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Hyponatremia

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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
https://www.readbyqxmd.com/read/29200139/hyperkalemia-and-acute-kidney-injury-in-an-adolescent-thinking-outside-the-box
#1
Adam Szadkowski, Allison J Pollock, Awni M Al-Subu
Addison disease is a rare endocrine disorder, which typically presents with nonspecific symptoms including weight loss, fatigue, and nausea in conjunction with hyponatremia and hyperkalemia. This case demonstrates key diagnostic clues in evaluation of an adolescent who presented with severe hyperkalemia and acute kidney injury that was resistant to insulin, glucose, and sodium polystyrene sulfonate and was found to have primary adrenal insufficiency.
December 1, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29174200/group-2-adrenal-insufficiency-screening-methods-and-confirmation-of-diagnosis
#2
Philippe Chanson, Laurence Guignat, Bernard Goichot, Olivier Chabre, Dinane Samara Boustani, Rachel Reynaud, Dominique Simon, Antoine Tabarin, Damien Gruson, Yves Reznik, Marie-Laure Raffin Sanson
A diagnosis of adrenal insufficiency should be suspected in the presence of a number of non-specific symptoms (fatigue, anorexia, weight loss, hypotension, hyponatremia and hyperkalemia amongst adrenal causes of insufficiency). The diagnosis should be considered in case of pituitary disease or a state of shock. Treatment should be commenced immediately without waiting for confirmation from biochemical tests, which rely on cortisol level at 8am (expected to be low) and on ACTH level (expected to be high in the case of primary adrenal insufficiency)...
November 22, 2017: Annales D'endocrinologie
https://www.readbyqxmd.com/read/29166900/association-between-borderline-dysnatremia-and-mortality-insight-into-a-new-data-mining-approach
#3
Yannick Girardeau, Anne-Sophie Jannot, Gilles Chatellier, Olivier Saint-Jean
BACKGROUND: Even small variations of serum sodium concentration may be associated with mortality. Our objective was to confirm the impact of borderline dysnatremia for patients admitted to hospital on in-hospital mortality using real life care data from our electronic health record (EHR) and a phenome-wide association analysis (PheWAS). METHODS: Retrospective observational study based on patient data admitted to Hôpital Européen George Pompidou, between 01/01/2008 and 31/06/2014; including 45,834 patients with serum sodium determinations on admission...
November 22, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/29078838/cerebral-salt-wasting-syndrome-diagnosis-by-urine-sodium-excretion
#4
Allen I Arieff, Ramin Gabbai, Ira D Goldfine
BACKGROUND: Cerebral salt-wasting syndrome (CSWS) was initially described over 60 years ago in hyponatremic patients with a cerebral lesion. However, the diagnostic criteria for CSWS have not been fully established. Thus, when hyponatremia is observed in patients with CSWS, they may be misdiagnosed as having the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Thus, it is critical to differentiate between these 2 conditions because their treatments are diametrically opposed...
October 2017: American Journal of the Medical Sciences
https://www.readbyqxmd.com/read/29031361/treatment-of-disorders-of-sodium-balance-in-chronic-kidney-disease
#5
REVIEW
David H Ellison
Extracellular fluid volume expansion is nearly universal in patients with CKD. Such volume expansion has features similar to the syndrome of heart failure with preserved ejection fraction, which not only leads to symptoms but can also lead to further organ damage. Unique treatment challenges are present in this patient population, including low glomerular filtration, which limits sodium chloride filtration, intrinsic tubule predisposition to sodium chloride retention, and proteinuria. In addition, pharmacokinetic considerations alter the disposition of diuretics in patients with CKD and nephrotic syndrome...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28879182/vasopressin-receptor-antagonists-in-hyponatremia-uses-and-misuses
#6
REVIEW
Helbert Rondon-Berrios, Tomas Berl
Decreases in the concentration of sodium in plasma constitute hyponatremia, the commonest electrolyte disorder in clinical medicine. It is now well established that its presence conveys an increased mortality risk even when the decrement is mild. In addition, recent evidence suggests that chronic and apparently asymptomatic hyponatremia is associated with increased morbidity including neurocognitive deficits and bone fractures. Furthermore, hyponatremia is associated with higher health care-related expenses...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28783044/phenotypic-and-pharmacogenetic-evaluation-of-patients-with-thiazide-induced-hyponatremia
#7
James S Ware, Louise V Wain, Sarath K Channavajjhala, Victoria E Jackson, Elizabeth Edwards, Run Lu, Keith Siew, Wenjing Jia, Nick Shrine, Sue Kinnear, Mahli Jalland, Amanda P Henry, Jenny Clayton, Kevin M O'Shaughnessy, Martin D Tobin, Victor L Schuster, Stuart Cook, Ian P Hall, Mark Glover
Thiazide diuretics are among the most widely used treatments for hypertension, but thiazide-induced hyponatremia (TIH), a clinically significant adverse effect, is poorly understood. Here, we have studied the phenotypic and genetic characteristics of patients hospitalized with TIH. In a cohort of 109 TIH patients, those with severe TIH displayed an extended phenotype of intravascular volume expansion, increased free water reabsorption, urinary prostaglandin E2 excretion, and reduced excretion of serum chloride, magnesium, zinc, and antidiuretic hormone...
September 1, 2017: Journal of Clinical Investigation
https://www.readbyqxmd.com/read/28697950/sodium-levels-on-admission-are-associated-with-mortality-risk-in-hospitalized-patients
#8
Amit Akirov, Talia Diker-Cohen, Tali Steinmetz, Oren Amitai, Ilan Shimon
AIMS: Abnormal sodium values are common among hospitalized patients. We aimed to investigate the association of admission sodium values and mortality. METHODS: Historical prospectively data of adult patients hospitalized to medical wards between January 2011 and December 2013. Admission sodium values were classified to five categories: severe hyponatremia (<125mEq/L), mild hyponatremia (125-135mEq/L), normal sodium values (135-145mEq/L), mild hypernatremia (145-150mEq/L) and severe hypernatremia (>150mEq/L)...
July 8, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28619670/hyponatraemia-diagnosis-and-treatment-clinical-practice-guidelines
#9
Goce Spasovski, Raymond Vanholder, Bruno Allolio, Djillali Annane, Steve Ball, Daniel Bichet, Guy Decaux, Wiebke Fenske, Ewout J Hoorn, Carole Ichai, Michael Joannidis, Alain Soupart, Robert Zietse, Maria Haller, Sabine van der Veer, Wim van Biesen, Evi Nagler, Liliana Gonzalez-Espinoza, Alberto Ortiz
Hyponatremia, defined as a serum sodium concentration <135mmol/l, is the most common water-electrolyte imbalance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from mild to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay. Despite this, the management of hyponatremia patients remains problematic. The prevalence of hyponatremia in a wide variety of conditions and the fact that hyponatremia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and specialty-based approaches to diagnosis and treatment...
July 2017: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
https://www.readbyqxmd.com/read/28551002/development-of-a-computer-interpretable-clinical-guideline-model-for-decision-support-in-the-differential-diagnosis-of-hyponatremia
#10
Arturo González-Ferrer, M Ángel Valcárcel, Martín Cuesta, Joan Cháfer, Isabelle Runkle
INTRODUCTION: Hyponatremia is the most common type of electrolyte imbalance, occurring when serum sodium is below threshold levels, typically 135mmol/L. Electrolyte balance has been identified as one of the most challenging subjects for medical students, but also as one of the most relevant areas to learn about according to physicians and researchers. We present a computer-interpretable guideline (CIG) model that will be used for medical training to learn how to improve the diagnosis of hyponatremia applying an expert consensus document (ECDs)...
July 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/28504980/hyperchloremia-is-associated-with-acute-kidney-injury-in-patients-with-subarachnoid-hemorrhage
#11
Ofer Sadan, Kai Singbartl, Prem A Kandiah, Kathleen S Martin, Owen B Samuels
OBJECTIVE: To assess the prevalence of acute kidney injury in patients with subarachnoid hemorrhage patients. DESIGN: Retrospective analysis of all subarachnoid hemorrhage admissions. SETTINGS: Neurocritical care unit. PATIENTS: All patients with a diagnosis of subarachnoid hemorrhage between 2009 and 2014. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 1,267 patients included in this cohort, 16...
August 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28316939/application-of-established-pathophysiologic-processes-brings-greater-clarity-to-diagnosis-and-treatment-of-hyponatremia
#12
EDITORIAL
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
https://www.readbyqxmd.com/read/28303369/clinical-aspects-of-changes-in-water-and-sodium-homeostasis-in-the-elderly
#13
REVIEW
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
https://www.readbyqxmd.com/read/28131601/seasonal-variations-of-hyponatremia-in-the-emergency-department-age-related-changes
#14
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...
May 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28114143/electrolyte-and-acid-base-disorders-in-chronic-kidney-disease-and-end-stage-kidney-failure
#15
REVIEW
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
https://www.readbyqxmd.com/read/28081152/increased-serum-sodium-and-serum-osmolarity-are-independent-risk-factors-for-developing-chronic-kidney-disease-5-year-cohort-study
#16
MULTICENTER STUDY
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
https://www.readbyqxmd.com/read/27616761/a-systematic-literature-search-and-review-of-sodium-concentrations-of-body-fluids%C3%A2
#17
REVIEW
Elaine M Kaptein, Divya Sreeramoju, John S 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
https://www.readbyqxmd.com/read/27404682/high-serum-osmolarity-at-admission-determines-a-worse-outcome-in-patients-with-heart-failure-is-a-new-target-emerging
#18
MULTICENTER STUDY
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
https://www.readbyqxmd.com/read/27213601/-hypernatremia-diagnostics-and-therapy
#19
REVIEW
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
https://www.readbyqxmd.com/read/27220754/associations-of-dysnatremias-with-mortality-in-chronic-kidney-disease
#20
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...
July 1, 2017: Nephrology, Dialysis, Transplantation
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