Changes in copeptin levels before and 3 months after transsphenoidal surgery according to the presence of postoperative central diabetes insipidus

Copeptin levels reflect arginine vasopressin (AVP) release from the hypothalamus. Pituitary surgery often impairs AVP release and results in central diabetes insipidus (CDI). Here, we aimed to investigate how serum copeptin level changes 3 months after pituitary surgery and whether it has a diagnostic value for postoperative permanent CDI. Consecutive patients who underwent endoscopic transsphenoidal surgery at a single tertiary hospital were recruited. Serum copeptin levels were measured preoperatively and 3 months postoperatively. Among 88 patients, transient and permanent CDI occurred in 17 (19.3%) and 23 (26.1%), respectively. Three-month postoperative copeptin levels significantly declined from preoperative levels in permanent CDI group (P < 0.001, percentage difference = − 42.2%) and also in the transient CDI group (P = 0.002, − 27.2%). Three months postoperative copeptin level < 1.9 pmol/L under normal serum sodium levels was the optimal cutoff value for diagnosing permanent CDI with an accuracy of 81.8%, while 3-month postoperative copeptin level ≥ 3.5 pmol/L excluded the CDI with a negative predictive value of 100%. Conclusively, 3 months postoperative copeptin levels significantly decreased from preoperative levels in the transient CDI group as well as the permanent CDI group. Three-month postoperative copeptin levels ≥ 3.5 pmol/L under normal serum sodium levels may be diagnostic for excluding postoperative CDI.

MO172HYPONATREMIA IN PATIENTS WITH COVID19

Background Among laboratory abnormalities described in the context of SARS-COV-2 infection, hyponatremia seem to be the most common. The mechanism of this sodium disbalance is not well known. Aims Characterize the incidence, etiology and prognostic value of sodium disbalance in patients with COVID19. Method Observational pilot study with 37 patients admitted to Hospital Ramon y Cajal in Madrid, Spain, between March and April 2020, with a confirmed diagnosis of COVID19. Patients were followed until discharge or death. Clinical and laboratory data were collected at admission and before the clinical outcome. Variables were analyzed comparing hyponatremic vs eunatremic patients. Results Distribution of patients according to their serum sodium was as follows: 16 patients with hyponatremia (44%), 19 with normal serum sodium (51%) and 2 with hypernatremia (5%). The average sodium level in hyponatremic patients was 130 ±3.2 mmol/l, median urine sodium was 36 ±3.2 mmol/l (only 6 urine sample available). Hyponatremia was associated with dyspnea at admission and with higher levels of LDH, neutrophil cells account and C reactive protein. However, no worse prognostic was associated with lower serum sodium. All patients recover sodium levels at discharge treated with salt supplementation and free water intake. Conclusion mild hyponatremia is a common electrolyte disorder associated with COVID19. Sing as low urine sodium and recover with water and salt ingestion, point toward hydrosaline dehydration instead of SIADH as most common origin of hyponatremia.

Significance of hypernatremia due to SARS-CoV-2 associated ARDS in critically ill patients

Background and ObjectivesSARS-CoV-2-induced ARDS is a new entity that should be characterized as it appears to be different from standard ARDS. Hypernatremia is a biological alteration that seems to occur very often in this population without any clear cause. The present study aims to clarify the possible causes of hypernatremia and evaluate its impact on patient outcome.Patients and MethodsWe conducted a retrospective one-day prevalence study in 2 intensive care units, which only treated COVID-19 patients with moderate to severe ARDS. We measured blood and urine electrolytes in all the patients. Patients with chronic renal failure or renal replacement therapy were excluded from the study. Hypernatremia was defined as plasma sodium levels above 145 mmol/L.ResultsInclusion criteria were met in 17 out of 24 patients. Hypernatremia was present in 52% patients. All had a natriuresis higher than 20 mmol/L and a urine osmolality above 600 mOsm/L. Hypernatremia was acquired in ICU as all the patients had a normal serum sodium level at admission.ConclusionThe incidence of hypernatremia was elevated and appears to be linked to significant insensible water losses. This should trigger us to optimize the maintenance fluid therapy in critically ill patients with SARS-CoV-2-induced ARDS.

Prognostic Role of Hyponatremia in Heart Failure Patients Depending on Renal Disease: Clinical Evidence

Aim: Hyponatremia is very often associated with renal disease in patients with heart failure (HF) and, when present, determines a poor outcome. We investigated the role of hyponatremia in HF patients in whom the presence or absence renal insufficiency was accurately predefined. Methods: This was a cohort study based on the Spanish National Registry on Heart Failure (RICA), a multicenter, prospective registry that enrolls patients admitted for decompensated HF who were subsequently followed up for 1 year. We classified patients into 4 groups according to the presence or absence of renal disease defined by the hematocrit, urea, and gender formula (HUGE) and then according to the presence of hyponatremia (Na ≤135 mEq/L). Results: A total of 3,478 patients were included. Hyponatremia was more prevalent in the group with renal disease (22.1%) than without (18.4%). During admission, both groups with hyponatremia had more complications than those with normal serum sodium. During the 1-year follow-up, patients with hyponatremia and renal disease had a significantly worse outcome (HF mortality and readmission), HR 1.87, 95% CI 1.54–2.29, p < 0.001, compared to those with hyponatremia without renal disease, HR 1.01, 95% CI 0.79–1.3, p = 0.94. Conclusions: Hyponatremia is more prevalent in patients with renal insufficiency, and outcome is poorest when both renal disease and hyponatremia coexist. Patients with hyponatremia without renal disease show no differences in outcome compared to those without hyponatremia.

Oxcarbazepine Therapy for Complete Central Diabetes Insipidus

Oxcarbazepine and carbamazepine cause hyponatremia by unknown mechanisms. We describe a patient with complete central diabetes insipidus and seizures who developed worsening hyponatremia when her dose of oxcarbazepine was increased. The patient maintained a normal serum sodium level and has had appropriately concentrated urine for 5 years on just oxcarbazepine, despite undetectable antidiuretic hormone (ADH) levels. This suggests that oxcarbazepine (or one of its metabolites) may stimulate collecting tubule V2 receptor-G protein complex independent of ADH, resulting in increased renal tubular water reabsorption. Oxcarbazepine may be useful as an alternative therapy for patients with central diabetes insipidus.

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

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.

Gambaran elektrolit serum pada anak dengan diare akut

Acute diarrhea is defined as the sudden onset of 3 or more loose stools per day and lasts no longer than 14 days; chronic or persistent diarrhea lasts more than 14 days. Loss of fluid in large quantitiy such as diarrhea results in imbalance of fluid and electrolyte. The first influenced electrolytes are sodium and chloride since both are extracellular electrolytes. This study aimed to obtain the profile of serum electrolytes in children with acute diarrhea. Thus was a descriptive retrospective study using medical record data of patients hospitalized in the Paediatrics Department of Prof. Dr. R. D. Kandou Manado Hospital in the period of January 2015 - December 2015. The results showed that the highest incidence was among males (30 cases; 65.21%). Most cases were aged 1 - < 5 years (23 cases; 50%). Most serum sodium values were in the normal range (36 cases; 78.26%). Most cases had diarrhea without dehydration and had normal serum sodium (20 cases; 43.47%). Most cases had normal serum potassium levels (33 cases; 71.73%). Most inpatients were without dehydration (17 cases; 36.95%). Most cases had normal serum electrolyte levels (39 cases; 84.78%). Most of the diarrhea without dehydration ( 21 cases; 45.65%). Diarrhea was most often in those who were formula-fed (29 cases; 63.04%). Keywords: acute diarrhea, dehydration, electrolyte disturbance Abstrak: Diare akut didefinisikan sebagai onset mendadak 3 atau lebih mencret per hari dan berlangsung tidak lebih dari 14 hari sedangkan diare kronis atau persisten berlangsung lebih dari 14 hari. Bila terjadi kehilangan cairan dalam jumlah banyak secara terus menerus seperti pada diare maka keseimbangan cairan dan elektrolit dalam tubuh tidak dapat dipertahankan. Elektrolit yang pertama terpengaruh ialah natrium dan klorida karena keduanya merupakan elektrolit ekstrasel. Penelitian ini bertujuan untuk mendapatkan gambaran elektrolit serum pada anak dengan diare akut. Jenis penelitian retrospektif deskriptif menggunakan data rekam medik pasien rawat inap di Bagian Pediatri RSUP Prof. Dr. R.D. Kandou Manado periode Januari 2015 - Desember 2015. Hasil penelitian memperlihatkan bahwa insiden tertinggi pada laki-laki sebanyak 30 kasus (65,21%). Usia terbanyak antara 1 tahun - < 5 tahun yaitu 23 kasus (50%). Nilai natrium serum paling banyak pada kisaran normal yaitu 36 kasus (78,26%), paling banyak didapatkan pada penderita tanpa dehidrasi dengan natrium serum normal 20 kasus (43,47%). Kadar kalium serum normal secara keseluruhan berjumlah 33 kasus (71,73%), paling banyak pada penderita tanpa dehidrasi yaitu 17 kasus (36,95%). Kadar serum paling banyak pada kisaran normal yaitu 39 kasus (84,78%), dan paling banyak pada penderita tanpa dehidrasi yaitu 21 kasus (45,65%). Diare paling banyak pada yang diberi susu formula sebanyak 29 kasus (63,04 %).Kata kunci: diare akut, dehidrasi, gangguan elektrolit