: A retrospective study of 178 cases. Front Endocrinol (Lausanne) 2022; 13:958295. [PMID: 36120435 PMCID: PMC9478176 DOI: 10.3389/fendo.2022.958295] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the relationship between postoperative hypothalamo-hypophyseal injury (HHI) and postoperative water and sodium disturbances in patients with craniopharyngioma. METHODS The medical records, radiological data, and laboratory results of 178 patients (44 children and 134 adults) who underwent microsurgery for craniopharyngioma in a single center were reviewed. Postoperative HHI was assessed using magnetic resonance imaging. Structural defects of the hypothalamo-hypophyseal system (pituitary, pituitary stalk, floor and lateral wall of the third ventricle) were assessed in four standard T1-weighted images. The defect of each structure was assigned 1 score (0.5 for the unilateral injury of the third ventricle wall), and a HHI score was calculated. RESULTS The number of patients with HHI scores of 0-1, 2, 2.5-3, and >3 was 35, 49, 61, and 33, respectively. Diabetes insipidus (DI) worsened in 56 (31.5%) patients with preoperative DI, while 119 (66.9%) patients were diagnosed with new-onset DI. Hypernatremia and hyponatremia developed in 127 (71.3%) and 128 (71.9%) patients after surgery, respectively. Syndrome of inappropriate antidiuresis occurred in 97(54.5%) patients. During hospitalization, hypernatremia recurred in 33 (18.5%) patients and in 54 (35.7%) during follow-up, of which 18 (11.9%) were severe. DI persisted in 140 (78.7%) patients before discharge. No relationship was found between the HHI score and incidence of early DI, hyponatremia, syndrome of inappropriate diuretic hormone, or prolonged DI. Compared with patients with a score of 0-1, those with scores =2.5-3 (OR = 5.289, 95% CI:1.098-25.477, P = 0.038) and >3 (OR = 10.815, 95% CI:2.148-54.457, P = 0.004) had higher risk of developing recurrent hypernatremia. Patients with a score >3 had higher risk of developing severe hypernatremia during hospitalization (OR = 15.487, 95% CI:1.852-129.539, P = 0.011) and at follow-up (OR = 28.637, 95% CI:3.060-267.981, P = 0.003). CONCLUSIONS The neuroimaging scoring scale is a simple tool to semi-quantify HHI after surgery. Recurrent and severe hypernatremia should be considered in patients with a high HHI score (>2.5). An HHI score >3 is a potential predictor of adipsic DI development. Preventive efforts should be implemented in the perioperative period to reduce the incidence of potentially catastrophic complications.
Collapse
Affiliation(s)
- Can Du
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yueshuang Leng
- Radiological Intervention Center, Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Quanwei Zhou
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Ju-Xiong Xiao
- Radiological Intervention Center, Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Xian-Rui Yuan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- Department of Neurosurgery, The Institute of Skull Base Surgery and Neuro-oncology at Hunan, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Yuan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- Department of Neurosurgery, The Institute of Skull Base Surgery and Neuro-oncology at Hunan, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Jian Yuan,
| |
Collapse
|
28
|
Frazier SB, Fitzgerald NM. Hypernatremia in a Sleepy 2-Month-Old With Mention of Abnormal Eye Movements. Pediatr Emerg Care 2021; 37:e877-e878. [PMID: 30870334 DOI: 10.1097/pec.0000000000001791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Septo-optic dysplasia is a rare congenital heterogeneous malformation comprising at least 2 components of the triad: optic nerve hypoplasia, pituitary hormone abnormalities, and midline brain defects. We report a 2-month-old girl who presented with hypernatremia, constipation, and increased sleepiness with mother's recent appreciation of abnormal eye movements. We discuss the diagnosis and management of this patient who avoided significant morbidity by prompt diagnosis based initially on clinical suspicion. This case report emphasizes that thorough laboratory and physical evaluation of similar cases as presentation can vary considerably based on degree of pituitary dysfunction. Because of this variable presentation, diagnosis is typically delayed in otherwise healthy appearing infants early in their course of illness. To our knowledge, this is the first emergency medicine case report to discuss this diagnosis.
Collapse
|
29
|
Schujovitzky D, Cohen Hagay K, Cohen-Adam D, Greenberg M. [SEVERE HYPERNATREMIA IN A TEENAGE GIRL SUFFERING FROM ANOREXIA NERVOSA]. Harefuah 2021; 160:814-817. [PMID: 34957718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Hypernatremic dehydration is an uncommon condition, whose main treatment is fluid administration. In cases of extreme hypernatremia, that treatment paradoxically poses a real danger to the patient's morbidity and mortality. In very rare cases, restrictive type anorexia nervosa causes extreme dehydration that can result in elevated sodium levels. In this case study we present a teenage girl who suffers from restrictive anorexia nervosa and was admitted to the pediatric intensive care unit (PICU) with an acute confusional state, with extremely severe hypernatremia up to 203 mEq/L, combined with hyperglycemia up to 700 mg/dL. Under hypotonic electrolyte solution treatment, a gradual sodium level decrease of 8 mEq/L per day was achieved with complete normalization of sodium without any neurological damage. Moreover, glucose levels were normalized rapidly and spontaneously without additional treatment with insulin.
Collapse
Affiliation(s)
| | - Keren Cohen Hagay
- Unit of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Meidad Greenberg
- Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
30
|
Tzoulis P, Grossman AB, Baldeweg SE, Bouloux P, Kaltsas G. MANAGEMENT OF ENDOCRINE DISEASE: Dysnatraemia in COVID-19: prevalence, prognostic impact, pathophysiology, and management. Eur J Endocrinol 2021; 185:R103-R111. [PMID: 34370712 PMCID: PMC8428074 DOI: 10.1530/eje-21-0281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/06/2021] [Indexed: 11/08/2022]
Abstract
This review examines the prevalence, aetiology, pathophysiology, prognostic value, and investigation of dysnatraemia in hospitalised COVID-19 patients, taking into account all relevant studies published in PubMed and Cochrane Library studies until March 2021. Hyponatraemia is commonly observed in patients with bacterial pneumonia and is an independent predictor for excess mortality and morbidity. However, it remains unknown whether this association applies to coronavirus disease-2019 (COVID-19). Several studies reported a 20-35% prevalence for hyponatraemia and 2-5% for hypernatraemia in patients admitted with COVID-19. In addition, hyponatraemia on admission was a risk factor for progression to severe disease, being associated with an increased likelihood for the need for invasive mechanical ventilation, with an odds ratio (OR) of 1.83-3.30. Hyponatraemia seems to be an independent risk factor for mortality, with an OR of 1.40-1.50 compared to normonatraemia, while hypernatraemia is related to even worse outcomes than hyponatraemia. Furthermore, preliminary data show an inverse association between serum sodium and interleukin-6 levels, suggesting that hyponatraemia might be used as a surrogate marker for the risk of a cytokine storm and the need for treatment with interleukin antagonists. In conclusion, dysnatraemia is common and carries a poor prognosis in COVID-19 patients, indicating that it may play a future role in risk stratification and individualising therapy.
Collapse
Affiliation(s)
- Ploutarchos Tzoulis
- Division of Medicine, Department of Metabolism and Experimental Therapeutics, University College London, London, UK
- Correspondence should be addressed to P Tzoulis Email
| | - Ashley B Grossman
- Department of Endocrinology, OCDEM, University of Oxford, Oxford, UK
- Neuroendocrine Tumour Unit, Royal Free Hospital, London, UK
- Centre for Endocrinology, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Stephanie E Baldeweg
- Department of Diabetes and Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Medicine, University College London, London, UK
| | - Pierre Bouloux
- Centre for Neuroendocrinology, Royal Free Campus, University College London, London, UK
| | - Gregory Kaltsas
- First Department of Propaedeutic and Internal Medicine, Laiko University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
31
|
Shireen A, Tahmina F, Farhana Y, Umme T, Sukriti B, Hossain MK. Management of severe hypernatremic dehydration and acute kidney injury in children in a critical care nephrology and dialysis unit. Saudi J Kidney Dis Transpl 2021; 32:1431-1440. [PMID: 35532714 DOI: 10.4103/1319-2442.344764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Our study aimed to manage the children presented with severe hypernatremic dehydration and acute kidney injury (AKI) an updated fluid management protocol was used to find out the rate of decline of serum sodium per day and their outcome. This is a prospective interventional study was conducted from November 2015 up to October 2016 in the Critical Care Nephrology and Dialysis Unit of Dhaka Shishu (Children) Hospital, Bangladesh. A total of 45 children with hypernatremia and AKI were evaluated. Patients were treated by the calculated amount of dextrose in normal saline mixed with various dilutions of 3% NaCl with a difference of serum to infusate sodium concentration around 10 mEq/L as per the American Academy of Pediatrics - 2005. Intermittent peritoneal dialysis was done when in the failure stage of AKI or when serum sodium (Na+) >180 mEq/L. Depending on the outcome samples were divided into survival and death groups. Data were processed by software STATA 13 and analysis was done by one-way ANOVA, Tukey test, Chi-square test, F-test, and Student's t-test. Age ranged from one month to 6½ years and 91% were infants. Total 64% of patients were in the failure stage of AKI and majority were in the death group, 31% in injury and 4.4% patient in the risk stage. Out of 45 cases, 30 (67%) had severe hypernatremia. Significant reduction of serum Na+ was found and the rate of decline between days was optimum (8.4 mmol/L/day). Overall 60% survived with normal renal functions and 40% died. The calculated amount of dextrose in normal saline mixed with various dilutions of 3% NaCl is safe in severe hypernatremic dehydration with AKI.
Collapse
Affiliation(s)
- Afroz Shireen
- Department of Pediatric Nephrology, Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, Sher e Bangla Nagar, Dhaka, Bangladesh
| | - Ferdaus Tahmina
- Department of Pediatric Nephrology, Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, Sher e Bangla Nagar, Dhaka, Bangladesh
| | - Yasmin Farhana
- Department of Pediatric Nephrology, Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, Sher e Bangla Nagar, Dhaka, Bangladesh
| | - Tanjila Umme
- Department of Pediatric Nephrology, Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, Sher e Bangla Nagar, Dhaka, Bangladesh
| | - Baroi Sukriti
- Department of Pediatric Nephrology, Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, Sher e Bangla Nagar, Dhaka, Bangladesh
| | - Md Kawser Hossain
- Department of Pediatric Nephrology, Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, Sher e Bangla Nagar, Dhaka, Bangladesh
| |
Collapse
|
32
|
Shirai Y, Miura K, Nakamura-Utsunomiya A, Ishizuka K, Hattori M, Hattori M. Analysis of water and electrolyte imbalance in a patient with adipsic hypernatremia associated with subfornical organ-targeting antibody. CEN Case Rep 2021; 11:110-115. [PMID: 34420198 DOI: 10.1007/s13730-021-00638-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/16/2021] [Indexed: 11/27/2022] Open
Abstract
Patients with adipsic hypernatremia present with chronic hypernatremia because of defects in thirst sensation and dysregulated salt appetite, without demonstrable hypothalamic structural lesions. The involvement of autoantibodies directed against the sodium channel, Nax in the subfornical organ (SFO) has recently been reported. However, the pathophysiology of water and electrolyte imbalance underlying the disease has yet to be elucidated. We describe the case of a 5-year-old boy who complained of headaches and vomiting that gradually worsened. Brain magnetic resonance imaging detected no abnormal lesions. Blood laboratory testing revealed a serum sodium (Na) concentration of 152 mmol/L and a serum osmolarity of 312 mOsm/L. His body weight had slightly decreased, and his thirst sensation was absent. His plasma vasopressin concentration was 0.9 pg/mL, despite the high serum osmolarity. He was encouraged to drink water, and oral 1-deamino-8-D-arginine-vasopressin was administered. When serum sodium concentrations were normalized, plasma vasopressin concentrations were apparently normal and ranged from 0.8 to 2.0 pg/mL. He did not present with polyuria at any time. Immunohistochemical study using mouse brain sections and the patient's serum revealed the deposition of human immunoglobulin G (IgG) antibody in the mouse SFO. In conclusion, our observations suggested that water and electrolyte imbalance in adipsic hypernatremia is characterized by a certain amount of vasopressin release regardless of serum sodium concentrations with no response to hyperosmolarity.
Collapse
Affiliation(s)
- Yoko Shirai
- Department of Pediatric Nephrology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666, Japan
- Department of Pediatrics, Toho University Medical Center Ohashi Hospital, Tokyo, Japan
| | - Kenichiro Miura
- Department of Pediatric Nephrology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666, Japan.
| | - Akari Nakamura-Utsunomiya
- Department of Pediatrics, Hiroshima Prefectural Hospital, Hiroshima, Japan
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kiyonobu Ishizuka
- Department of Pediatric Nephrology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666, Japan
| | - Miku Hattori
- Department of Pediatrics, Toho University Medical Center Ohashi Hospital, Tokyo, Japan
| | - Motoshi Hattori
- Department of Pediatric Nephrology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666, Japan
| |
Collapse
|
33
|
Brennan M, Mulkerrin L, Wall D, O' Shea PM, Mulkerrin EC. A Comparison of Community-Acquired and Hospital-Acquired Hypernatraemia in Patients who are Acutely Admitted to Hospital. Ir Med J 2021; 114:407. [PMID: 34520642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background Hypernatraemia is associated with a short-term mortality of 20-60%. Age-related physiological changes predispose patients to hypernatraemia. This study reviewed acutely admitted patients comparing those with community-acquired (CAH) and hospital-acquired hypernatraemia (HAH). Methods A retrospective study of 102 consecutive acute medical in-patients with serum [Na]>145 mmol/L was conducted. Baseline characteristics, clinical presentation, laboratory values, monitoring, management and outcomes were compared between CAH and HAH groups. Results Patients were exclusively older (>69 years). Forty patients (39.2%) had CAH and sixty-two (61.8%) had HAH. Those with CAH were more likely to be NH residents, have dementia and reduced mobility. Most HAH patients had mild hypernatraemia initially (75.8%, n=47), and higher rates of acute kidney injury (27% (n=11) vs 8% (n=3)/p=0.02) were observed. Monitoring was inadequate and no patient had a free water deficit documented. Medication review and intravenous fluid prescribing was similar between groups. The median length of stay of discharged HAH patients was longer (22.5 vs 8 days/p=0.005). Mortality rates were similar (47% (n=29) vs 37% (n=15)/p=0.416). Time from admission to death was higher in HAH patients (16 vs 8 days/p=0.008). Conclusions Both CAH and HAH present similarly, however, older patients with cognitive/physical impairments are at an increased risk. Early identification of high-risk patients and adherence to best practice guidelines is required.
Collapse
Affiliation(s)
- M Brennan
- Department of Geriatric Medicine, Saolta University Health Care Group (SUHCG), University Hospital Galway, Co. Galway
| | - L Mulkerrin
- Department of Geriatric Medicine, Saolta University Health Care Group (SUHCG), University Hospital Galway, Co. Galway
| | - D Wall
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway
| | - P M O' Shea
- Department of Clinical Biochemistry, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - E C Mulkerrin
- Department of Geriatric Medicine, Saolta University Health Care Group (SUHCG), University Hospital Galway, Co. Galway
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
34
|
Basiratnia M, Derakhshan D, Fouladi D, Ranjbar K, Shahriarirad R. ROHHAD Syndrome an Inconspicuous Cause of Hypernatremia, A Case Report. Iran J Kidney Dis 2021; 15:319-321. [PMID: 34279004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/25/2021] [Accepted: 03/08/2021] [Indexed: 06/13/2023]
Abstract
Rapid-onset obesity with hypoventilation, hypothalamic dysfunction, and autonomic dysregulation (ROHHAD) syndrome is a rare, life threatening disease with unknown etiology. Dysnatremia is a common finding in these patients. Here we present a 12-year-old boy with multiple admissions due to hypernatremia and was repeatedly misdiagnosed. An eventual diagnosis of ROHHAD syndrome was made by integration of the previous ignored findings of sleep apnea and obesity. The diagnosis of this rare but potentially fatal syndrome should be considered in patients with dysnatremia associated with obesity and sleep apnea disorders.
Collapse
Affiliation(s)
| | - Dorna Derakhshan
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | | | | |
Collapse
|
35
|
Fernandez Martinez A, Barajas Galindo D, Ruiz Sanchez J. Management of hyponatraemia and hypernatraemia during the Covid-19 pandemic: a consensus statement of the Spanish Society for Endocrinology (Acqua Neuroendocrinology Group). Rev Endocr Metab Disord 2021; 22:317-324. [PMID: 33547563 PMCID: PMC7864617 DOI: 10.1007/s11154-021-09627-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 02/01/2023]
Abstract
SARS-COV2 infection has swiftly become a pandemic disease of historic relevance and widely variable outcomes. This variable prognosis is related both to uneven damage, among others, to lungs, heart and kidneys, and to a multisystemic inflammatory reaction. All these factors are known to disrupt water balance and potentially induce hyponatraemia or hypernatraemia. Water balance disorders are known mortality and morbidity risk factors in several clinical scenarios and their proper management, though often complex and hazardous, can reduce mortality and length of hospitalization. Clinical uncertainty over COVID-19 outcome, the variety of organs involved in both the infection and water balance and difficulties in clinical examination due to risk of contagion might obstruct proper management of dysnatremic disorders. Thus, the Acqua Neuroendocrinology Group of the Spanish Society for Endocrinology (SEEN) has endeavoured to provide evidence and expert based recommendations on the management of hyponatraemia and hypernatraemia in COVID-19 patients.
Collapse
|
36
|
Roquilly A, Moyer JD, Huet O, Lasocki S, Cohen B, Dahyot-Fizelier C, Chalard K, Seguin P, Jeantrelle C, Vermeersch V, Gaillard T, Cinotti R, Demeure dit Latte D, Mahe PJ, Vourc’h M, Martin FP, Chopin A, Lerebourg C, Flet L, Chiffoleau A, Feuillet F, Asehnoune K. Effect of Continuous Infusion of Hypertonic Saline vs Standard Care on 6-Month Neurological Outcomes in Patients With Traumatic Brain Injury: The COBI Randomized Clinical Trial. JAMA 2021; 325:2056-2066. [PMID: 34032829 PMCID: PMC8150692 DOI: 10.1001/jama.2021.5561] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Fluid therapy is an important component of care for patients with traumatic brain injury, but whether it modulates clinical outcomes remains unclear. OBJECTIVE To determine whether continuous infusion of hypertonic saline solution improves neurological outcome at 6 months in patients with traumatic brain injury. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial conducted in 9 intensive care units in France, including 370 patients with moderate to severe traumatic brain injury who were recruited from October 2017 to August 2019. Follow-up was completed in February 2020. INTERVENTIONS Adult patients with moderate to severe traumatic brain injury were randomly assigned to receive continuous infusion of 20% hypertonic saline solution plus standard care (n = 185) or standard care alone (controls; n = 185). The 20% hypertonic saline solution was administered for 48 hours or longer if patients remained at risk of intracranial hypertension. MAIN OUTCOMES AND MEASURES The primary outcome was Extended Glasgow Outcome Scale (GOS-E) score (range, 1-8, with lower scores indicating worse functional outcome) at 6 months, obtained centrally by blinded assessors and analyzed with ordinal logistic regression adjusted for prespecified prognostic factors (with a common odds ratio [OR] >1.0 favoring intervention). There were 12 secondary outcomes measured at multiple time points, including development of intracranial hypertension and 6-month mortality. RESULTS Among 370 patients who were randomized (median age, 44 [interquartile range, 27-59] years; 77 [20.2%] women), 359 (97%) completed the trial. The adjusted common OR for the GOS-E score at 6 months was 1.02 (95% CI, 0.71-1.47; P = .92). Of the 12 secondary outcomes, 10 were not significantly different. Intracranial hypertension developed in 62 (33.7%) patients in the intervention group and 66 (36.3%) patients in the control group (absolute difference, -2.6% [95% CI, -12.3% to 7.2%]; OR, 0.80 [95% CI, 0.51-1.26]). There was no significant difference in 6-month mortality (29 [15.9%] in the intervention group vs 37 [20.8%] in the control group; absolute difference, -4.9% [95% CI, -12.8% to 3.1%]; hazard ratio, 0.79 [95% CI, 0.48-1.28]). CONCLUSIONS AND RELEVANCE Among patients with moderate to severe traumatic brain injury, treatment with continuous infusion of 20% hypertonic saline compared with standard care did not result in a significantly better neurological status at 6 months. However, confidence intervals for the findings were wide, and the study may have had limited power to detect a clinically important difference. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03143751.
Collapse
Affiliation(s)
- Antoine Roquilly
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Jean Denis Moyer
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Paris, France
| | - Olivier Huet
- CHU de Brest, Anesthesia and Intensive Care Unit, Brest, France
| | | | - Benjamin Cohen
- CHU de Tours, Anesthesia and Intensive Care Unit, Tours, France
| | | | - Kevin Chalard
- CHU de Montpellier, Anesthesia and Intensive Care Unit, Montpellier, France
| | - Philippe Seguin
- CHU de Rennes, Anesthesia and Intensive Care Unit, Rennes, France
| | - Caroline Jeantrelle
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Paris, France
| | | | - Thomas Gaillard
- CHU d’Angers, Anesthesia and Intensive Care Unit, Angers, France
| | - Raphael Cinotti
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Dominique Demeure dit Latte
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Pierre Joachim Mahe
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Mickael Vourc’h
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Florian Pierre Martin
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Alice Chopin
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Celine Lerebourg
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Laurent Flet
- CHU de Nantes, Service de pharmacie, Hôtel Dieu, Nantes, France
| | - Anne Chiffoleau
- DRCI, Departement promotion, cellule vigilances, CHU Nantes, Nantes, France
| | - Fanny Feuillet
- DRCI, Plateforme de Méthodologie et de Biostatistique, CHU Nantes, Nantes, France
- Université de Nantes, Université de Tours, INSERM, SPHERE U1246, Nantes, France
| | - Karim Asehnoune
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
| |
Collapse
|
37
|
Tzoulis P, Waung JA, Bagkeris E, Hussein Z, Biddanda A, Cousins J, Dewsnip A, Falayi K, McCaughran W, Mullins C, Naeem A, Nwokolo M, Quah H, Bitat S, Deyab E, Ponnampalam S, Bouloux PM, Montgomery H, Baldeweg SE. Dysnatremia is a Predictor for Morbidity and Mortality in Hospitalized Patients with COVID-19. J Clin Endocrinol Metab 2021; 106:1637-1648. [PMID: 33624101 PMCID: PMC7928894 DOI: 10.1210/clinem/dgab107] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Dysnatremia is an independent predictor of mortality in patients with bacterial pneumonia. There is paucity of data about the incidence and prognostic impact of abnormal sodium concentration in patients with coronavirus disease 2019 (COVID-19). OBJECTIVE This work aimed to examine the association of serum sodium during hospitalization with key clinical outcomes, including mortality, need for advanced respiratory support and acute kidney injury (AKI), and to explore the role of serum sodium as a marker of inflammatory response in COVID-19. METHODS This retrospective longitudinal cohort study, including all adult patients who presented with COVID-19 to 2 hospitals in London over an 8-week period, evaluated the association of dysnatremia (serum sodium < 135 or > 145 mmol/L, hyponatremia, and hypernatremia, respectively) at several time points with inpatient mortality, need for advanced ventilatory support, and AKI. RESULTS The study included 488 patients (median age, 68 years). At presentation, 24.6% of patients were hyponatremic, mainly due to hypovolemia, and 5.3% hypernatremic. Hypernatremia 2 days after admission and exposure to hypernatremia at any time point during hospitalization were associated with a 2.34-fold (95% CI, 1.08-5.05; P = .0014) and 3.05-fold (95% CI, 1.69-5.49; P < .0001) increased risk of death, respectively, compared to normonatremia. Hyponatremia at admission was linked with a 2.18-fold increase in the likelihood of needing ventilatory support (95% CI, 1.34-3.45, P = .0011). Hyponatremia was not a risk factor for in-hospital mortality, except for the subgroup of patients with hypovolemic hyponatremia. Sodium values were not associated with the risk for AKI and length of hospital stay. CONCLUSION Abnormal sodium levels during hospitalization are risk factors for poor prognosis, with hypernatremia and hyponatremia being associated with a greater risk of death and respiratory failure, respectively. Serum sodium values could be used for risk stratification in patients with COVID-19.
Collapse
Affiliation(s)
- Ploutarchos Tzoulis
- Department of Metabolism & Experimental Therapeutics, Division of Medicine, University College London, London, UK
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
- Correspondence: Ploutarchos Tzoulis, MD, PhD, MSc (Hons), MRCP, Department of Metabolism & Experimental Therapeutics, Division of Medicine, University College London, Gower St, WC1E 6BT, London, UK.
| | - Julian A Waung
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Emmanouil Bagkeris
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Ziad Hussein
- Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Medicine, University College London, London, UK
| | - Aiyappa Biddanda
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - John Cousins
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Alice Dewsnip
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Kanoyin Falayi
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Will McCaughran
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Chloe Mullins
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Ammara Naeem
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Muna Nwokolo
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Helen Quah
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
| | - Syed Bitat
- Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
| | - Eithar Deyab
- Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
| | - Swarupini Ponnampalam
- Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
| | - Pierre-Marc Bouloux
- Centre for Neuroendocrinology, Royal Free Campus, University College London, London, UK
| | - Hugh Montgomery
- Department of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK
- UCL Institute for Human Health and Performance, University College London, London, UK
| | - Stephanie E Baldeweg
- Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Medicine, University College London, London, UK
| |
Collapse
|
38
|
Wang P, Tan X, Li Q, Qian M, Cheng A, Ma B, Wan P, Zhang X, Guo C, Sheng M, Yi M, Yu M. Extra-pulmonary complications of 45 critically ill patients with COVID-19 in Yichang, Hubei province, China: A single-centered, retrospective, observation study. Medicine (Baltimore) 2021; 100:e24604. [PMID: 33655925 PMCID: PMC7939178 DOI: 10.1097/md.0000000000024604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/11/2021] [Indexed: 01/08/2023] Open
Abstract
Mortality of critically ill patients with coronavirus disease 2019 (COVID-19) was high. Aims to examine whether time from symptoms onset to intensive care unit (ICU) admission affects incidence of extra-pulmonary complications and prognosis in order to provide a new insight for reducing the mortality. A single-centered, retrospective, observational study investigated 45 critically ill patients with COVID-19 hospitalized in ICU of The Third People's Hospital of Yichang from January 17 to March 29, 2020. Patients were divided into 2 groups according to time from symptoms onset to ICU admission (>7 and ≤7 days) and into 2 groups according to prognosis (survivors and non-survivors). Epidemiological, clinical, laboratory, radiological characteristics and treatment data were studied. Compared with patients who admitted to the ICU since symptoms onset ≤7 days (55.6%), patients who admitted to the ICU since symptoms onset >7 days (44.4%) were more likely to have extra-pulmonary complications (19 [95.0%] vs 16 [64.0%], P = .034), including acute kidney injury, cardiac injury, acute heart failure, liver dysfunction, gastrointestinal hemorrhage, hyperamylasemia, and hypernatremia. The incidence rates of acute respiratory distress syndrome, pneumothorax, and hospital-acquired pneumonia had no difference between the 2 groups. Except activated partial thromboplastin and Na+ concentration, the laboratory findings were worse in group of time from symptoms onset to ICU admission >7 days. There was no difference in mortality between the 2 groups. Of the 45 cases in the ICU, 19 (42.2%) were non-survivors, and 16 (35.6%) were with hospital-acquired pneumonia. Among these non-survivors, hospital-acquired pneumonia was up to 12 (63.2%) besides higher incidence of extra-pulmonary complications. However, hospital-acquired pneumonia occurred in only 4 (15.4%) survivors. Critically ill patients with COVID-19 who admitted to ICU at once might get benefit from intensive care via lower rate of extra-pulmonary complications.
Collapse
Affiliation(s)
- Peng Wang
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
| | - Xiang Tan
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
| | - Qian Li
- Department of Pulmonary and Critical Care Medicine, The Third People's Hospital of Yichang, China Three Gorges University Third People's Hospital
| | - Min Qian
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
| | - Aiguo Cheng
- Department of Pulmonary and Critical Care Medicine, The Third People's Hospital of Yichang, China Three Gorges University Third People's Hospital
| | - Baohua Ma
- Medical Department, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang, Yichang, Hubei, China
| | - Peng Wan
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
| | - Xinli Zhang
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
| | - Changyun Guo
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
| | - Mengting Sheng
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
| | - Mengqiu Yi
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
| | - Min Yu
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
| |
Collapse
|
39
|
Kunapareddy T, Kalisetty S. Glyphosate poisoning - a case report. J Postgrad Med 2021; 67:36-38. [PMID: 33533750 PMCID: PMC8098880 DOI: 10.4103/jpgm.jpgm_766_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/15/2020] [Accepted: 11/30/2020] [Indexed: 11/25/2022] Open
Abstract
Glyphosate is the most commonly used broad-spectrum, non-selective herbicide in the world. The toxicity is supposed to be due to uncoupling of oxidative phosphorylation and the surfactant polyoxyethylene amine (POEA)- mediated cardiotoxicity. Clinical features of this herbicide poisoning are varied, ranging from asymptomatic to even death. There is no antidote and aggressive supportive therapy is the mainstay of treatment for glyphosate poisoning. We present a 69-year-old female patient with suicidal consumption of around 500 ml of Glycel®. Initially, gastric lavage was done and intravenous fluids were given. Within two hours of presentation, the patient developed respiratory distress needing intubation, hypotension needing vasopressor support, and severe lactic acidosis. She also developed acute respiratory distress syndrome, hypokalemia, hypernatremia, and aspiration pneumonia. Our patient was critically ill with multiple poor prognostic factors, but with timely aggressive supportive management, the patient gradually recovered.
Collapse
Affiliation(s)
- T Kunapareddy
- Department of Internal Medicine, Capital Hospital, Poranki, Vijayawada, Andhra Pradesh, India
| | - S Kalisetty
- Department of Emergency Medicine, Capital Hospital, Poranki, Vijayawada, Andhra Pradesh, India
| |
Collapse
|
40
|
Brennan M, Mulkerrin L, O'Keeffe ST, O'Shea PM. Approach to the Management of Hypernatraemia in Older Hospitalised Patients. J Nutr Health Aging 2021; 25:1161-1166. [PMID: 34866143 DOI: 10.1007/s12603-021-1692-5] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hypernatraemia is associated with high morbidity and mortality and is more common in patients of older age, nursing home residents and those with cognitive impairment and restricted mobility. The most common cause in hospital settings is water dehydration due to reduced intake although other causes should be identified. Once identified, prompt management is necessary to avoid delayed correction as prolonged hypernatremia is associated with increased hospital stay and mortality. Comprehensive history-taking and physical examination, basic investigations and medication review are essential to identify causative and remediable factors in those admitted with hypernatraemia. Accurate calculation of fluid deficit and ongoing losses is essential in order to ensure adequate fluid replacement, The administration of appropriate, usually hypotonic, fluids is also essential to the timely restoration of eunatraemia. Although evidence of definite harm resulting from rapid correction is lacking, a serum sodium reduction rate of <12 mmol/l day is advised with the caveat that close monitoring of electrolytes is required to ensure the desired correction rate is being achieved. Medical and nursing professionals should have access to a local hospital protocol to guide management of patients with hypernatraemia to improve patient outcomes and mitigate the risk of harm, particularly from under-recognition and slow correction.
Collapse
Affiliation(s)
- M Brennan
- Dr Michelle Brennan, Specialist Registrar in Geriatric and General Internal Medicine, Department of Geriatric Medicine, Saolta University Healthcare Group, University Hospital Galway, Newcastle Road, Galway H91 YR71, Ireland. Tel No: 00535 91 524222,
| | | | | | | |
Collapse
|
41
|
Imaizumi T, Nakatochi M, Fujita Y, Yamamoto R, Watanabe K, Maekawa M, Yamawaka T, Katsuno T, Maruyama S. Glucocorticoid treatment is associated with ICU-acquired hypernatremia: a nested case-control study. Clin Exp Nephrol 2020; 25:131-139. [PMID: 32960424 PMCID: PMC7506169 DOI: 10.1007/s10157-020-01967-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hypernatremia is a major electrolyte disorder associated with death among critically ill patients. Glucocorticoid therapy may cause hypernatremia in refractory septic shock patients, but the association between glucocorticoid and intensive care unit (ICU)-acquired hypernatremia (IAH) remains unclear. The aim of this study was to clarify whether glucocorticoid administration was associated with IAH. METHODS This was a nested case-control study using data from an established cohort including 121 IAH cases identified from 1756 patients who were admitted to ICU in a tertiary care facility in Japan. We included patients who were admitted with a normal range of serum sodium concentrations (130-149 mEq/L) from January 1, 2013 to December 31, 2015 and remained in ICU for ≥ 2 days. Hypernatremia was defined as serum sodium concentration ≥ 150 mEq/L. Each case was matched to one control. RESULTS Multivariable conditional logistic regression revealed high-dose glucocorticoid {odds ratio (OR), 4.15 [95% confidence interval (CI) 1.29-13.4]}, acute kidney injury (AKI) [OR, 2.72 (95% CI 1.31-5.62)], and osmotic diuretics [OR, 3.44 (95% CI 1.41-8.39)] to be significantly associated with IAH. The contents and amounts of fluid infusion were not significantly associated with IAH. There were also significant duration-response effects between duration of glucocorticoid use and IAH; however, pulse glucocorticoid administration was not associated with IAH. CONCLUSION In this nested case-control study, we demonstrated a significant association between IAH and high-dose glucocorticoid with significant duration-response effects. Serum sodium concentrations should be monitored carefully in critically ill patients administered prolonged high-dose glucocorticoid.
Collapse
Affiliation(s)
- Takahiro Imaizumi
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masahiro Nakatochi
- Biostatistics and Bioinformatics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Yoshiro Fujita
- Department of Nephrology, Chubu Rosai Hospital, Nagoya, Japan
| | - Rie Yamamoto
- Department of Nephrology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Kennshi Watanabe
- Department of Nephrology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Michitaka Maekawa
- Department of Nephrology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Taishi Yamawaka
- Department of Nephrology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Takayuki Katsuno
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| |
Collapse
|
42
|
Abstract
The treatment of central diabetes insipidus has not changed significantly in recent decades, and dDAVP and replacement of free water deficit remain the cornerstones of treatment. Oral dDAVP has replaced nasal dDAVP as a more reliable mode of treatment for chronic central diabetes insipidus. Hyponatraemia is a common side effect, occurring in one in four patients, and should be avoided by allowing a regular break from dDAVP to allow a resultant aquaresis. Hypernatraemia is less common, and typically occurs during hospitalization, when access to water is restricted, and in cases of adipsic DI. Management of adipsic DI can be challenging, and requires initial inpatient assessment to establish dose of dDAVP, daily fluid prescription, and eunatraemic weight which can guide day-to-day fluid targets in the long-term.
Collapse
Affiliation(s)
- Aoife Garrahy
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland.
| | - Christopher J Thompson
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland.
| |
Collapse
|
43
|
Abstract
In the pregnant patient, hypotonic polyuria in the setting of elevated serum osmolality and polydipsia should narrow the differential to causes related to diabetes insipidus (DI). Gestational DI, also called transient DI of pregnancy, is a distinct entity, unique from central DI or nephrogenic DI which may both become exacerbated during pregnancy. These three different processes relate to vasopressin, where increased metabolism, decreased production or altered renal sensitivity to this neuropeptide should be considered. Gestational DI involves progressively rising levels of placental vasopressinase throughout pregnancy, resulting in decreased endogenous vasopressin and resulting hypotonic polyuria worsening through the pregnancy. Gestational DI should be distinguished from central and nephrogenic DI that may be seen during pregnancy through use of clinical history, urine and serum osmolality measurements, response to desmopressin and potentially, the newer, emerging copeptin measurement. This review focuses on a brief overview of osmoregulatory and vasopressin physiology in pregnancy and how this relates to the clinical presentation, pathophysiology, diagnosis and management of gestational DI, with comparisons to the other forms of DI during pregnancy. Differentiating the subtypes of DI during pregnancy is critical in order to provide optimal management of DI in pregnancy and avoid dehydration and hypernatremia in this vulnerable population.
Collapse
Affiliation(s)
- Sonia Ananthakrishnan
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine/Boston Medical Center, 72 Concord Street, Evans 122, Boston, MA, 02118, United States.
| |
Collapse
|
44
|
Ranjan R, Lo SCY, Ly S, Krishnananthan V, Lim AK. Progression to Severe Hypernatremia in Hospitalized General Medicine Inpatients: An Observational Study of Hospital-Acquired Hypernatremia. ACTA ACUST UNITED AC 2020; 56:medicina56070358. [PMID: 32709029 PMCID: PMC7404557 DOI: 10.3390/medicina56070358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 12/16/2022]
Abstract
Background and objectives: Hypernatremia can be community or hospital-acquired, and there may be specific factors unique to the hospital environment, such as intravenous fluid treatment, which contribute to hypernatremia. The aim of this study was to determine the factors associated with the progression from moderate to severe hospital-acquired hypernatremia among patients admitted under general medicine. Materials and Methods: In this retrospective, single-center cohort study (2012 to 2017), we used ICD-10 coding and medical records to identify adult patients who developed moderate hypernatremia and followed them for progression to severe hypernatremia. We profiled the serum biochemistry and the volume and composition of prescribed intravenous fluids. We applied logistic regression to determine the factors associated with the progression to severe hypernatremia, using the patients with moderate hypernatremia as reference. Results: Of the 180 medical inpatients (median age of 81 years) with moderate hospital-acquired hypernatremia, 9.4% progressed to severe hypernatremia. Normal saline comprised 76% of intravenous fluid volume administered prior to onset of moderate hypernatremia. After the onset, 38% of fluid volume prescribed remained normal saline. The factors independently associated with progression to severe hypernatremia included chronic kidney disease stage (odds ratio 2.38, 95% CI: 1.26-4.50, P = 0.008) and serum creatinine increase (per 10 µmol/L, OR 1.29, 95% CI: 1.07-1.57, P = 0.009). Conclusions: Patients with chronic kidney disease and acute kidney injury may have an increased risk of severe hospital-acquired hypernatremia.
Collapse
Affiliation(s)
- Ramessh Ranjan
- Monash Health General Medicine, Dandenong Hospital, 135 David Street, Dandenong, VIC 3175, Australia; (R.R.); (S.C.-Y.L.); (S.L.); (V.K.)
| | - Stacey C.-Y. Lo
- Monash Health General Medicine, Dandenong Hospital, 135 David Street, Dandenong, VIC 3175, Australia; (R.R.); (S.C.-Y.L.); (S.L.); (V.K.)
| | - Stephanie Ly
- Monash Health General Medicine, Dandenong Hospital, 135 David Street, Dandenong, VIC 3175, Australia; (R.R.); (S.C.-Y.L.); (S.L.); (V.K.)
| | - Visakan Krishnananthan
- Monash Health General Medicine, Dandenong Hospital, 135 David Street, Dandenong, VIC 3175, Australia; (R.R.); (S.C.-Y.L.); (S.L.); (V.K.)
| | - Andy K.H. Lim
- Monash Health General Medicine, Dandenong Hospital, 135 David Street, Dandenong, VIC 3175, Australia; (R.R.); (S.C.-Y.L.); (S.L.); (V.K.)
- Department of Medicine, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia
- Correspondence: or
| |
Collapse
|
45
|
Brennan M, Murray O, O'Shea PM, Mulkerrin EC. Increased rates of hypernatraemia during modest heatwaves in temperate climates. QJM 2020; 113:266-270. [PMID: 31665466 DOI: 10.1093/qjmed/hcz280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hypernatraemia is associated with morbidity and mortality, particularly in the older person. Last summer, Ireland experienced prolonged periods of excessive heat. The Irish meteorological service defines a heatwave as temperatures exceeding 25°C for five consecutive days. AIM This study sought to compare the frequency of hypernatraemia (sodium (Na+) >145 mmol/l) observed during a modest heatwave with that during average ambient temperature in the temperate Irish climate. DESIGN Retrospective cross-sectional analysis with nested case-control study. METHODS The 10-day period from 24 June to 3 July in 2017 and 2018 were chosen as the control and heatwave periods, respectively. Patients aged >65 with at least one Na+ value recorded on the laboratory information system were included. Local meteorological data, age, gender and Na+ levels were evaluated. RESULTS Maximum air temperatures were significantly higher during the heatwave period (mean 27°C vs. 16.8°C, P < 0.0001). Hypernatraemia was present in 3.6% (66/1840) of samples collected during the heatwave compared to 1.4% (23/1593) in the control period. The mean age of affected patients was similar in both groups, 75 years ±7 (P = 1.000). Almost half of participants (49.5%) were male. The frequency of hypernatraemia observed was not influenced by gender, P = 0.33. The median sodium concentrations were similar in both groups, P = 1.00. CONCLUSION Hypernatraemia was 2.5 times more frequent in samples drawn during the heatwave compared to the control period. In this study, neither age nor gender impacted the profile of patients diagnosed with hypernatraemia. A modest rise in temperatures increases hypernatraemia rates in temperate climates.
Collapse
Affiliation(s)
- M Brennan
- Department of Geriatric Medicine, Saolta University Health Care Group (SUHCG), University Hospital Galway, Newcastle Road, Galway, Ireland
| | - O Murray
- Department of Pharmacology & Therapeutics, National University of Ireland, Newcastle Road, Galway, Ireland
| | - P M O'Shea
- Department of Clinical Biochemistry, Saolta University Health Care Group (SUHCG), University Hospital Galway, Newcastle Road, Galway, Ireland
| | - E C Mulkerrin
- Department of Geriatric Medicine, Saolta University Health Care Group (SUHCG), University Hospital Galway, Newcastle Road, Galway, Ireland
| |
Collapse
|
46
|
Tuli G, Matarazzo P, de Sanctis L. Clinical Approach to Sodium Homeostasis Disorders in Children with Pituitary-Suprasellar Tumors. Neuroendocrinology 2020; 110:161-171. [PMID: 31401632 DOI: 10.1159/000502609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/06/2019] [Accepted: 08/09/2019] [Indexed: 11/19/2022]
Abstract
Children with pituitary-suprasellar tumors are at high risk of developing sodium metabolism disorders since the tumoral mass itself or surgical and medical treatment can damage AVP release circuits. Additional risk factors are represented by the use of hypotonic fluids, the young age, total parenteral nutrition, and obstructive hydrocephalus secondary to tumor pathology. The most frequent hyponatremic disorders related to AVP in these patients are the syndrome of inappropriate ADH secretion and the cerebral/renal salt wasting syndrome, while hypernatremic conditions include central diabetes insipidus (CDI) and adipsic CDI. The main challenge in the management of these patients is to promptly distinguish the AVP release disorder at the base of the sodium imbalance and treat it correctly by avoiding rapid sodium fluctuations. These disorders can coexist or follow each other in a few hours or days; therefore, careful clinical and biochemical monitoring is necessary, especially during surgery, the use of chemotherapeutic agents, or radiotherapy. This monitoring should be performed by experienced healthcare professionals and should be multidisciplinary, including pediatric endocrinologists, neurosurgeons, and oncologists since maintaining sodium homeostasis also plays a prognostic role in terms of disease survival, therapeutic response, hospitalization rate, and mortality. In this review, we analyze the management of sodium homeostasis disorders in children with pituitary-suprasellar tumors and discuss the main challenges in the diagnosis and treatment of these conditions based on literature data and over 30 years of clinical experience at our Department of Pediatric Endocrinology.
Collapse
Affiliation(s)
- Gerdi Tuli
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, City of Health and Science University Hospital of Turin, Turin, Italy,
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy,
| | - Patrizia Matarazzo
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, City of Health and Science University Hospital of Turin, Turin, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Luisa de Sanctis
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, City of Health and Science University Hospital of Turin, Turin, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| |
Collapse
|
47
|
Rodriguez A, Fogelfeld L, Robertson G. Hypernatremic Hydrophobic Transient Adipsia Without Organic or Severe Psychiatric Disorder. J Clin Endocrinol Metab 2019; 104:5427-5430. [PMID: 31373657 DOI: 10.1210/jc.2019-01446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/29/2019] [Indexed: 02/13/2023]
Abstract
CONTEXT Psychogenic adipsic hypernatremia is an exceedingly rare and life-threatening condition, occurring in those with severe psychiatric disorders. Its diagnosis requires exclusion of congenital or acquired hypothalamic pathologic entities. We present the case of a patient who experienced transient severe hypernatremia without evidence of brain pathologic features or known psychiatric disease. In our patient, the transient adipsic hypernatremia had resulted from an episode of mild depression that resolved spontaneously. CASE DESCRIPTION A 46-year-old healthy woman who had had three recurrent admissions within 1 month had presented for evaluation of intractable nausea and vomiting with a history of a recent episode of a depressive mood change. Each admission had shown substantial hypernatremia (maximum plasma sodium, 166 mEq/L) accompanied by a strong aversion to consuming water. The findings from the diagnostic evaluation showed elevated serum osmolality and lower than expected urine osmolality (urine osmolality range, 474-501 mOsm/kg). This finding, along with an MRI scan showing the presence of a normal posterior pituitary bright spot, suggested that the osmoregulation of her thirst and arginine vasopressin (AVP) secretion were both defective during the attack. The patient was evaluated by psychiatry. Mild depression was diagnosed, and the patient started treatment with mirtazapine, which she only took for a few days. The patient's hypernatremia had completely recovered with resolution of her depression within 2 months. CONCLUSION A mild mood disorder can cause transient dysregulation of the thirst mechanism and AVP secretion through not yet identified mechanisms.
Collapse
Affiliation(s)
- Aleida Rodriguez
- Division of Endocrinology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
- Division of Endocrinology, Rush University Medical Center, Chicago, Illinois
| | - Leon Fogelfeld
- Division of Endocrinology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
- Division of Endocrinology, Rush University Medical Center, Chicago, Illinois
| | - Gary Robertson
- Department of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
48
|
Abstract
Sodium perturbations are a common complication after pituitary surgery, with hyponatremia being the most frequent. Postoperative assessments should be tailored to the early and late periods, and monitoring sodium perturbations is recommended. Cerebral salt wasting is rare after pituitary surgery, and diagnosis and management can be challenging. Providing patient counseling and close postoperative follow-up is important to effectively manage diabetes insipidus and reduce hospital readmissions due to sodium perturbations.
Collapse
Affiliation(s)
- Kevin C J Yuen
- Department of Neuroendocrinology, Barrow Pituitary Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, University of Arizona College of Medicine and Creighton School of Medicine, 124 W Thomas Road, Suite 300, Phoenix, AZ 85013, USA.
| | - Adnan Ajmal
- Department of Internal Medicine and Endocrinology, St. Joseph's Hospital and Medical Center, Creighton University School of Medicine, 500 W Thomas Road, Suite 900B Phoenix, AZ 85013, USA
| | - Ricardo Correa
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Phoenix Veterans Administration Medical Center, University of Arizona College of Medicine, Creighton School of Medicine and Mayo School of Medicine, 650 E Indian School Road, Building 21, Suite 117, Phoenix, AZ 85014, USA
| | - Andrew S Little
- Department of Neurosurgery, Barrow Pituitary Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, University of Arizona College of Medicine, 300 W Thomas Road, Phoenix, AZ 85013, USA
| |
Collapse
|
49
|
Abstract
Hypernatremic dehydration in exclusively breast-fed neonates is associated with a free water deficit secondary to inadequate fluid intake. It is a common but underrecognized problem in the primary care setting, as the degree of dehydration can be underestimated due to fluid shifts. Neonates of primiparous mothers and those who experience greater weight loss in the first week of life are at higher risk of developing hypernatremic dehydration and most often present for care between 6 and 10 days of life. No consensus treatment guidelines exist, but most experts recommend a goal reduction rate of serum sodium levels of 0.5 mEq/L per hour with correction over 48 hours. Serum sodium level greater than 160 mEq/L is a risk factor for morbidity and mortality. Complications of hypernatremic dehydration, with seizure being most common, usually occur during improper correction. Several small studies have documented varying degrees of neurodevelopmental delay on long-term follow-up of patients admitted for hypernatremic dehydration treatment as a neonate. [Pediatr Ann. 2019;48(5):e197-e200.].
Collapse
|
50
|
Butts B, Calhoun DA, Denney TS, Lloyd SG, Gupta H, Gaddam KK, Aban I, Oparil S, Sanders PW, Patel R, Collawn JF, Dell'Italia LJ. Plasma xanthine oxidase activity is related to increased sodium and left ventricular hypertrophy in resistant hypertension. Free Radic Biol Med 2019; 134:343-349. [PMID: 30695690 PMCID: PMC6588431 DOI: 10.1016/j.freeradbiomed.2019.01.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/30/2018] [Accepted: 01/22/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The extra-renal effects of aldosterone on left ventricular (LV) structure and function are exacerbated by increased dietary sodium in persons with hypertension. Previous studies demonstrated endothelial dysfunction and increased oxidative stress with high salt diet in normotensive salt-resistant subjects. We hypothesized that increased xanthine oxidase (XO), a product of endothelial cells, is related to 24-h urinary sodium and to LV hypertrophy and function in patients with resistant hypertension (RHTN). METHODS The study group included persons with RHTN (n = 91), defined as a blood pressure > 140/90 mmHg on ≥ 3 medications at pharmacologically effective doses. Plasma XO activity and 24-h urine were collected, and cardiac magnetic resonance imaging (MRI) was performed to assess LV function and morphology. Sixty-seven normotensive persons on no cardiovascular medications served as controls. A subset of RHTN (n = 19) received spironolactone without salt restriction for six months with follow-up XO activity measurements and MRI analyses. RESULTS XO activity was increased two-fold in RHTN vs. normal and was positively correlated with LV mass, LV diastolic function, and 24-h urinary sodium. In RHTN patients receiving spironolactone without salt restriction, LV mass decreased, but LV diastolic function and XO activity did not improve. Baseline urinary sodium was positively associated with rate of change of LV mass to volume ratio and the LV E/A ratio. CONCLUSIONS These results demonstrate a potential role of endothelium-derived oxidative stress and excess dietary salt in the pathophysiology of LV hypertrophy and diastolic dysfunction in persons with RHTN unaffected by the addition of spironolactone.
Collapse
Affiliation(s)
- Brittany Butts
- Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, USA; Nell Hodgson Woodruff School of Nursing, Emory University, USA
| | - David A Calhoun
- Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, USA
| | - Thomas S Denney
- Department of Electrical and Computer Engineering, Auburn University, USA
| | - Steven G Lloyd
- Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, USA
| | - Himanshu Gupta
- Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, USA; Birmingham Department of Veterans Affairs Medical Center, USA
| | - Krishna K Gaddam
- Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, USA
| | - Inmaculada Aban
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, USA
| | - Paul W Sanders
- Division of Nephrology, University of Alabama at Birmingham School of Medicine, USA
| | - Rakesh Patel
- Center for Free Radical Biology and Department of Pathology, University of Alabama at Birmingham, USA
| | - James F Collawn
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, USA
| | - Louis J Dell'Italia
- Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, USA; Birmingham Department of Veterans Affairs Medical Center, USA.
| |
Collapse
|