Hyponatremia in patients receiving parenteral nutrition: the importance of correcting serum sodium for total proteins. The role of the composition of parenteral nutrition in the development of hyponatremia

Gómez-Hoyos, Emilia; Fernández-Peña, Silvia; Cuesta, Martín; Ortolá, Ana; Matía, Pilar; Pérez-Ferre, Natalia; Luis, Daniel Antonio de; Calle-Pascual, Alfonso; Rubio, Miguel A.; Vega, Isabelle Runkle-De la

doi:10.1038/s41430-017-0026-5

Cited by 7 publications

(4 citation statements)

References 24 publications

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“…Abnormal antidiuretic hormone sections due to stress and sickness could be one explanation. Of note, one study observed that adult hospitalized patients receiving TPN were more likely to develop hyponatremia than hospitalized patients who were not [21].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Hyponatremia and Associated Factors in Preterm Infants in Saudi Arabia

Bamehrez¹

2022

Cureus

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Objective: To investigate the incidence of hyponatremia in preterm infants. The secondary aim was to determine the risk factors of late-onset of hyponatremia (LOH) and their influence on neonatal outcomes.Study design: The present study is a retrospective cohort study of 71 preterm infants born before 32 weeks of gestation at King Abdulaziz University Hospital and admitted to the neonatal intensive care unit, level 3, from January to December 2019. Hyponatremia was defined as a sodium level ≤ 132 mEq/L. Retrieved maternal characteristics included age, parity, booking status, medical problems, antenatal steroids, and method of delivery. Retrieved infant characteristics included birth weight, gestational age, Apgar scores, total parenteral nutrition (TPN), breast milk or formula feeding, and body weight. as well as data on early onset of sepsis, chronic lung disease (CLD), patent ductus arteriosus, retinopathy of prematurity, severe intraventricular hemorrhage, and prescribed antibiotics and diuretics.Results: Out of 72 preterm infants, 27% were diagnosed with hyponatremia. Early-onset hyponatremia (EOH) affected 7% (n=5) of the infants while 22.5% (n=16) of preterm neonates developed LOH (two infants developed both EOH and LOH). None of the investigated maternal characteristics were significantly associated with hyponatremia. Some infant characteristics were significantly associated with LOH: lower birth weight, lower gestational age, exclusive breastfeeding, longer duration TPN, and use of diuretics and antibiotics. Infants with LOH had longer hospital stays (p < 0.001) and higher risks of extra-uterine growth retardation (p = 0.007), CLD (p < 0.001), and sepsis (p = 0.001).Conclusion: Twenty-seven percent of preterm infants in King Abdul Aziz University Hospital are born with or develop hyponatremia. Risk factors significantly associated with LOH included lower gestational age, lower birth weight, exclusive breastfeeding, long-term TPN, and prescribed diuretics and antibiotics. Possible outcomes of hyponatremia were long-term hospital stays, growth retardation, sepsis, and CLD.

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Section: Discussionmentioning

confidence: 99%

Incidence of Hyponatremia and Associated Factors in Preterm Infants in Saudi Arabia

Bamehrez¹

2022

Cureus

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“…Hyponatremia is more frequently encountered in patients (18%) receiving parenteral nutrition (PN) than in other hospitalized patients, and this has been associated with higher mortality 25 . Some studies estimate that the correction of hyponatremia by accounting for total protein may yield a higher estimate of the prevalence of hyponatremia 26 . Hospitalized patients may require PN when they need bowel rest for another clinical indication (gastrointestinal malignancy, obstruction, intractable diarrhea, or vomiting) and enteral nutrition is not feasible 26 .…”

Section: Special Considerationsmentioning

confidence: 99%

“…Some studies estimate that the correction of hyponatremia by accounting for total protein may yield a higher estimate of the prevalence of hyponatremia 26 . Hospitalized patients may require PN when they need bowel rest for another clinical indication (gastrointestinal malignancy, obstruction, intractable diarrhea, or vomiting) and enteral nutrition is not feasible 26 . Patients undergoing PN may experience non‐osmotic release of ADH due to various drugs or in the presence of nausea or pain.…”

Section: Special Considerationsmentioning

confidence: 99%

“…Administration of excess fluid in a setting of ADH upregulation may explain the observed occurrence of hyponatremia with PN. Severe malnutrition, female sex, nausea or vomiting, and opiate use have been shown to be risk factors associated with development of hyponatremia in patients receiving PN, 25 whereas the sodium content of PN has not been shown to be associated with hyponatremia 26 …”

Section: Special Considerationsmentioning

confidence: 99%

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Demystifying hyponatremia: A clinical guide to evaluation and management

et al. 2022

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Hyponatremia (serum sodium <135 mEq/L) is a frequent electrolyte abnormality complicating the clinical care of hospitalized patients. Hyponatremia has been associated with an increased risk of mortality. Hyponatremia can be seen in patients with euvolemia, hypovolemia, or hypervolemia. Evaluation of hyponatremia relies on clinical assessment and estimation of serum sodium, urine electrolytes, and serum and urine osmolality in addition to other case‐specific laboratory parameters. In addition, point‐of‐care ultrasonography is an important adjunct to physical assessment in estimation of volume status. Understanding the pathophysiology of the underlying process can lead to a timely diagnosis and appropriate management of hyponatremia.

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Prevention of complications for hospitalized patients receiving parenteral nutrition: A narrative review

Al‐Zubeidi,

Davis,

Rahhal

2024

Nut in Clin Prac

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Hospitalized patients may benefit from parenteral nutrition to address their compromised nutrition status attributed to limited oral/enteral intake and increased nutrient/energy requirement during acute illness. Parenteral nutrition, however, can be associated with many complications that can negatively impact patient outcomes. In this review, we focus on potential metabolic and catheter‐related complications associated with parenteral nutrition use. We report on potential risk factors for such complications and highlight strategies for prevention and early recognition. To optimize outcomes, key findings include the creation and implementation of evidence‐based protocols with proven efficacy. For each hospital unit delivering parenteral nutrition to patients, tracking compliance with established protocols and patient outcomes is crucial for ongoing improvement through identification of gaps, proper reeducation and training, and ongoing refinement of care protocols. Establishment of specialized inpatient nutrition support teams should be considered.

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Hyponatremia in patients receiving parenteral nutrition: the importance of correcting serum sodium for total proteins. The role of the composition of parenteral nutrition in the development of hyponatremia

Abstract: A majority of patients receiving PN present hyponatremia, when indirect SNa levels are corrected for TP. The development of hyponatremia during PN is not related to the composition of the PN.

Cited by 7 publications

References 24 publications

Incidence of Hyponatremia and Associated Factors in Preterm Infants in Saudi Arabia

Incidence of Hyponatremia and Associated Factors in Preterm Infants in Saudi Arabia

Demystifying hyponatremia: A clinical guide to evaluation and management

Prevention of complications for hospitalized patients receiving parenteral nutrition: A narrative review

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