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hypernatremia guidelines

Maulee Hiromi Arambewela, Noel P Somasundaram, Chaminda Garusinghe
BACKGROUND: Hypernatremia is a frequent occurrence among hospitalized patients. Severe hypernatremia is associated with mortality rates of over 60 %. Extreme hypernatremia, defined as sodium levels >190 mmol/l, is a rare occurrence. The literature on electrocardiographic changes occurring with this degree of hypernatremia is extremely scarce. We report the case of an 11-year-old Sri Lankan girl who presented with sodium levels of 226 mmol/l following infusion with 3 % hypertonic saline who developed diffuse QT prolongation leading to fatal ventricular tachycardia...
October 1, 2016: Journal of Medical Case Reports
Amanda E Hagan, Crystal A Farrington, Geoffrey C Wall, Mark M Belz
BACKGROUND: Hyperkalemia is a common problem in hospitalized patients, especially those with underlying chronic kidney disease, but evidence-based guidelines for its treatment are lacking. Sodium polystyrene sulfonate (SPS), a cation exchange resin first approved by the FDA for the treatment of hyperkalemia in 1958, is frequently used alone or in conjunction with other medical therapies to lower serum potassium. Recently, the safety and efficacy of SPS have come into question based on multiple reported cases of bowel necrosis associated with SPS administration...
January 2016: Clinical Nephrology
Thibault Senterre, Ibrahim Abu Zahirah, Catherine Pieltain, Virginie de Halleux, Jacques Rigo
OBJECTIVES: The aim of the present study was to evaluate electrolyte and mineral homeostasis in very-low-birth-weight (VLBW) infants who received high protein and energy intakes with a unique standardized parenteral nutrition solution containing electrolytes and minerals from birth onward. METHODS: Prospective cohort study in 102 infants with birth weight <1250 g. The evolution of plasma biochemical parameters was described during the first 2 weeks of life. RESULTS: During the first 3 days of life, mean parenteral intakes were 51 ± 8 kcal · kg · day with 2...
October 2015: Journal of Pediatric Gastroenterology and Nutrition
J Hensen
The diuretic tolvaptan has been approved for more than 5 years for the indications of euvolemic hyponatremia due to syndrome of inappropriate antidiuretic hormone (SIADH) secretion. In recent years many patients have been treated with tolvaptan and many physicians could gather practical experience. Other countries, such as the USA had already gained greater experience, also in the indications for hypervolemic hyponatremia. After approval was granted more than 5000 patients worldwide were included in the so-called hyponatremia register and 22 active centers in Germany with 317 patients participated...
July 2015: Der Internist
Fenella G Maggs
Hypernatraemia is a common finding among patients presenting to hospital. The aim of this observational study was to discover what types of patients presented with hypernatraemia and whether they were appropriately managed. The management of hypernatraemia was audited against common standards of care. Hypernatraemia at presentation carries a poor prognosis and in this study management of hypernatraemia was found to be done poorly, possibly because for many patients aggressive management was deemed inappropriate...
June 2014: Clinical Medicine: Journal of the Royal College of Physicians of London
Nikolas Deubner, Dominik Berliner, Anna Frey, Gülmisal Güder, Susanne Brenner, Wiebke Fenske, Bruno Allolio, Georg Ertl, Christiane E Angermann, Stefan Störk
AIMS: To investigate in detail the correlates of dysnatremia, and to estimate its differential prognostic relevance in patients with heart failure with reduced or preserved LVEF. Background Hyponatraemia has been shown to carry important prognostic information in patients with heart failure with reduced left ventricular ejection fraction (LVEF). However, exact serum sodium cut-off levels are not defined and the implications for heart failure with preserved ejection fraction (HF-pEF) are unclear...
October 2012: European Journal of Heart Failure
Matthew E Fink
PURPOSE OF REVIEW: Hyperosmolar therapy is one of the core medical treatments for brain edema and intracranial hypertension, but controversy exists regarding the use of the most common agents, mannitol, and hypertonic saline. This article describes the relative merits and adverse effects of these agents using the best available clinical evidence. RECENT FINDINGS: Mannitol is effective and has been used for decades in the treatment of traumatic brain injury, but it may precipitate acute renal failure if serum osmolarity exceeds 320 mOsm/L...
June 2012: Continuum: Lifelong Learning in Neurology
Wendy L Wright
Sodium and fluid management in the brain injured patient directly impacts cerebral edema and cerebral perfusion pressure. Sodium is a major determinant of neuronal size and therefore hyponatremia is aggressively avoided, as hypoosmolar states result in cerebral edema. Negative fluid balance is often avoided because resultant drop in cerebral perfusion pressure can contribute to cerebral ischemia, further inducing secondary neuronal injury. Patients with brain injury are at risk for disorders of sodium and fluid balance (eg, syndrome of inappropriate antidiuresis, cerebral salt wasting, and diabetes insipidus)...
August 2012: Current Neurology and Neuroscience Reports
Harpal Singh, Ankit Parakh, Srikanta Basu, Bimbadarh Rath
UNLABELLED: Plasmodium vivax (Pv) malaria is being increasingly recognized as a cause of severe malaria in children. OBJECTIVES: To describe the various severe manifestations associated with vivax malaria by retrospective analysis of records. METHODS: Children between the ages of 0 and 18 years with a confirmed diagnosis of Pv malaria monoinfection done by peripheral blood film (PBF) and/or rapid diagnostic test (RDT) admitted between June and September 2009 were included...
June 2011: Journal of Infection and Public Health
Hala M Alshayeb, Arif Showkat, Fatima Babar, Therese Mangold, Barry M Wall
INTRODUCTION: Hypernatremia is a common problem in hospitalized patients and is associated with high morbidity and mortality. This study was designed to evaluate whether physicians follow the recommended guidelines for the rate of correction of hypernatremia of ≤0.5 mEq/L/hr and to evaluate the effect of the rate of correction of severe hypernatremia on the mortality of hospitalized patients. METHODS: A retrospective chart review of 131 consecutively hospitalized patients with severe hypernatremia (serum sodium ≥155 mEq/L) was performed...
May 2011: American Journal of the Medical Sciences
Alice J Braga, Amber E R Young
BACKGROUND: The incidence of venous thromboembolic (VTE) events in children has increased in recent years (J Neurosurg, 101, 2004, 32; J Thromb Haemost, 1, 2003, 1443) yet there is currently no consensus as to what VTE prophylaxis, if any, should be applied to the pediatric population. OBJECTIVES/AIMS: Our aim was to audit current practice in pediatric VTE prophylaxis across England and Wales and to advocate simple measures for prevention. We illustrate the importance of the condition with a series of cases from the South West Paediatric Burns and Neurosurgical Services based in Bristol...
April 2011: Paediatric Anaesthesia
Asad E Patanwala, Albert Amini, Brian L Erstad
PURPOSE: The use of hypertonic saline injection in trauma patients is discussed. SUMMARY: Patients with hemorrhage, burns, and traumatic brain injury (TBI) may develop hypovolemic shock and require resuscitation. Compared with conventional isotonic crystalloids, hypertonic saline has several advantages, including hemodynamic, immune-modulating, and antiinflammatory effects, for use in trauma patients for resuscitation. In addition, hypertonic saline is also used in patients with TBI to reduce intracranial pressure (ICP)...
November 15, 2010: American Journal of Health-system Pharmacy: AJHP
Arthur J Siegel, Pierre d'Hemecourt, Marvin M Adner, Terry Shirey, Jeffrey L Brown, Kent B Lewandrowski
Dysnatremia may cause life-threatening encephalopathy in marathon runners. Hypernatremia and exercise-associated hyponatremia (EAH) may manifest with mental status changes and, if untreated, progress to coma and death. We reviewed the on-site blood sodium testing and treatment in collapsed runners at the finish-line medical tent at the Boston marathons from 2001 through 2008. Dysnatremia was diagnosed in 429 (32.5%) of 1,319 collapsed runners. Hypernatremia was present in 366 (27.7%) and hyponatremia in 63 (4...
September 2009: American Journal of Clinical Pathology
Helio Autran de Morais, Stephen P DiBartola
This article serves as a quick reference for hypernatremia. Guidelines for analysis and causes, signs, and a stepwise approach are presented.
May 2008: Veterinary Clinics of North America. Small Animal Practice
Anjana Perianayagam, Richard H Sterns, Stephen M Silver, Marvin Grieff, Robert Mayo, John Hix, Ruth Kouides
BACKGROUND AND OBJECTIVES: Adherence to therapeutic guidelines for the treatment of hyponatremia becomes difficult when water diuresis emerges during therapy. The objective of this study was to assess the effectiveness and safety of desmopressin acetate as a therapeutic agent to avoid overcorrection of hyponatremia and to lower the plasma sodium concentration again after inadvertent overcorrection. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Retrospective chart review was conducted of all patients who were given desmopressin acetate during the treatment of hyponatremia during 6 yr in a 528-bed community teaching hospital...
March 2008: Clinical Journal of the American Society of Nephrology: CJASN
Jessica Carpenter, Steve Weinstein, John Myseros, Gilbert Vezina, Michael J Bell
INTRODUCTION: For years, the maintenance of normal or supranormal serum sodium (Na) concentrations has been believed to be beneficial in brain injuries. Recently published guidelines for cerebral trauma recommend the use of hypertonic saline to achieve hypernatremia for the management of increased intracranial pressure and these standards are generally practiced across most diseases in neurocritical care including stroke, hemorrhage and tumors. Severe hyponatremia has long been known to be detrimental, but objective evidence for the harm of mild hyponatremia as a secondary injury has been scarce...
2007: Neurocritical Care
Neena Modi
No abstract text is available yet for this article.
June 2007: Archives of Disease in Childhood
D M Alscher, K Herrlinger, E F Stange
The intestines and kidney are the most important excretion organs. Both organ systems are key players in keeping the homeostatic balance regarding hydration and electrolytes. Disturbances of function can lead to enormous and sometimes life-threatening complications. Intestinal diseases lead often to diarrhoea, which can be associated with fluid loss of up to 20 l per day. The accompanying electrolyte disturbances can be hypo- or hypernatremia in combination with hypokalemia. The therapy is substitution guided by knowledge of the pathophysiology...
November 2006: Der Internist
Steven G Achinger, Michael L Moritz, Juan Carlos Ayus
Dysnatremias are a common clinical entity that are often associated with poor outcomes. This review takes a case study approach to understand how dysnatremias can result in devastating neurologic consequences. Concrete guidelines are provided for prevention, early recognition and treatment along with a discussion of how urinary electrolytes and osmolality can be used to guide therapy. Case studies in hyponatremic encephalopathy include the post-operative state, thiazide diuretics, extreme exercise and DDAVP use...
April 2006: Southern Medical Journal
M A Martínez Olmos, M J Martínez Vázquez, M Montero Hernández, P Siquier Homar, J Valdueza Beneitez, M J Morales Gorría, M J Arbones Fernández-Vega, E Pena González, M T Inaraja Bobo
INTRODUCTION: In total parenteral nutrition (TPN) nutritional support multidisciplinary teams (NSMT) must provide a high quality nutritional assistance based on evidence and daily follow-up of patients with TPN. OBJECTIVES: To assess the degree of adherence to quality standards of care provided to patients on TPN by the NSMT in two consecutive annual periods, according to structure, procedure, and outcomes indicators, previously defined in the team working protocol...
January 2006: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
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