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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
John K Maesaka, Louis J Imbriano, Nobuyuki Miyawaki
Hyponatremia, serum sodium < 135 mEq/L, is the most common electrolyte abnormality and is in a state of flux. Hyponatremic patients are symptomatic and should be treated but our inability to consistently determine the causes of hyponatremia has hampered the delivery of appropriate therapy. This is especially applicable to differentiating syndrome of inappropriate antidiuresis (SIAD) from cerebral salt wasting (CSW) or more appropriately, renal salt wasting (RSW), because of divergent therapeutic goals, to water-restrict in SIAD and administer salt and water in RSW...
March 6, 2017: World Journal of Nephrology
Christian A Koch, Tibor Fulop
The population of elderly individuals is increasing worldwide. With aging, various hormonal and kidney changes occur, both affecting water homeostasis. Aging is a risk factor for chronic kidney disease (CKD) and many features of CKD are reproduced in the aging kidney. Dehydration and hyperosmolarity can be triggered by diminished thirst perception in this population. Elderly with dementia are especially susceptible to abnormalities of their electrolyte and body water homeostasis and should be (re-)assessed for polypharmacy...
March 2017: Reviews in Endocrine & Metabolic Disorders
Mauro Giordano, Tiziana Ciarambino, Pietro Castellino, Lorenzo Malatino, Alessandro Cataliotti, Luca Rinaldi, Giuseppe Paolisso, Luigi Elio Adinolfi
STUDY OBJECTIVE: We investigated seasonal prevalence of hyponatremia in the emergency department (ED). DESIGN: A cross-sectional study using clinical chart review. SETTING: University Hospital ED, with approximately 28 000 patient visits a year. TYPE OF PARTICIPANTS: We reviewed 15 049 patients, subdivided in 2 groups: the adult group consisting of 9822 patients aged between 18 and 64years old and the elderly group consisting of 5227 patients aged over 65years presenting to the ED between January 1st, 2014 and December 31st, 2015...
January 15, 2017: American Journal of Emergency Medicine
Tsering Dhondup, Qi Qian
The kidneys play a pivotal role in the regulation of electrolyte and acid-base balance. With progressive loss of kidney function, derangements in electrolytes and acid-base inevitably occur and contribute to poor patient outcomes. As chronic kidney disease (CKD) has become a worldwide epidemic, medical providers are increasingly confronted with such problems. Adequate diagnosis and treatment will minimize complications and can potentially be lifesaving. In this review, we discuss the current understanding of the disease process, clinical presentation, diagnosis and treatment strategies, integrating up-to-date knowledge in the field...
2017: Blood Purification
Masanari Kuwabara, Ichiro Hisatome, Carlos A Roncal-Jimenez, Koichiro Niwa, Ana Andres-Hernando, Thomas Jensen, Petter Bjornstad, Tamara Milagres, Christina Cicerchi, Zhilin Song, Gabriela Garcia, Laura G Sánchez-Lozada, Minoru Ohno, Miguel A Lanaspa, Richard J Johnson
BACKGROUND: Epidemics of chronic kidney disease (CKD) not due to diabetes mellitus (DM) or hypertension have been observed among individuals working in hot environments in several areas of the world. Experimental models have documented that recurrent heat stress and water restriction can lead to CKD, and the mechanism may be mediated by hyperosmolarity that activates pathways (vasopressin, aldose reductase-fructokinase) that induce renal injury. Here we tested the hypothesis that elevated serum sodium, which reflects serum osmolality, may be an independent risk factor for the development of CKD...
2017: PloS One
Elaine M Kaptein, Divya Sreeramoju, John M Kaptein, Matthew J Kaptein
BACKGROUND: Wide ranges of sodium concentrations for different body fluid losses have been noted with minimal substantiating data and variability among sources, leading to use of "cumulative fluid balance" regardless of composition in hospitalized patients. AIMS: To define the sodium concentrations of fluid losses from the body. METHOD: We performed a systematic search and literature review in adult humans using PubMed database. RESULTS: Inclusion criteria were met for 107 full-text articles...
October 2016: Clinical Nephrology
José Carlos Arévalo-Lorido, Juana Carretero Gómez, Francesc Formiga, Alicia Conde-Martel, Margarita Carrera-Izquierdo, Alberto Muela-Molinero, Melitón Francisco Dávila-Ramos, Ana Serrado-Iglesias, Luis Manzano-Espinosa, Manuel Montero-Pérez-Barquero
AIMS: The osmolarity of human serum is restricted to a tightly regulated range, and any deviation has clinical implications. Our aim in this study was to establish whether differences in serum osmolarity in heart failure (HF) patients are related with a worse outcome. METHODS: We evaluated the prognostic value of serum osmolarity in patients with HF from the Spanish National Registry on Heart Failure (RICA), a multicenter, prospective registry that enrolls patients admitted for decompensated HF and follows them for 1year...
October 15, 2016: International Journal of Cardiology
Christian Arndt, Hinnerk Wulf
Hypernatremia is a common electrolyte disorder that reflects an imbalance in the water balance of the body, often resulting from an increased loss of free water compared to sodium excretion. It is rarely based on excessive sodium intake. The clinical presentation is often characterized by a central nervous system dysfunction (confusion, coma) and pronounced thirst (in awake patients). In addition to medical history, the volume status of the patient and the osmolality of urine are leading in the differential diagnosis...
May 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Haiquan Huang, Stacey E Jolly, Medha Airy, Susana Arrigain, Jesse D Schold, Joseph V Nally, Sankar D Navaneethan
BACKGROUND: Hyponatremia and hypernatremia are associated with death in the general population and those with chronic kidney disease (CKD). We studied the associations between dysnatremias, all-cause mortality and causes of death in a large cohort of Stage 3 and 4 CKD patients. METHODS: We included 45 333 patients with Stage 3 and 4 CKDs followed in a large healthcare system. Associations between hyponatremia (<136 mmol/L) and hypernatremia (>145), and all-cause mortality and causes of death (cardiovascular, malignancy related and non-cardiovascular/non-malignancy related) were studied using Cox proportional hazards and competing risk models...
May 24, 2016: Nephrology, Dialysis, Transplantation
Joseph G Verbalis, Arthur Greenberg, Volker Burst, Jean-Philippe Haymann, Gudmundur Johannsson, Alessandro Peri, Esteban Poch, Joseph A Chiodo, Jiten Dave
BACKGROUND: The syndrome of inappropriate antidiuretic hormone secretion is the most common cause of hyponatremia in clinical practice, but current management of hyponatremia and outcomes in patients with syndrome of inappropriate antidiuretic hormone secretion are not well understood. The objective of the Hyponatremia Registry was to assess the current state of management of hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion in diverse hospital settings, specifically which diagnostic and treatment modalities are currently used and how rapidly and reliably they result in an increase in serum sodium concentration ([Na(+)])...
May 2016: American Journal of Medicine
Diana Yuan Yng Chiu, Philip A Kalra, Smeeta Sinha, Darren Green
AIMS: The prevalence of hyponatraemia in the outpatient setting has not been thoroughly explored, and little is known about the prognostic implication of dysnatraemia in chronic kidney disease (CKD) patients, in particular accommodating the effect of concurrent medications. METHODS: This is a prospective observational study of non-dialysis-dependent CKD patients managed in a nephrology clinic. Patients enrolled between 2002 and 2012 in the Chronic Renal Insufficiency Standards Implementation Study were assessed...
June 2016: Nephrology
Connie M Rhee, Vanessa A Ravel, Juan Carlos Ayus, John J Sim, Elani Streja, Rajnish Mehrotra, Alpesh N Amin, Danh V Nguyen, Steven M Brunelli, Csaba P Kovesdy, Kamyar Kalantar-Zadeh
BACKGROUND: A consistent association between low serum sodium measured at a single-point-in-time (baseline sodium) and higher mortality has been observed in hemodialysis patients. We hypothesized that both low and high time-varying sodium levels (sodium levels updated at quarterly intervals as a proxy of short-term exposure) are independently associated with higher death risk in hemodialysis patients. METHODS: We examined the association of baseline and time-varying pre-dialysis serum sodium levels with all-cause mortality among adult incident hemodialysis patients receiving care from a large national dialysis organization during January 2007-December 2011...
June 2016: Nephrology, Dialysis, Transplantation
Jens Titze, Natalia Rakova, Christoph Kopp, Anke Dahlmann, Jonathan Jantsch, Friedrich C Luft
Sodium balance is achieved within a matter of days and everything that enters should come out; sodium stores are of questionable relevance and sodium accumulation is accompanied by weight gain. Careful balance studies oftentimes conflicted with this view, and long-term studies suggested that total body sodium (TBNa) fluctuates independent of intake or body weight. We recently performed the opposite experiment in that we fixed sodium intake for weeks at three levels of sodium intake and collected all urine made...
July 2016: Nephrology, Dialysis, Transplantation
Vikash K Sinha, Benjamin Ko
Cirrhosis is characterized by systemic and splanchnic vasodilation that leads to excessive nonosmotic secretion of vasopressin (antidiuretic hormone). Hyponatremia is a common electrolyte abnormality in advanced liver disease that results from the impaired ability of the kidney to excrete solute-free water that leads to "dilutional" hyponatremia-water retention disproportionate to the retention of sodium. Hyponatremia in liver diseases carries the prognostic burden, correlates with the severity of cirrhosis, and, in recent studies, has also been implicated in the pathogenesis of hepatic encephalopathy...
September 2015: Advances in Chronic Kidney Disease
San-E Ishikawa
An exaggerated increase in circulatory blood volume is linked to congestive heart failure. Despite this increase, reduction of the "effective circulatory blood volume" in congestive heart failure is associated with decreased cardiac output, and can weaken the sensitivity of baroreceptors. Thereafter, tonic inhibition of the baroreceptor-mediated afferent pathway of vagal nerves is removed, providing an increase in non-osmotic release of arginine vasopressin (AVP). In the renal collecting duct, the aquaporin-2 (AQP2) water channel is regulated by sustained elevation of AVP release, and this leads to augmented hydroosmotic action of AVP, that results in exaggerated water retention and dilutional hyponatremia...
2015: Journal of Clinical Medicine
Renata S Mendes, Márcio Soares, Carla Valente, José Hermógenes Suassuna, Eduardo Rocha, Elizabeth R Maccariello
BACKGROUND AND OBJECTIVES: The present study aimed to evaluate the prognostic impact of predialysis dysnatremia in patients with acute kidney injury requiring renal replacement therapy (RRT). DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: A secondary analysis of a prospective multicenter cohort study was performed. Serum sodium (Na) concentrations were categorized immediately before the first RRT as normonatremia (135≤Na ≤145mEq/L), hyponatremia (mild [130≤Na ≤134mEq/L] or severe [Na ≤129mEq/L]), and hypernatremia (mild [146≤Na ≤155mEq/L] or severe [Na ≥156mEq/L])...
October 2015: Journal of Critical Care
Volker Burst, Johannes Hensen
Guidelines have become very common in modern medicine. Their primary aim should be to provide evidence-based guidance and insight and to help to convey the best possible care to patients. As a consequence, guidelines also play a critical role in liability issues. Hyponatremia is a frequently encountered condition which is considered challenging by many physicians. It is therefore highly appreciated, that two interdisciplinary guidelines on hyponatremia have been published recently. Unfortunately, the given recommendations differ substantially...
April 2015: Deutsche Medizinische Wochenschrift
C S Haas
Hyponatremia is the most commonly occurring electrolyte disorder and is associated with increased morbidity and mortality—independent of the underlying disease. Despite its high prevalence, hyponatremia is often underestimated and inadequately addressed in clinical routine. Depending on disease stage and severity, the electrolyte disorder can present with a wide spectrum of neurological signs and symptoms, ranging from adynamia and gait disturbances, to syncope or coma. While the underlying causes of hyponatremia may be manifold, their identification is crucial to initiating adequate therapeutic measures for symptomatic and causal therapy...
December 2014: Der Internist
Horacio J Adrogué, Nicolaos E Madias
No abstract text is available yet for this article.
November 2014: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
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