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Hyponatremia physiology

Craig Hutto, Mindy French
Dysnatremia is a common finding in the intensive care unit (ICU) and may be a predictor for mortality and poor clinical outcomes. Depending on the time of onset (ie, on admission vs later in the ICU stay), the incidence of dysnatremias in critically ill patients ranges from 6.9% to 15%, respectively. The symptoms of sodium derangement and their effect on brain physiology make early recognition and correction paramount in the neurologic ICU. Hyponatremia in brain injured patients can lead to life-threatening conditions such as seizures and may worsen cerebral edema and contribute to alterations in intracranial pressure...
June 2017: Nursing Clinics of North America
Fei Zhou, Ya-Ling Gao, Zheng-Jin Liu, Yi-Qun Hu
BACKGROUND & OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) is a procedure to provide enteral nutrition for critically ill patients. It is commonly used in clinical practice; however, the widespread use of PEG is controversial. Our objective was to evaluate the therapeutic effect of nutritional support by PEG in these critically ill patients. METHODS: A total of 64 critically ill patients including 41 males and 23 females (aged 23-84) were identified by the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system during September 2004 to June 2012...
January 2017: Pakistan Journal of Medical Sciences Quarterly
Caprice Cadacio, Phuong-Thu Pham, Ruchika Bhasin, Anita Kamarzarian, Phuong-Chi Pham
While some electrolyte disturbances are immediately life-threatening and must be emergently treated, others may be delayed without immediate adverse consequences. We discuss a patient with alcoholism and diabetes mellitus type 2 who presented with volume depletion and multiple life-threatening electrolyte and metabolic derangements including severe hyponatremia (serum sodium concentration [SNa] 107 mEq/L), hypophosphatemia ("undetectable," <1.0 mg/dL), and hypokalemia (2.2 mEq/L), moderate diabetic ketoacidosis ([DKA], pH 7...
2017: Case Reports in Nephrology
Daniel C Andreoli, William L Whittier
A reset osmostat as a cause of hyponatremia can be found in a variety of clinical settings, including pulmonary and neurologic diseases, as well as in physiologic circumstances such as pregnancy. This teaching case describes a 72-year-old white man with a long-standing history of self-medicating with desmopressin acetate (DDAVP) who presented with profound hyponatremia. On discontinuation of DDAVP treatment, he was found to have a reset osmostat. The mild hyponatremia persisted on follow-up. We theorize that the reset osmostat may have developed secondary to long-standing DDAVP use...
February 17, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Sheri L Core, Kathleen S Curtis
Body fluid homeostasis requires a complex suite of physiological and behavioral processes. Understanding of the role of the central nervous system (CNS) in integrating these processes has been advanced by research employing immunohistochemical techniques to assess responses to a variety of body fluid challenges. Such techniques have revealed sex/estrogen differences in CNS activation in response to hypotension and hypernatremia. In contrast, it has been difficult to conclusively identify specific CNS areas and neurotransmitter systems that are activated by hyponatremia using these techniques...
January 25, 2017: Physiology & Behavior
Ladan Golestaneh, Joel Neugarten, William Southern, Faraj Kargoli, Amanda Raff
PURPOSE: Hyponatremia is a common electrolyte disorder and is associated with mortality. We examined the frequency of appropriate testing in response to an episode of inpatient hyponatremia in a large urban hospital to better inform our educational intervention. We then evaluated the impact of a live CME activity with a focus on CKD- and ESRD-associated hyponatremia physiology, on diagnostic practices of audience hospitalist attendings. METHODS: We performed a retrospective database analysis of all patients admitted to Montefiore Medical Center in 2014 to examine the performance of hospital staff in response to hyponatremia across all CKD stages...
March 2017: International Urology and Nephrology
Julien Guillaumin, Stephen P DiBartola
This review article discusses normal and abnormal sodium balance in small animals. The terms and concepts central to understanding normal sodium and water balance are presented as well as of the physiology of body fluid compartments and the movement of fluid between those compartments. As dysnatremia is a very common disorder across the spectrum of critically ill patients, the main focus of the article is to present several clinical examples of both acute and chronic hypernatremia and hyponatremia and their practical, clinical management...
March 2017: Veterinary Clinics of North America. Small Animal Practice
Yushui Ma, Likun Hou, Fei Yu, Gaixia Lu, Shanshan Qin, Ruting Xie, Huiqiong Yang, Tingmiao Wu, Pei Luo, Li Chai, Zhongwei Lv, Xiaodong Peng, Chunyan Wu, Da Fu
To clarify the association between carboplatin and electrolyte abnormality, a pooled-analysis was performed with the adverse event reports of non-small cell lung cancer patients. A total of 19901 adverse events were retrieved from the FDA Adverse Event Reporting System (FAERS). Pooled reporting odds ratios (RORs) and 95% CIs suggested that carboplatin was significantly associated with hyponatremia (pooled ROR = 1.57, 95% CI 1.18-2.09, P = 1.99×10-3) and hypokalemia (pooled ROR = 2.37, 95% CI 1.80-3.10, P = 5...
March 14, 2017: Oncotarget
Alladi Mohan, G Sivaram Naik, J Harikrishna, D Prabath Kumar, M H Rao, Kvs Sarma, K K Guntupalli
BACKGROUND & OBJECTIVES: Ingestion of Cleistanthus collinus causes hypokalemia and cardiac arrhythmias leading to mortality in most cases. We undertook this retrospective study to evaluate the clinical presentation and predictors of outcome in critically ill patients admitted with C. collinus poisoning. METHODS: The case records of 56 patients admitted to the medical intensive care unit (MICU) of a tertiary care teaching hospital in south India (2000-2014) with C...
June 2016: Indian Journal of Medical Research
Robert Sümpelmann, Karin Becke, Sebastian Brenner, Christian Breschan, Christoph Eich, Claudia Höhne, Martin Jöhr, Franz-Josef Kretz, Gernot Marx, Lars Pape, Markus Schreiber, Jochen Strauss, Markus Weiss
This consensus- based S1 Guideline for perioperative infusion therapy in children is focused on safety and efficacy. The objective is to maintain or re-establish the child's normal physiological state (normovolemia, normal tissue perfusion, normal metabolic function, normal acid- base- electrolyte status). Therefore, the perioperative fasting times should be as short as possible to prevent patient discomfort, dehydration, and ketoacidosis. A physiologically composed balanced isotonic electrolyte solution (BS) with 1-2...
January 2017: Paediatric Anaesthesia
James Bales, Susan Cho, Thao Kim Tran, Gina Alvis Korab, Nita Khandelwal, Charles F Spiekerman, Aaron M Joffe
BACKGROUND: Hyponatremia is common in patients with subarachnoid hemorrhage, but its effect on outcomes remains contentious. Fluctuation in sodium has been reported to negatively affect perioperative outcomes in general surgical patients, but not specifically in patients with a subarachnoid hemorrhage. The primary aim was to describe the relationship between 1) hyponatremia and/or 2) sodium fluctuations during intensive care and neurologic outcome at hospital discharge. METHODS: Adults suffering aneurysmal subarachnoid hemorrhage between January 2012 and September 2013 were retrospectively reviewed...
September 13, 2016: World Neurosurgery
Jennifer S Hanberg, Veena Rao, Jozine M Ter Maaten, Olga Laur, Meredith A Brisco, F Perry Wilson, Justin L Grodin, Mahlet Assefa, J Samuel Broughton, Noah J Planavsky, Tariq Ahmad, Lavanya Bellumkonda, W H Wilson Tang, Chirag R Parikh, Jeffrey M Testani
BACKGROUND: Recent epidemiological studies have implicated chloride, rather than sodium, as the driver of poor survival previously attributed to hyponatremia in heart failure. Accumulating basic science evidence has identified chloride as a critical factor in renal salt sensing. Our goal was to probe the physiology bridging this basic and epidemiological literature. METHODS AND RESULTS: Two heart failure cohorts were included: (1) observational: patients receiving loop diuretics at the Yale Transitional Care Center (N=162) and (2) interventional pilot: stable outpatients receiving ≥80 mg furosemide equivalents were studied before and after 3 days of 115 mmol/d supplemental lysine chloride (N=10)...
August 2016: Circulation. Heart Failure
F Grundmann
Disturbances of water and electrolyte balance are commonly encountered in older patients due to a multitude of physiological changes and preexisting morbidities with hyponatremia being the most common disorder. Even mild chronic hyponatremia can lead to cognitive deficits and gait instability and is associated with an increased rate of falls and fractures. Additionally, experimental and epidemiological data suggest that hyponatremia promotes bone resorption and therefore increases the risk of osteoporosis. Furthermore, osteoporosis and sarcopenia can be stimulated by hypomagnesemia...
August 2016: Zeitschrift Für Gerontologie und Geriatrie
Rui Zhang, Songyan Wang, Mian Zhang, Lijuan Cui
Hyponatremia is a common condition encountered in clinical practice. A number of studies have associated low serum sodium levels with increased mortality in various patient populations, such as hospitalized patients and patients with various comorbid conditions; recent studies have shown that individuals with chronic kidney disease also are afflicted by hyponatremia. However, few studies have focused on patients with hemodialysis. Evidence supporting the incidence and prevalence of hyponatremia, clinical characteristics and the association with patient outcomes with hemodialysis is limited...
January 2017: Hemodialysis International
Helbert Rondon-Berrios, Tomas Berl
Hyponatremia, the most common electrolyte disorder in hospitalized patients is associated with increased risk of mortality even when mild and apparently asymptomatic. Likewise morbidity manifested as attention deficits, gait disturbances, falls, fractures, and osteoporosis is more prevalent in hyponatremic subjects. Hyponatremia also generates a significant financial burden. Therefore, it is important to explore approaches that effectively and safely treat hyponatremia. Currently available strategies are physiologically sound and affordable but lack evidence from clinical trials and are limited by variable efficacy, slow response, and/or poor compliance...
March 2016: Best Practice & Research. Clinical Endocrinology & Metabolism
Melissa Lee, Briana Vecchio-Pagán, Neeraj Sharma, Abdul Waheed, Xiaopeng Li, Karen S Raraigh, Sarah Robbins, Sangwoo T Han, Arianna L Franca, Matthew J Pellicore, Taylor A Evans, Kristin M Arcara, Hien Nguyen, Shan Luan, Deborah Belchis, Jozef Hertecant, Joseph Zabner, William S Sly, Garry R Cutting
Elevated sweat chloride levels, failure to thrive (FTT), and lung disease are characteristic features of cystic fibrosis (CF, OMIM #219700). Here we describe variants in CA12 encoding carbonic anhydrase XII in two pedigrees exhibiting CF-like phenotypes. Exome sequencing of a white American adult diagnosed with CF due to elevated sweat chloride, recurrent hyponatremia, infantile FTT and lung disease identified deleterious variants in each CA12 gene: c.908-1 G>A in a splice acceptor and a novel frameshift insertion c...
May 15, 2016: Human Molecular Genetics
Yonghwang Ha, Jeong A Jeong, Youngsam Kim, David G Churchill
Alkali metals, especially sodium and potassium, are plentiful and vital in biological systems. They take on important roles in health and disease. Such roles include the regulation of homeostasis, osmosis, blood pressure, electrolytic equilibria, and electric current. However, there is a limit to our present understanding; the ions have a great ability and capacity for action in health and disease, much greater than our current understanding. For the regulation of physiological homeostasis, there is a crucial regulator (renin-angiotensin system, RAS), found at both peripheral and central levels...
2016: Metal Ions in Life Sciences
Shang-Lin Chou, Ming-Yueh Chou, Yu-Hsuan Wang, Fon-Chu Kuo, Wei-Fong Kao
BACKGROUND: Several changes in physiological characteristics occur during long-distance and 24-hour ultramarathons, including hyponatremia, skeletal muscle breakdown, plasma volume changes, iron depletion, anemia, and possible hepatic damage. The purpose of this study was to investigate the impact of hepatitis B virus (HBV) carrier status on liver function during multi-day races. METHODS: This prospective study recruited 10 Taiwanese runners who were scheduled to participate in the 7-day 2008 Athens Ultramarathon Festival Race, and three of them were chronic carriers of HBV...
April 2016: Journal of the Chinese Medical Association: JCMA
Anibal Basile-Filho, Mayra Goncalves Menegueti, Edson Antonio Nicolini, Alessandra Fabiane Lago, Edson Zangiacomi Martinez, Maria Auxiliadora-Martins
BACKGROUD: The dysnatremias (hyponatremia and hypernatremia) are relatively common findings on admission of intensive care unit (ICU) patients and may represent a major risk. The aim of the study was to assess the ability of serum sodium levels and the Acute Physiology and Chronic Health Evaluation II (APACHE II) to predict mortality of surgical critically ill patients. METHODS: One hundred and ninety-five surgical patients (62% males and 38% females; mean age of 51...
February 2016: Journal of Clinical Medicine Research
Andrew H Coles, Mayra Tisminetzky, Jorge Yarzebski, Darleen Lessard, Joel M Gore, Chad E Darling, Robert J Goldberg
BACKGROUND: Limited data exist about the magnitude of and the factors associated with prognosis within 1 year for patients discharged from the hospital after acute decompensated heart failure. Data are particularly limited from the more generalizable perspective of a population-based investigation and should be further stratified according to currently recommended ejection fraction (EF) findings. METHODS AND RESULTS: The hospital medical records of residents of the Worcester, Massachusetts, metropolitan area who were discharged after acute decompensated heart failure from all 11 medical centers in central Massachusetts during 1995, 2000, 2002, 2004, and 2006 were reviewed...
December 2015: Journal of the American Heart Association
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