scholarly journals SEVERE HYPONATREMIA: CASE OF SERUM SODIUM 93MEQ/L

CHEST Journal ◽  
2020 ◽  
Vol 158 (4) ◽  
pp. A804 ◽  
Author(s):  
Niloufar Gharib
Keyword(s):  
Serum Sodium ◽  
Severe Hyponatremia

Frequency and Severity of Chlorothiazide-Induced Hyponatremia in the Neonatal Intensive Care Unit

2021 ◽  
Author(s):  
Maura Harkin ◽  
Peter N. Johnson ◽  
Stephen B. Neely ◽  
Lauren White ◽  
Jamie L. Miller
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Serum Sodium ◽  
Neonatal Intensive Care ◽  
Primary Objective ◽  
Severe Hyponatremia ◽  
Days Of Therapy ◽  
Neonates And Infants ◽  
Sodium Supplementation

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

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

1985 ◽  
Vol 248 (5) ◽  
pp. F711-F719 ◽  
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.

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

2019 ◽  
Vol 14 (7) ◽  
pp. 975-982 ◽  
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.

Serum sodium correction rate and the outcome in severe hyponatremia

2017 ◽  
Vol 35 (11) ◽  
pp. 1691-1694 ◽  
Author(s):  
Mauro Giordano ◽  
Tiziana Ciarambino ◽  
Emanuela Lo Priore ◽  
Pietro Castellino ◽  
Lorenzo Malatino ◽  
...  
Keyword(s):  
Serum Sodium ◽  
Severe Hyponatremia ◽  
Correction Rate ◽  
Sodium Correction

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

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.

scholarly journals Hyponatremia in Children and Adults with Prader–Willi Syndrome: A Survey Involving Seven Countries

2021 ◽  
Vol 10 (16) ◽  
pp. 3555
Author(s):  
Muriel Coupaye ◽  
Karlijn Pellikaan ◽  
Anthony P. Goldstone ◽  
Antonino Crinò ◽  
Graziano Grugni ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Adrenal Insufficiency ◽  
Psychotropic Medication ◽  
Serum Sodium ◽  
Medical Records ◽  
Nocturnal Enuresis ◽  
Fluid Intake ◽  
Prader Willi Syndrome ◽  
Severe Hyponatremia ◽  
Diuretic Treatment

In Prader–Willi syndrome (PWS), conditions that are associated with hyponatremia are common, such as excessive fluid intake (EFI), desmopressin use and syndrome of inappropriate antidiuretic hormone (SIADH) caused by psychotropic medication. However, the prevalence of hyponatremia in PWS has rarely been reported. Our aim was to describe the prevalence and severity of hyponatremia in PWS. In October 2020, we performed a retrospective study based on the medical records of a large cohort of children and adults with PWS from seven countries. Among 1326 patients (68% adults), 34 (2.6%) had at least one episode of mild or moderate hyponatremia (125 ≤ Na < 135 mmol/L). The causes of non-severe hyponatremia were often multi-factorial, including psychotropic medication in 32%, EFI in 24% and hyperglycemia in 12%. No obvious cause was found in 29%. Seven (0.5%) adults experienced severe hyponatremia (Na < 125 mmol/L). Among these, five recovered completely, but two died. The causes of severe hyponatremia were desmopressin treatment for nocturnal enuresis (n = 2), EFI (n = 2), adrenal insufficiency (n = 1), diuretic treatment (n = 1) and unknown (n = 1). In conclusion, severe hyponatremia was very rare but potentially fatal in PWS. Desmopressin treatment for nocturnal enuresis should be avoided. Enquiring about EFI and monitoring serum sodium should be included in the routine follow-ups of patients with PWS.

scholarly journals Serum sodium as a prognostic marker in dengue fever cases admitted to PICU in Navodaya hospital, Raichur, India

2016 ◽  
Vol 4 (1) ◽  
pp. 222
Author(s):  
A. Akshay Reddy ◽  
T. Prashanth Reddy ◽  
Pranam G. M. ◽  
Usha Pranam ◽  
G. A. Manjunath
Keyword(s):  
Dengue Fever ◽  
Serum Sodium ◽  
Normal Serum ◽  
Bleeding Complications ◽  
Severe Hyponatremia ◽  
Electrolyte Disturbance ◽  
Medical College ◽  
High Dependency ◽  
Hepatobiliary Complications ◽  
Normal Serum Sodium

Background: Dengue fever is an arboviral infection which is mosquito transmitted, most common in tropical and subtropical countries. Worldwide around 2.5 billion population are at the risk of developing dengue infection.Methods: The study was carried out in a 5 bedded (high dependency unit) PICU of Navodaya Medical College and Hospital, Raichur, Karnataka, India. The study was approved by the ethical committee of the hospital. The study was performed over a period of 12 months from August 2015 - August 2016. The study group included individuals from the age group of 1 month to 18 years, who were diagnosed with dengue fever. Results: Out of the total 99 cases, 36 cases had no variation in serum sodium levels, 33 cases were mild hyponatremic, 12 cases were moderate hyponatremic and 18 cases were severely hyponatremic. Out of the 36 cases with normal serum sodium levels, only 1 case progressed to bleeding complications. Out of the 33 cases with mild serum sodium levels, 2 cases progressed to complications out of which 1 case having bleeding manifestations and 1 case having both bleeding and central nervous system (CNS) complications.Conclusions: Hyponatremia is the most common electrolyte disturbance in dengue fever as well as dengue associated complications. The lower the serum sodium levels the higher is the incidence of complications associated with dengue fever. The incidence of CNS and bleeding complications is more as compared to the RS and hepatobiliary complications. The incidence of RS and hepatobiliary complications is high with moderate and severe hyponatremia. Thus serum sodium plays a most important role in the prognosis of dengue fever and associated complications.

scholarly journals Sertraline induced hyponatremia

2017 ◽  
Vol 10 (4) ◽  
pp. 1 ◽  
Author(s):  
H Dhananjay Bhat ◽  
Harish Thanusubramanian ◽  
Balaji O
Keyword(s):  
Sodium Chloride ◽  
Antidiuretic Hormone ◽  
Serum Sodium ◽  
Hormone Secretion ◽  
Newly Diagnosed ◽  
Carcinoma Of The Breast ◽  
Severe Hyponatremia ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
History Of

A 53 year old female patient with a history of carcinoma of the breast in remission and dilated cardiomyopathy on treatment was newly diagnosed with depression. She was started on Sertraline 50mg once a day. 2 days later she developed severe hyponatremia (serum sodium 114mEq/l). Her condition further deteriorated and on the 6th day her medication was stopped and replaced with mirtazapine. Osmolality studies she was diagnosed with SIADH (Syndrome of Inappropriate Antidiuretic Hormone secretion). She was treated with IV sodium chloride for her hyponatremia. At discharge serum sodium levels improved (127mEq/l)  and subsequent follow up 4 weeks later showed normal sodium values (138mEq/L)Keywords: Sodium chloride, Syndrome of inappropriate antidiuretic hormone, Serum sodium, Serum osmolarity.

scholarly journals Neurologic sequelae after treatment of severe hyponatremia: a multicenter perspective.

1994 ◽  
Vol 4 (8) ◽  
pp. 1522-1530
Author(s):  
R H Sterns ◽  
J D Cappuccio ◽  
S M Silver ◽  
E P Cohen
Keyword(s):  
Serum Sodium ◽  
Average Rate ◽  
Central Pontine Myelinolysis ◽  
High Rate ◽  
Neurologic Complications ◽  
Severe Hyponatremia ◽  
Presenting Symptoms ◽  
Relative Risks ◽  
Neurologic Sequelae ◽  
American Society

Severe, symptomatic hyponatremia is often treated urgently to increase the serum sodium to 120 to 130 mmol/L. Recently, this approach has been challenged by evidence linking "rapid correction" (> 12 mmol/L per day) to demyelinating brain lesions. However, the relative risks of persistent, severe hyponatremia and iatrogenic injury have not been well quantified. Data were sought on patients with serum sodium levels < or = 105 mmol/L from the membership of the American Society of Nephrology. Respondents were given a report form asking specific questions regarding the cause of hyponatremia, presenting symptoms, rate of correction, and neurologic sequelae. Data on 56 patients were analyzed. Fourteen developed posttherapeutic complications (10 permanent, 4 transient) after correction to a serum sodium > 120 mmol/L. Eleven of these 14 patients (including 3 with documented central pontine myelinolysis) had a biphasic course in which neurologic findings initially improved and then worsened on the second to sixth day. Posttherapeutic complications were not explained by age, sex, alcoholism, presenting symptoms, or hypoxic episodes. Increased chronicity of hyponatremia and a high rate of correction in the first 48 h of treatment were significantly associated with complications. No neurologic complications were observed among patients corrected by < 12 mmol/L per 24 h or by < 18 mmol/L per 48 h or in whom the average rate of correction to a serum sodium of 120 mmol/L was < or = 0.55 mmol/L per hour. It was concluded that patients with severe chronic hyponatremia are most likely to avoid neurologic complications when their electrolyte disturbance is corrected slowly.

Prediction of serum sodium based on diurnal weight gain among schizophrenics subject to water intoxication

1990 ◽  
Vol 5 (4) ◽  
pp. 265-267
Author(s):  
WVR Vieweg ◽  
DP Harrington ◽  
RA Leadbetter ◽  
PL Hundley ◽  
GR Yank
Keyword(s):  
Weight Gain ◽  
Serum Sodium ◽  
Sodium Concentration ◽  
Water Intoxication ◽  
Serum Sodium Concentration ◽  
Severe Hyponatremia

SummaryWe related normalized diurnal weight gain (NDWG) to a decrease in serum sodium concentration (DSOD) among 8 schizophrenics subject to water intoxication. DSOD = 0.422 + 1.675 × NDWG (n = 8, r = 0.864, P = 0.006). We used this relationship to interdict drinking and, thus, prevent severe hyponatremia.

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