scholarly journals Hyponatremia at the onset of necrotizing enterocolitis is associated with intestinal surgery and higher mortality

2021 ◽  
Author(s):  
Elena Palleri ◽  
Veronica Frimmel ◽  
Urban Fläring ◽  
Marco Bartocci ◽  
Tomas Wester
Keyword(s):  
Medical Treatment ◽  
Necrotizing Enterocolitis ◽  
Odds Ratio ◽  
Intestinal Ischemia ◽  
Sodium Level ◽  
Primary Outcome ◽  
Plasma Sodium ◽  
Intestinal Surgery ◽  
Indication For Surgery ◽  
Plasma Sodium Level

AbstractIt has previously been shown that hyponatremia reflects the severity of inflammation in pediatric gastrointestinal diseases. Interpretation of electrolyte disorders is a common, but not well studied challenge in neonatology, especially in the context of early detection of necrotizing enterocolitis and bowel necrosis. The aim of this study was to assess if hyponatremia, or a decrease in plasma sodium level, at the onset of necrotizing enterocolitis (NEC) is associated with intestinal ischemia/necrosis requiring bowel resection and/or NEC-related deaths. This was a retrospective cohort study including patients with verified NEC (Bell’s stage ≥ 2) during the period 2009–2014. Data on plasma sodium 1–3 days before and at the onset of NEC were collected. The exposure was hyponatremia, defined as plasma sodium < 135 mmol/L and a decrease in plasma sodium. Primary outcome was severe NEC, defined as need for intestinal resection due to intestinal ischemia/necrosis and/or NEC-related death within 2 weeks of the onset of NEC. Generalized linear models were applied to analyze the primary outcome and presented as odds ratio. A total of 88 patients with verified NEC were included. Fifty-four (60%) of them had severe NEC. Hyponatremia and a decrease in plasma sodium at onset of NEC were associated with increased odds of severe NEC (OR crude 3.91, 95% CI (1.52–10.04) and 1.19, 95% CI (1.07–1.33), respectively). Also, a sub-analysis, excluding infants with pneumoperitoneum during the NEC episode, showed an increased odds ratio for severe NEC in infants with hyponatremia (OR 23.0, 95% CI (2.78–190.08)).Conclusions: The findings of hyponatremia and/or a sudden decrease in plasma sodium at the onset of NEC are associated with intestinal surgery or death within 2 weeks. What is Known:• Clinical deterioration, despite optimal medical treatment, is a relative indication for surgery in infants with necrotizing enterocolitis.• Hyponatremia is a common condition in preterm infants from the second week of life. What is New:• Hyponatremia and a decrease in plasma sodium level at the onset of necrotizing enterocolitis are positively associated with need of surgery or death within 2 weeks.• In infants with necrotizing enterocolitis, without pneumoperitoneum, where clinical deterioration despite optimal medical treatment is the only indication for surgery, hyponatremia, or a decrease in plasma sodium level can predict the severity of the disease.

PATHOGENESIS OF SEIZURES OCCURRING DURING RESTORATION OF PLASMA TONICITY TO NORMAL IN ANIMALS PREVIOUSLY CHRONICALLY HYPERNATREMIC

PEDIATRICS ◽  
1969 ◽  
Vol 43 (1) ◽  
pp. 54-64
Author(s):  
Gwendolyn R. Hogan ◽  
Philip R. Dodge ◽  
Sheila R. Gill ◽  
Susan Master ◽  
Juan F. Sotos
Keyword(s):  
Sodium Chloride ◽  
Water Content ◽  
Nasogastric Tube ◽  
Chloride Solution ◽  
Sodium Chloride Solution ◽  
Sodium Level ◽  
Plasma Sodium ◽  
Plasma Sodium Level ◽  
The Mean ◽  
The Brain

The present study describes the results of rehydration of rabbits rendered chronically hypernatremic by the administration of one molar sodium chloride solution by nasogastric tube for 23½ to 5 days. When these animals were rehydrated intravenously over a 4-hour period with 2.5% dextrose in water, returning the plasma sodium level to normal, 55% of them developed focal or generalized convulsions. The mean water content of brain tissue of the group of animals who had seizures was significantly greater than that of a normal group of animals and comparable to that found in a water-intoxicated group of animals. This elevation of water content could be accounted for by both an elevated content of potassium and chloride in the brain. The potassium content of the brain was higher in the rehydrated group of animals without than those with seizures. Ways by which the observed changes may be related to the development of seizures are discussed.

scholarly journals A comparative analysis of hydrochlorothiazide and chlorthalidone induced hyponatremia at the dose commonly prescribed in clinical practice

2018 ◽  
Vol 7 (5) ◽  
pp. 935
Author(s):  
Sura Kishore Mishra ◽  
Abinash Panda
Keyword(s):  
Sodium Level ◽  
Dose Range ◽  
Treated Group ◽  
Relative Difference ◽  
Cross Sectional Study ◽  
Plasma Sodium ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Treatment Of Hypertension ◽  
Plasma Sodium Level

Background: Despite the differences in cardiovascular outcomes, pharmacokinetics, pharmacodynamics, the diuretics, chlorthalidone (CTD) and hydrochlorothiazide (HCTZ) are often considered as interchangeable. There is an on-going debate whether CTD should be preferred over HCTZ, because it appears to be more effective in the prevention of cardiovascular events. The relative difference in the incidence of hypokalemia and hyponatremia, is also a topic of debate. With this background, the study was carried out to compare the prevalence of hyponatremia between CTD and HCTZ used in the treatment of hypertension at the dose commonly prescribed in clinical practice.Methods: This was a cross sectional study carried out on a convenience sample of 74 adult patients with provisional diagnosis of hyponatremia or with a plasma sodium level of less than 135mmol/L and having a history of anti-hypertensive use of HTCZ or CTD in the dose range of 12.5-25mg/day and 6.25-12.5mg/day respectively. Chi square test and independent samples ‘t’ test were used analyse the results in GraphPad Prism 6.0.Results: HCTZ was found to be the preferred diuretic in hypertension, whereas CTD was preferred in the age group of 65-74 years. The symptoms indicative of hyponatremia as well as a lower plasma sodium level were more common in the HTCZ treated group. Patients of hypertension using CTD were less predisposed to hyponatremia (OR 0.804, 95% CI 0.207-3.12).Conclusions: Chlorthalidone, when used at a lower dose of 6.25-12.5mg/day for the treatment of hypertension cause a lesser risk of hyponatremia than hydrochlorothiazide.

scholarly journals Plasma Sodium Level Is Associated With Bone Loss Severity in Women With Anorexia Nervosa

2012 ◽  
Vol 73 (11) ◽  
pp. e1379-e1383 ◽  
Author(s):  
Elizabeth A. Lawson ◽  
Pouneh K. Fazeli ◽  
Genevieve Calder ◽  
Hannah Putnam ◽  
Madhusmita Misra ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Bone Loss ◽  
Sodium Level ◽  
Plasma Sodium ◽  
Plasma Sodium Level ◽  
Loss Severity

scholarly journals Hypernatremia post hydatid cyst resection: case report

2021 ◽  
Vol 8 (2) ◽  
pp. 726
Author(s):  
S. P. Sharma ◽  
Nishant Pathak ◽  
Ritu Grewal ◽  
Anuj Singh
Keyword(s):  
Hydatid Cyst ◽  
Hypertonic Saline ◽  
Sodium Level ◽  
Tertiary Care ◽  
Plasma Sodium ◽  
Care Hospital ◽  
Plasma Sodium Level ◽  
Scolicidal Agent ◽  
High Level ◽  
Clinical Conditions

Hypernatremia or increased sodium level is defined as the plasma sodium level over 145 m mol/l. The electrolyte abnormality is associated with severe mortality (40-60%). Patients presenting acutely with this entity have varied clinical spectrum ranging from unresponsive state, dysphagia, shortness of breath, vomiting to seizures, coma or to even death. Iatrogenic hypernatremia usually a rare entity ensues after usage of hypertonic saline as scolicidal agent during hydatid cyst resection surgeries. There is a need of high level of suspicion, to be maintained in all patients being managed for clinical conditions requiring use of hypertonic saline (3-20% NS). Here we present a case of iatrogenic hypernatremia, post-surgical resection of hydatid cyst, with clinical manifestation and subsequent management in our tertiary care hospital.

Hyponatraemia during Oxcarbazepine Therapy

1989 ◽  
Vol 8 (5) ◽  
pp. 337-344 ◽  
Author(s):  
S.C. Pendlebury ◽  
D.K. Moses ◽  
M.J. Eadie
Keyword(s):  
Adverse Effect ◽  
Sodium Level ◽  
Seizure Control ◽  
Fluid Intake ◽  
Refractory Epilepsy ◽  
Plasma Sodium ◽  
Plasma Sodium Level ◽  
The Mean ◽  
Dose Dependent

A clinical and pharmacokinetic study was carried out progressively substituting a new anticonvulsant oxcarbazepine for its congener carbamazepine in a group of patients with refractory epilepsy. Although oxcarbazepine showed possible though not statistically significant advantages of better seizure control and was probably less sedating, its use was associated with a dose-dependent reduction in plasma sodium levels in 12 of 15 patients. The mean plasma sodium level fell from 137.5 ± 5.2 (s.d.) to 128.5 ± 6.1 mE/1. Imposed restriction of fluid intake may have minimized the degree of hyponatraemia. This adverse effect may limit the role of the drug as an anticonvulsant or necessitate special precautions when it is used. However, the possibility of employing the drug in diabetes insipidus may be worth exploring.

scholarly journals Impact of digitally acquired peer diagnostic input on diagnostic confidence in outpatient cases: A pragmatic randomized trial

2020 ◽  
Author(s):  
Elaine C Khoong ◽  
Valy Fontil ◽  
Natalie A Rivadeneira ◽  
Mekhala Hoskote ◽  
Shantanu Nundy ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Randomized Trial ◽  
Odds Ratio ◽  
Primary Outcome ◽  
Mixed Effects ◽  
Regression Analyses ◽  
Diagnostic Confidence ◽  
Diagnostic Uncertainty ◽  
Intervention Impact ◽  
High Uncertainty

Abstract Objective The study sought to evaluate if peer input on outpatient cases impacted diagnostic confidence. Materials and Methods This randomized trial of a peer input intervention occurred among 28 clinicians with case-level randomization. Encounters with diagnostic uncertainty were entered onto a digital platform to collect input from ≥5 clinicians. The primary outcome was diagnostic confidence. We used mixed-effects logistic regression analyses to assess for intervention impact on diagnostic confidence. Results Among the 509 cases (255 control; 254 intervention), the intervention did not impact confidence (odds ratio [OR], 1.46; 95% confidence interval [CI], 0.999-2.12), but after adjusting for clinician and case traits, the intervention was associated with higher confidence (OR, 1.53; 95% CI, 1.01-2.32). The intervention impact was greater in cases with high uncertainty (OR, 3.23; 95% CI, 1.09- 9.52). Conclusions Peer input increased diagnostic confidence primarily in high-uncertainty cases, consistent with findings that clinicians desire input primarily in cases with continued uncertainty.

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