iatrogenic hypernatraemia

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)...

Although sodium bicarbonate can be a life-saving antidote for patients with overdoses resulting in sodium channel blockade, there has been a concerning rise in cases referred to the Poisons Information Centre where inappropriately large doses of bicarbonate have been used resulting in iatrogenic harm. We present a series of three clinical cases where excessive bicarbonate was used to treat poisonings and discuss our approach to managing cardiotoxicity secondary to sodium channel blockade. Serial blood gas analysis should be performed when using bicarbonate to ensure pH targets are met and severe alkalaemia, hypernatraemia and hypokalaemia are avoided...

OBJECTIVE: To compare the changes in serum sodium and acid/base status in patients receiving hypotonic and isotonic solutions. DESIGN: A randomised, controlled and double-blind clinical trial. SETTING: Department of Paediatrics in a tertiary general hospital (Hospital Universitario Austral) in Buenos Aires, Argentina. PATIENTS: Children between 29 days and 15 years of age who were hospitalised in the paediatric intensive care unit and general hospital between 12 January 2010 and 30 November 2016, and who required exclusively parenteral maintenance solutions for at least 24 hours...

Background : To prevent the risk of iatrogenic hyponatraemia in hospitalised children, isotonic fluid has been recommended as maintenance intravenous fluid (IVF). There are few studies which compare half normal saline with normal saline as maintenance IVF in general paediatric wards. Aim : To compare the safety and efficacy of half normal saline with normal saline as maintenance IVF in general paediatric wards. Methods : Children aged between 3 months and 5 years with an anticipated requirement for IVF for 24 h were randomised to receive either half normal saline (0...

A 66-year-old Caucasian male became unconscious 2 weeks after initiation of add-on therapy with empagliflozin for poorly controlled type 2 diabetes mellitus. The inpatient had recently suffered focal pontine stroke, rendering him bedridden and requiring increased nursing care, including assistance with drinking. The patient had received empagliflozin 10 mg once daily for glycaemic control. Investigations revealed hypernatraemia (164 mmol/l), a urine glucose level of 3935 mg/dl, and a creatinine level of 2...

BACKGROUND: Microsurgical and endoscopic techniques are commonly utilized surgical approaches to pituitary pathologies. There are limited data comparing these 2 procedures. OBJECTIVE: To evaluate postoperative complications, associated costs, and national and regional trends of microscopic and endoscopic techniques in the United States employing a nationwide database. METHODS: The Truven MarketScan database 2010 to 2014 was queried and Current Procedural Terminology codes identified patients that underwent microscopic and/or endoscopic transsphenoidal pituitary surgery...

AIM: Using hypotonic intravenous solutions for baseline fluid needs in paediatric patients on a nil by mouth diet may cause serious complications, including hyponatraemia, cerebral oedema and even death. We analysed the evolution of natraemia and explored any adverse effects on children treated with intravenous isotonic fluids. METHODS: This was a prospective study of 50 patients consecutively admitted to a general paediatric ward who were treated with isotonic intravenous fluids and on a nil by mouth diet...

Hypernatraemia after hypertonic saline irrigation of a hepatitic hydatid cyst is a rare but serious complication. Neurological symptoms and signs are frequently seen in hypernatraemia. However, other symptoms, such as fever, acute pulmonary oedema, congestive cardiac failure and muscular alterations, may appear. It has recently been suggested that hypernatraemia increases the risk of thrombosis.We present the first report of an adult patient who survived a severe acute iatrogenic hypernatraemia and hyper-coagulability resulting from hypertonic saline irrigation of intra-abdominal hydatid cysts...

We present a case of a 51-year-old man with panhypopituarism who developed clinically mild encephalopathy with a lesion in the splenium of the corpus callosum, in the setting of acute influenza A infection. The patient's initial presentation included hypernatraemia due to pre-existing iatrogenic central diabetes insipidus. Despite adequate treatment of hypernatraemia, his course was complicated by otherwise unexplained mild encephalopathy. Brain MRI revealed a diffusion restricted lesion in the splenium of the corpus callosum...

OBJECTIVE: The purpose of this study is to analyse whether the use of hypotonic fluids increases the risk of iatrogenic hyponatraemia in children hospitalised with acute gastroenteritis (AGE). PATIENTS AND METHODS: Prospective study carried out on 205 patients with ages ranging from 1 to 28 months and admitted with a diagnosis of mild or moderate dehydration due to AGE and treated with intravenous hypotonic fluids in a paediatric department in Madrid (Spain). The degree of dehydration at presentation was estimated using standard clinical measures...

Elevated levels of sodium that may be detected in the analysis of post-mortem fluid samples may arise from a wide variety of organic illnesses and environmental factors that have caused either water depletion or solute gain. When hypernatraemia is suspected at autopsy a careful history is required with particular emphasis on pre-existing medical conditions such as renal or gastrointestinal disease. In addition, detailed information is required on the circumstances of death, including any clinical symptoms and signs that the deceased may have manifested, or medical procedures such as dialysis, colonoscopy or intravenous fluid replacement...

OBJECTIVE: To determine the aetiology, symptoms and outcome of extreme sodium derangement in a paediatric inpatient population. METHODOLOGY: A retrospective study of children with extreme disturbance of their plasma sodium (> or = 165 mmol/L or < or = 115 mmol/L) admitted to a tertiary referral centre during a 72-month period. RESULTS: Twenty-seven cases of hypernatraemia and 21 of hyponatraemia were reviewed. Sodium disturbance developed after hospital admission in 27/57 cases (57%)...

Creatinine clearance decreases with age by 1 ml/min/year after 40 years of age, although serum creatinine remains constant because of reduction of muscle mass. Reduction of water intake may occur in the elderly because of a reduced sensation of thirst; this is associated with a tendency to lose water with urine. The capacity to respond to sodium load is impaired in aged kidneys, thereby leading to ECV expansion and hypertension. But there is also, in the elderly, a reduced capacity for retaining sodium (FENa is higher than in young subjects), making old subjects sensitive to salt depletion and ECV contraction...

Current knowledge on renal sodium handling during the neonatal period is reviewed with particular reference to its clinical implications. It has been demonstrated that fractional sodium excretion is inversely proportional to the maturity of the neonate. The high rate of urinary sodium excretion in the low-birth-weight premature infants results in sodium depletion, hyponatraemia and hypoosmolality; evidence has been provided to indicate that it may contribute to the development of late metabolic acidosis, failure to gain weight and impaired function of the central nervous system...

The elderly are at risk of developing hypernatraemia because of age-related changes in renal function and body composition. The pathophysiology and aetiology of hypernatraemia are reviewed with emphasis on iatrogenic factors. A rational approach to management is discussed and clear guidelines for treatment described.

We report a retrospective study of hypernatraemia (serum sodium concentration greater than 150 mmol/l) in an adult in-patient population of a health district during one year. The incidence was 0.3% with at least 60% of cases developing after hospital admission, mainly in elderly patients. Dehydration appeared to be the major cause, with the use of diuretics, depressed conscious level or febrile illness implicated in a majority. Most patients had more than one contributory factor and iatrogenic causes were common...

A seven-week-old infant was found to be hypernatraemic after oral administration of an electrolyte solution. It is recommended that such solutions are not used in the outpatient treatment of children.