Serum sodium correction rate and the outcome in severe hyponatremia

Objective Although thiazide diuretics are commonly used in the neonatal intensive care unit (NICU), the risk of thiazide-induced hyponatremia in infants has not been well documented. The primary objective of this study was to determine the frequency and severity of hyponatremia in neonates and infants receiving enteral chlorothiazide. Secondary objectives included identifying: (1) percent change in serum sodium from before chlorothiazide initiation to nadir, (2) time to reach nadir serum sodium concentration, and (3) percentage of patients on chlorothiazide receiving sodium supplementation. Study Design This was a retrospective cohort study of NICU patients admitted between July 1, 2014 and July 31, 2019 who received ≥1 dose of enteral chlorothiazide. Mild, moderate, and severe hyponatremia were defined as serum sodium of 130 to 134 mEq/L, 120 to 129 mEq/L, and less than 120 mEq/L, respectively. Data including serum electrolytes, chlorothiazide dosing, and sodium supplementation were collected for the first 2 weeks of therapy. Descriptive and inferential statistics were performed in SAS software, Version 9.4. Results One hundred and seven patients, receiving 127 chlorothiazide courses, were included. The median gestational age at birth and postmenstrual age at initiation were 26.0 and 35.9 weeks, respectively. The overall frequency of hyponatremia was 35.4% (45/127 courses). Mild, moderate, and severe hyponatremia were reported in 27 (21.3%), 16 (12.6%), and 2 (1.6%) courses. The median percent decrease in serum sodium from baseline to nadir was 2.9%, and the median time to nadir sodium was 5 days. Enteral sodium supplements were administered in 52 (40.9%) courses. Sixteen courses (12.6%) were discontinued within the first 14 days of therapy due to hyponatremia. Conclusion Hyponatremia occurred in over 35% of courses of enteral chlorothiazide in neonates and infants. Given the high frequency of hyponatremia, serum sodium should be monitored closely in infants receiving chlorothiazide. Providers should consider early initiation of sodium supplements if warranted. Key Points

Download Full-text

Rapid correction of severe hyponatremia in the rat: histopathological changes in the brain

AJP Renal Physiology ◽

10.1152/ajprenal.1985.248.5.f711 ◽

1985 ◽

Vol 248 (5) ◽

pp. F711-F719 ◽

Cited By ~ 10

Author(s):

J. C. Ayus ◽

R. K. Krothapalli ◽

D. L. Armstrong

Keyword(s):

Serum Sodium ◽

Brain Lesions ◽

The Other ◽

Histopathological Changes ◽

Water Restriction ◽

Severe Hyponatremia ◽

Group Iii ◽

Group I ◽

The Brain ◽

Rapid Correction

The purpose of the present studies was to examine the effects of rapid correction of severe hyponatremia (serum sodium less than 120 meq/liter) either to mildly hyponatremic levels (serum sodium = 130 meq/liter) or to normonatremic levels (serum sodium = 150 meq/liter) on the brain histology of rats. In group I, 13% of the rats revealed brain lesions following correction to mildly hyponatremic levels by the administration of 855 mM NaCl. All the rats (100%) in group II had brain lesions following correction to normonatremic levels by 24 h of water restriction. Similarly, all the rats in group III showed brain lesions following correction to normonatremic levels by the administration of 855 mM NaCl. Severe hyponatremia by itself did not cause any brain lesions in another group. We conclude that rapid correction of severe hyponatremia to mildly hyponatremic levels by the administration of 855 mM NaCl does not cause significant brain lesions. On the other hand, rapid correction to normonatremic levels either by water restriction or by the administration of 855 mM NaCl results in significant brain lesions.

Download Full-text

SEVERE HYPONATREMIA: CASE OF SERUM SODIUM 93MEQ/L

CHEST Journal ◽

10.1016/j.chest.2020.08.749 ◽

2020 ◽

Vol 158 (4) ◽

pp. A804 ◽

Cited By ~ 1

Author(s):

Niloufar Gharib

Keyword(s):

Serum Sodium ◽

Severe Hyponatremia

Download Full-text

330: Low Frequency of Overly Rapid Serum Sodium Correction During Treatment of Euvolemic or Hypervolemic Hyponatremia With Conivaptan

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2007.06.391 ◽

2007 ◽

Vol 50 (3) ◽

pp. S104

Author(s):

L.E. Wagoner ◽

S. Rosansky ◽

D. Zeltser ◽

J.G. Verbalis ◽

B. McNutt ◽

...

Keyword(s):

Serum Sodium ◽

Low Frequency ◽

Sodium Correction

Download Full-text

Desmopressin to Prevent Rapid Sodium Correction in Severe Hyponatremia: A Systematic Review

The American Journal of Medicine ◽

10.1016/j.amjmed.2015.04.040 ◽

2015 ◽

Vol 128 (12) ◽

pp. 1362.e15-1362.e24 ◽

Cited By ~ 23

Author(s):

Thomas E. MacMillan ◽

Terence Tang ◽

Rodrigo B. Cavalcanti

Keyword(s):

Systematic Review ◽

Severe Hyponatremia ◽

Sodium Correction

Download Full-text

Multifactorial diabetes insipidus during pregnancy: a challenging diagnosis

BMJ Case Reports ◽

10.1136/bcr-2020-238410 ◽

2021 ◽

Vol 14 (3) ◽

pp. e238410

Author(s):

Alexandra Novais Araújo ◽

Maria Cunha ◽

Tiago Marques ◽

Maria João Guerreiro Martins Bugalho

Keyword(s):

Diabetes Insipidus ◽

Serum Sodium ◽

Antiretroviral Treatment ◽

Growth Restriction ◽

Obstetric Ultrasound ◽

Adequate Treatment ◽

Foetal Growth ◽

Foetal Growth Restriction ◽

Underlying Disorder ◽

Sodium Correction

Diabetes insipidus (DI) is characterised by thirst and polydipsia with hypotonic polyuria. Several forms exist, namely, central or pituitary, nephrogenic and gestational and must be differentiated for adequate treatment. We describe the case of a 41-year-old woman chronically infected with HIV who had been recently medicated with a tenofovir-based antiretroviral treatment and who, at 22 weeks of pregnancy, presented with transient gestational DI. Obstetric ultrasound revealed oligohydramnios and foetal growth restriction that did not improve despite serum sodium correction. The severity of the case suggested the presence of an underlying disorder and elevated copeptin levels indicated that an underlying subclinical form of nephrogenic DI, possibly induced by HIV-related nephropathy or tenofovir use, was present and rendered clinically overt during pregnancy.

Download Full-text

Derivation and Validation of a Novel Risk Score to Predict Overcorrection of Severe Hyponatremia

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.12251018 ◽

2019 ◽

Vol 14 (7) ◽

pp. 975-982 ◽

Cited By ~ 1

Author(s):

Jason D. Woodfine ◽

Manish M. Sood ◽

Thomas E. MacMillan ◽

Rodrigo B. Cavalcanti ◽

Carl van Walraven

Keyword(s):

Confidence Interval ◽

Risk Score ◽

Serum Sodium ◽

Latent Class ◽

Tertiary Care ◽

External Validation ◽

Volume Overload ◽

Care Hospital ◽

Severe Hyponatremia ◽

Glucose Levels

Background and objectivesOsmotic demyelination syndrome is the most concerning complication of severe hyponatremia, occurring with an overly rapid rate of serum sodium correction. There are limited clinical tools to aid in identifying individuals at high risk of overcorrection with severe hyponatremia.Design, setting, participants, & measurementsWe identified all patients who presented to a tertiary-care hospital emergency department in Ottawa, Canada (catchment area 1.2 million) between January 1, 2003 and December 31, 2015, with serum sodium (corrected for glucose levels) <116 mmol/L. Overcorrection was determined using 14 published criteria. Latent class analysis measured the independent association of baseline factors with a consensus overcorrection status on the basis of the 14 criteria, and was summarized as a risk score, which was validated in two cohorts.ResultsA total of 623 patients presented with severe hyponatremia (mean initial value 112 mmol/L; SD 3.2). The prevalence of no, unlikely, possible, and definite overcorrection was 72%, 4%, 10%, and 14%, respectively. Overcorrection was independently associated with decreased level of consciousness (2 points), vomiting (2 points), severe hypokalemia (1 point), hypotonic urine (4 points), volume overload (−5 points), chest tumor (−5 points), patient age (−1 point per decade, over 50 years), and initial sodium level (<110 mmol/L: 4 points; 110–111 mmol/L: 2 points; 112–113 mmol/L: 1 point). These points were summed to create the Severe Hyponatremic Overcorrection Risk (SHOR) score, which was significantly associated with overcorrection status (Spearman correlation 0.45; 95% confidence interval, 0.36 to 0.49) and was discriminating (average dichotomized c-statistic 0.77; 95% confidence interval, 0.73 to 0.81). The internal (n=119) and external (n=95) validation cohorts had significantly greater use of desmopressin, which was significantly associated with the SHOR score. The SHOR score was significantly associated with overcorrection status in the internal (P<0.001) but not external (P=0.39) validation cohort.ConclusionsIn patients presenting with severe hyponatremia, overcorrection was common and predictable using baseline information. Further external validation of the SHOR is required before generalized use.

Download Full-text

Correction rate of severe hyponatremia and central pontine myelinolysis

American Journal of Psychiatry ◽

10.1176/ajp.149.5.715b ◽

1992 ◽

Vol 149 (5) ◽

pp. 715b-716 ◽

Cited By ~ 2

Keyword(s):

Central Pontine Myelinolysis ◽

Severe Hyponatremia ◽

Correction Rate ◽

Pontine Myelinolysis ◽

Central Pontine

Download Full-text

Osmotic demyelination syndrome following slow correction of hyponatraemia

BMJ Case Reports ◽

10.1136/bcr-2020-241407 ◽

2021 ◽

Vol 14 (8) ◽

pp. e241407

Author(s):

Isabel Saunders ◽

David M Williams ◽

Aliya Mohd Ruslan ◽

Thinzar Min

Keyword(s):

Antidiuretic Hormone ◽

Serum Sodium ◽

Inflammatory Markers ◽

Urine Osmolality ◽

Fluid Restriction ◽

Osmotic Demyelination Syndrome ◽

Electrolyte Disturbance ◽

Osmotic Demyelination ◽

Sodium Correction ◽

Hospital Inpatients

Hyponatraemia is the most common electrolyte disturbance observed in hospital inpatients. We report a 90-year-old woman admitted generally unwell following a fall with marked confusion. Examination revealed a tender suprapubic region, and investigations observed elevated inflammatory markers and bacteriuria. Admission investigations demonstrated a serum sodium of 110 mmol/L with associated serum osmolality 236 mmol/kg and urine osmolality 346 mmol/kg. She was treated for hyponatraemia secondary to syndrome of inappropriate antidiuretic hormone (SIADH) and urosepsis. However, her serum sodium failed to normalise despite fluid restriction, necessitating treatment with demeclocycline and hypertonic saline. Despite slow reversal of hyponatraemia over 1 month, the patient developed generalised seizures with pontine and thalamic changes on MRI consistent with osmotic demyelination syndrome (ODS). This case highlights the risk of ODS, a rare but devastating consequence of hyponatraemia treatment, despite cautious sodium correction.

Download Full-text

The study of incidence of post operative delirium in geriatric patients with hyponatremia undergoing coronary artery bypass grafting procedure in a tertiary care hospital

International Journal Of Medical Science And Clinical Invention ◽

10.18535/ijmsci/v5i1.13 ◽

2018 ◽

Vol 5 (1) ◽

pp. 3439-3441

Author(s):

Dr Aswin Rajeev ◽

George Paul ◽

Dr Sunil K S ◽

Dr Priya Vijayakumar

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Elderly Patients ◽

Coronary Artery Bypass ◽

Serum Sodium ◽

Artery Bypass ◽

Bypass Grafting ◽

Care Hospital ◽

Severe Hyponatremia ◽

Artery Bypass Grafting

Delirium, defined as an acute disorder of attention and global cognitive function is a common, serious and potentially preventable source of morbidity and mortality in hospitalized elderly patients. Different studies have shown that existence of hyponatremia in perioperative period can contribute to delirium.To assess the incidence of post operative delirium in elderly patients with peri operative hyponatremia undergoing coronary artery bypass grafting (a major cardiac surgery).Prospective cohort study, Study Period: 1 ½ years. Using a prepared questionnaire after obtaining fully informed written consent. 3 visits for each patient: 1) before surgery, 2) in the ICU: 48 hours after surgery, 3) In ward after shifting out from ICU. Details from patients, care givers and nursing staff regarding features of delirium are obtained. Patients were classified into two groups, one group included patients with normal/mild hyponatremia (serum sodium>/= 130 mEq/L) and other group with moderate to severe hyponatremia (serum sodium</=129.9) for convenience of analysis.Out of total 250 patients included in the study, 43 (17.2%) patients developed post operative delirium. Patients with moderate- severe hyponatremia had more chance for development of post operative delirium. Out of 146 patients with moderate- severe hyponatremia 37 (25.34%) patients developed post operative delirium compared to 6 (5.77%) patients with normal or mild hyponatremia (p:<0.001). Hyponatremia in peri operative period is a risk factor contributing to post operative delirium and patient’s sodium levels should be closely monitored in peri operative period.

Download Full-text