collection
https://read.qxmd.com/read/34938749/dysnatremias-in-chronic-kidney-disease-pathophysiology-manifestations-and-treatment
#21
REVIEW
Soraya Arzhan, Susie Q Lew, Todd S Ing, Antonios H Tzamaloukas, Mark L Unruh
The decreased ability of the kidney to regulate water and monovalent cation excretion predisposes patients with chronic kidney disease (CKD) to dysnatremias. In this report, we describe the clinical associations and methods of management of dysnatremias in this patient population by reviewing publications on hyponatremia and hypernatremia in patients with CKD not on dialysis, and those on maintenance hemodialysis or peritoneal dialysis. The prevalence of both hyponatremia and hypernatremia has been reported to be higher in patients with CKD than in the general population...
2021: Frontiers in Medicine
https://read.qxmd.com/read/34784242/tissue-sodium-storage-in-patients-with-heart-failure-a-new-therapeutic-target
#22
JOURNAL ARTICLE
Sandrine Lemoine, Fabio R Salerno, Alireza Akbari, Robert S McKelvie, Christopher W McIntyre
BACKGROUND: Preclinical data suggest sodium deposited (without water) in tissues may lead to aberrant remodeling and systemic inflammation, independently of fluid overload in patients with heart failure (HF). Tissue salt storage can be measured noninvasively and quantitatively with 23 Na-magnetic resonance imaging. We aimed to investigate the possibility that patients with HF complicated by renal dysfunction are subject to higher tissue sodium concentration exposure than patients with chronic kidney disease alone...
November 2021: Circulation. Cardiovascular Imaging
https://read.qxmd.com/read/34603798/total-body-sodium-balance-in-chronic-kidney-disease
#23
REVIEW
Kylie Martin, Sven-Jean Tan, Nigel D Toussaint
Excess sodium intake is a leading but modifiable risk factor for mortality, with implications on hypertension, inflammation, cardiovascular disease, and chronic kidney disease (CKD). This review will focus mainly on the limitations of current measurement methods of sodium balance particularly in patients with CKD who have complex sodium physiology. The suboptimal accuracy of sodium intake and excretion measurement is seemingly more marked with the evolving understanding of tissue (skin and muscle) sodium. Tissue sodium represents an extrarenal influence on sodium homeostasis with demonstrated clinical associations of hypertension and inflammation...
2021: International Journal of Nephrology
https://read.qxmd.com/read/34599374/-hypo-and-hypernatremia-in-the-intensive-care-unit-pitfalls-in-volume-management
#24
REVIEW
Johannes Schilling, Friederike Compton, Kai Schmidt-Ott
Hypo- and hypernatremias are very frequent in intensive care unit (ICU) patients and are closely related to volume disturbances and volume management in the ICU. They are associated with longer ICU stays and significant increases in mortality. Treating them is more complex than it may initially appear. Hyponatremias are differentiated based on tonicity and volume status. With hypertonic and isotonic hyponatremias, the primary focus of treatment is the underlying hyperglycemia. In case of hypotonic hypovolemic hyponatremia, the condition is treated with balanced crystalloid solutions...
November 2021: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://read.qxmd.com/read/34528418/-hyponatremia-and-thiazides
#25
JOURNAL ARTICLE
Sonia Bensabre, Sofia Zisimopoulou, Antoinette Pechère-Bertschi
Thiazide diuretics (hydrochlorothiazide) and « thiazide-like » (chlorthalidone, indapamide) are widely prescribed due to their effectiveness in the treatment of arterial hypertension. The use of thiazides may be complicated by hyponatremia that is associated with increased morbidity and mortality. The pathophysiology of thiazide-induced hyponatremia is not yet clear. It is currently difficult to predict who will develop thiazide-induced hyponatremia. Genetic predisposition is considered, and several studies are attempting to clarify it in order to identify patients at risk of developing hyponatremia after taking a thiazide...
September 15, 2021: Revue Médicale Suisse
https://read.qxmd.com/read/34520642/a-comparison-of-community-acquired-and-hospital-acquired-hypernatraemia-in-patients-who-are-acutely-admitted-to-hospital
#26
JOURNAL ARTICLE
M Brennan, L Mulkerrin, D Wall, P M O' Shea, E C Mulkerrin
Background Hypernatraemia is associated with a short-term mortality of 20-60%. Age-related physiological changes predispose patients to hypernatraemia. This study reviewed acutely admitted patients comparing those with community-acquired (CAH) and hospital-acquired hypernatraemia (HAH). Methods A retrospective study of 102 consecutive acute medical in-patients with serum [Na]>145 mmol/L was conducted. Baseline characteristics, clinical presentation, laboratory values, monitoring, management and outcomes were compared between CAH and HAH groups...
August 19, 2021: Irish Medical Journal
https://read.qxmd.com/read/34510658/magnetic-resonance-imaging-determination-of-tissue-sodium-in-patients-with-chronic-kidney-disease
#27
REVIEW
Kylie Martin, Sven-Jean Tan, Nigel D Toussaint
Excess sodium is a major modifiable contributor to hypertension and cardiovascular risk. Knowledge of sodium storage and metabolism has derived mainly from indirect measurements of dietary sodium intake and urinary sodium excretion, however both attempt to measure body sodium and fluid in a two-compartment model of intracellular and extracellular spaces. Our understanding of total body sodium has recently included a storage pool in tissues. In the last two decades, sodium-23 magnetic resonance imaging (23 Na MRI) has allowed dynamic quantification of tissue sodium in vivo...
February 2022: Nephrology
https://read.qxmd.com/read/34508830/hypertonic-saline-for-hyponatremia-meeting-goals-and-avoiding-harm
#28
JOURNAL ARTICLE
Helbert Rondon-Berrios, Richard H Sterns
Hypertonic saline has been used for the treatment of hyponatremia for nearly a century. There is now general consensus that hypertonic saline should be used in patients with hyponatremia associated with moderate or severe symptoms to prevent neurological complications. However, much less agreement exists among experts regarding other aspects of its use. Should hypertonic saline be administered as a bolus injection or continuous infusion? What is the appropriate dose? Is a central venous line necessary? Should desmopressin be used concomitantly and for how long? This article considers these important questions, briefly explores the historical origins of hypertonic saline use for hyponatremia, and reviews recent evidence behind its indications, dosing, administration modality and route, combined use with desmopressin to prevent rapid correction of serum sodium, and other considerations such as the need and degree for fluid restriction...
June 2022: American Journal of Kidney Diseases
https://read.qxmd.com/read/34414205/acute-and-chronic-hyponatremia
#29
REVIEW
Murad Kheetan, Iheanyichukwu Ogu, Joseph I Shapiro, Zeid J Khitan
Hyponatremia is the most common electrolyte disorder in clinical practice. Catastrophic complications can occur from severe acute hyponatremia and from inappropriate management of acute and chronic hyponatremia. It is essential to define the hypotonic state associated with hyponatremia in order to plan therapy. Understanding cerebral defense mechanisms to hyponatremia are key factors to its manifestations and classification and subsequently to its management. Hypotonic hyponatremia is differentiated on the basis of urine osmolality, urine electrolytes and volume status and its treatment is decided based on chronicity and the presence or absence of central nervous (CNS) symptoms...
2021: Frontiers in Medicine
https://read.qxmd.com/read/34390572/association-of-pre-eskd-hyponatremia-with-post-eskd-outcomes-among-incident-eskd-patients
#30
JOURNAL ARTICLE
Maria V Marroquin, John Sy, Carola-Ellen Kleine, Justin Oveyssi, Jui-Ting Hsiung, Christina Park, Melissa Soohoo, Csaba P Kovesdy, Connie M Rhee, Elani Streja, Kamyar Kalantar-Zadeh, Ekamol Tantisattamo
BACKGROUND: Hyponatremia is one of the most common electrolyte disturbances in advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) patients, and has been shown to be associated with higher mortality risk. However, the relationship between hyponatremia during late-stage CKD and the risk of poor outcomes after ESKD transition is unknown. METHODS: We conducted a retrospective cohort study including 32 257 US veterans transitioning to ESKD from 1 October 2007 to 30 March 2015...
January 25, 2022: Nephrology, Dialysis, Transplantation
https://read.qxmd.com/read/34292875/endocrinology-in-the-time-of-covid-19-2021-updates-the-management-of-diabetes-insipidus-and-hyponatraemia
#31
JOURNAL ARTICLE
Mirjam Christ-Crain, Ewout J Hoorn, Mark Sherlock, Chris J Thompson, John Wass
COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counselling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion...
August 27, 2021: European Journal of Endocrinology
https://read.qxmd.com/read/34276975/a-novel-clinical-nomogram-for-the-evaluation-of-disorders-of-plasma-osmolality
#32
JOURNAL ARTICLE
Philip J G M Voets, Nils P J Vogtländer, Karin A H Kaasjager
Disorders of water and sodium homeostasis in the human body-or dysnatraemias-are frequently encountered in clinical practice, but their analysis is often complex and their management is often troublesome. For many clinicians, it remains challenging to correctly interpret all relevant biochemical parameters involved in the analysis of dysnatraemia, especially when a rapid 'bedside' evaluation is required to initiate treatment. By mathematically deriving the relationship between plasma osmolality and urine osmolality under physiological circumstances, we were able to propose a novel and clinically useful nomogram for the rapid evaluation of disorders of plasma osmolality...
June 2021: Clinical Kidney Journal
https://read.qxmd.com/read/34221761/the-combined-use-of-fractional-urate-and-potassium-excretion-in-the-diagnosis-of-diuretic-induced-hyponatremia
#33
JOURNAL ARTICLE
Vincenzo Bassi, Olimpia Fattoruso
Introduction Thiazide and loop-diuretics are among the most widely used drugs in the therapy of hypertension and chronic heart failure. Furthermore, hyponatremia is the most prevalent electrolyte imbalance affecting up to 25-30% of hospitalized patients while syndrome of inappropriate antidiuresis (SIAD) is involving approximately 35% of hyponatraemic inpatients. Clinical and laboratoristic algorithms support the differential diagnosis of hypotonic hyponatremia in actual guidelines of SIAD, but a potential bias is represented by the misleading clinical assessment of the extracellular volume status in diuretic-treated patients where the necessity of withdrawal of the therapy is mandatory...
May 28, 2021: Curēus
https://read.qxmd.com/read/34218456/management-of-dysnatremias-with-continuous-renal-replacement-therapy
#34
JOURNAL ARTICLE
Lenar T Yessayan, Balazs Szamosfalvi, Mitchell H Rosner
Disorders of serum sodium concentration are common in critically ill patients who may have concomitant acute kidney injury, chronic kidney disease, or end-stage kidney disease. Many of these patients may require customized serum sodium level management with dialysis which, if not strictly controlled, can lead to significant complications. Thus, controlled correction of the serum sodium level is necessary to avoid the development of osmotic demyelination syndrome in hyponatremic patients and dialysis disequilibrium syndrome in hypernatremic patients...
November 2021: Seminars in Dialysis
https://read.qxmd.com/read/34132028/characteristics-of-urinary-sodium-excretion-in-patients-with-chronic-kidney-disease-in-jiangsu-china
#35
JOURNAL ARTICLE
Lianqin Sun, Suyan Duan, Chenyan Zuo, Zhiying Sun, Guangyan Nie, Chengning Zhang, Ming Zeng, Bin Sun, Yanggang Yuan, Ningning Wang, Huijuan Mao, Changying Xing, Bo Zhang
The current study aimed to assess the dietary salt intake in patients with CKD in Jiangsu province and investigate the relationship of urinary sodium excretion with blood pressure. A total of 800 patients with CKD stages 1-4 were recruited. All enrolled patients were asked to collect complete 24-h urine specimen. At the same time, patient's demographic and laboratory data were recorded. The mean age was 47.45 ± 15.25 years old, including 423 men and 377 women. There was no significant difference in urinary sodium excretion among different stages of CKD (p = ...
July 2021: Journal of Clinical Hypertension
https://read.qxmd.com/read/33999276/fluid-induced-harm-in-the-hospital-look-beyond-volume-and-start-considering-sodium-from-physiology-towards-recommendations-for-daily-practice-in-hospitalized-adults
#36
REVIEW
Niels Van Regenmortel, Lynn Moers, Thomas Langer, Ella Roelant, Tim De Weerdt, Pietro Caironi, Manu L N G Malbrain, Paul Elbers, Tim Van den Wyngaert, Philippe G Jorens
PURPOSE: Iatrogenic fluid overload is a potential side effect of intravenous fluid therapy in the hospital. Little attention has been paid to sodium administration as a separate cause of harm. With this narrative review, we aim to substantiate the hypothesis that a considerable amount of fluid-induced harm is caused not only by fluid volume, but also by the sodium that is administered to hospitalized patients. METHODS: We show how a regular dietary sodium intake is easily surpassed by the substantial amounts of sodium that are administered during typical hospital stays...
May 17, 2021: Annals of Intensive Care
https://read.qxmd.com/read/33658833/serum-sodium-levels-predict-mortality-in-elderly-acute-kidney-injury-patients-a-retrospective-observational-study
#37
JOURNAL ARTICLE
Qinglin Li, Yan Wang, Zhi Mao, Hongjun Kang, Feihu Zhou
Purpose: We examined the relationship between different levels of serum sodium and mortality among elderly patients with acute kidney injury (AKI). Methods: We retrospectively enrolled elderly patients from Chinese PLA General Hospital from 2007, to 2018. All-cause mortality was examined according to eight predefined sodium levels: <130.0 mmol/L, 130.0-134.9 mmol/L, 135.0-137.9 mmol/L, 138.0-141.9 mmol/L, 142.0-144.9 mmol/L, 145.0-147.9 mmol/L, 148.0-151.9 mmol/L, and ≥152...
2021: International Journal of General Medicine
https://read.qxmd.com/read/33646842/in-hyponatremia-rapid-intermittent-bolus-vs-slow-continuous-infusion-of-hypertonic-saline-did-not-differ-for-overcorrection-of-serum-sodium
#38
COMMENT
Anthony A Donato, Benjamin J Lloyd
Baek SH, Jo YH, Ahn S, et al. Risk of overcorrection in rapid intermittent bolus vs slow continuous infusion therapies of hypertonic saline for patients with symptomatic hyponatremia: the SALSA randomized clinical trial. JAMA Intern Med. 2021;181:81-92. 33104189.
March 2021: Annals of Internal Medicine
https://read.qxmd.com/read/33642485/successful-sodium-level-correction-with-a-3-saline-bolus-before-intermittent-hemodialysis-for-a-patient-with-severe-hyponatremia-accompanied-by-acute-kidney-injury
#39
JOURNAL ARTICLE
Miyuki Kodama, Daisuke Hirai, Seijiro Tsuji, Jaegi Shim, Mitsuteru Koizumi, Koichi Seta, Kensei Yahata
A 60-year-old man presented to the emergency department with lightheadedness. He had severe hyponatremia (109 mEq/L) complicated by acute kidney injury (AKI) (serum creatinine: 9.08 mg/dL). Because he was somnolescent, his hyponatremia was initially treated by administering a 130-mL bolus of 3% saline 2 to 5 times per day for 5 days. He subsequently underwent intermittent hemodialysis without any neurological problems. Previous reports have described patients with hyponatremia and AKI being treated with continuous renal replacement therapy...
August 15, 2021: Internal Medicine
https://read.qxmd.com/read/33635825/treatment-of-symptomatic-hyponatremia-with-hypertonic-saline-a-real-life-observational-study
#40
JOURNAL ARTICLE
Irina Chifu, Amelie Gerstl, Björn Lengenfelder, Dominik Schmitt, Nils Nagler, Martin Fassnacht, Dirk Weismann
OBJECTIVE: Treatment of symptomatic hyponatremia is not well established. The European guidelines recommend bolus-wise administration of 150 mL of 3% hypertonic saline. This recommendation is, however, based on low level of evidence. DESIGN: Observational study. METHODS: Sixty-two consecutive hyponatremic patients admitted to the emergency department or intensive care unit of the University Hospital Wuerzburg were divided in subgroups according to treatment (150 mL bolus of 3% hypertonic saline or conventional treatment) and symptom severity...
May 2021: European Journal of Endocrinology
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