Clinical practice guideline on diagnosis and treatment of hyponatraemia

Spasovski, Goce; Vanholder, Raymond; Allolio, Bruno; Annane, Djillali; Ball, Steve; Bichet, Daniel G.; Decaux, Guy; Fenske, Wiebke; Hoorn, Ewout; Ichai, Carole; Joannidis, Michael; Soupart, Alain; Zietse, Robert; Haller, Maria; Veer, Sabine S. Van Der; Biesen, Wim Van; Nagler, Evi

doi:10.1007/s00134-014-3210-2

Cited by 532 publications

(180 citation statements)

References 44 publications

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“…Für die "erlaubte" Geschwindigkeit finden sich in der Literatur unterschiedliche Angaben. Nach den aktuellsten Empfehlungen sollte der Anstieg der Na + -Konzentration im Serum innerhalb der ersten 24 h <10 mmol/l und in den ersten 48 h <18 mmol/l liegen [11,14].…”

Section: » Eine Zu Schnelleunclassified

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Die häufigsten Elektrolytstörungen in der Notaufnahme

Schmidt

2015

Internist

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Hyponatremia is the most common form of electrolyte disorder in the emergency room. The symptoms are unspecific and include nausea, dizziness and often falls. Typical symptoms of severe hypernatremia are vomiting, cerebral seizures, somnolence and even coma. The specific initial laboratory diagnostics include measurement of serum electrolytes, serum glucose, serum and urine osmolarity and sodium in urine. The main aim of the clinical examination is to estimate the volume status. If a patient has hypovolemia an infusion of isotonic sodium chloride solution (0.9 %) is the method of choice. If the patient is euvolemic the syndrome of inappropriate antidiuretic hormone secretion (SIADH) or (neurotropic) drugs might be the cause. In these cases the primary measure is restriction of fluid intake. As a rapid correction of sodium levels can lead to pontine myelinolysis, the increase in sodium concentration must not be less than 10 mmol/l within the first 24 h and 18 mmol/l within the first 48 h. Clinical symptoms of hyperkalemia include neurological (e.g. muscle weakness, paresis, hyperreflexia, cramps and dysesthesia), gastrointestinal (e.g. nausea, vomiting and diarrhea) and cardiac symptoms (e.g. dysrhythmia and conductance disorders). Calcium injection stabilizes cardiac rhythm disorders immediately. For a rapid drop in potassium by shifting the potassium to the intracellular space, administration of glucose with insulin and high-dose inhalative administration of betamimetics can be used. Potassium elimination is achieved by infusion of isotonic sodium choride (0.9 %) with i.v. administration of furosemide, ion exchange resins and hemodialysis.

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Section: » Eine Zu Schnelleunclassified

“…Dies kann wiederholt werden, bis sich der klinische Zustand des Patienten verbessert oder ein Anstieg um 5 mmol/l erzielt wurde. Danach ist die Kochsalzgabe zu stoppen und eine kausale Therapie einzuleiten [11].…”

Section: Praktisches Vorgehen Beim Akut Gefährdeten Patientenunclassified

Die häufigsten Elektrolytstörungen in der Notaufnahme

Schmidt

2015

Internist

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“…For this reason, the correction target was recently lowered to 4-6 mmol/24 h in patients at high risk of ODS [4]. However, if hyponatraemia is severe, acute and accompanied by neurological symptoms, correction should be initiated promptly with boluses of hypertonic saline (recommended 2 ml/kg of 3% saline) [6,11]. If using other fluids, the expected change in serum [Na + ] with 1 litre of specified solution can be calculated as Δ [Na + ] serum = ([Na + ] intravenous solution - [Na + ] serum )/(total body water + 1) [2].…”

Section: Discussionmentioning

confidence: 99%

Correction of Hyper- and Hyponatraemia during Continuous Renal Replacement Therapy

et al. 2015

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Background: Severe hyper- and hyponatraemia is associated with significant risks, yet its correction can also have serious consequences when implemented too fast or inadequately. The safe correction of serum sodium levels is particularly challenging when renal replacement therapy (RRT) is required. Methods: Using 2 case scenarios, we aim to illustrate a simple method of correcting hyper- and hyponatraemia safely by step-wise manipulation of the dialysate/replacement fluid. Results: During continuous RRT, hypernatraemia can be corrected effectively and safely by adding small pre-calculated amounts of 30% NaCl to the dialysate/replacement fluid bags aiming for a [Na⁺] in the fluid that allows safe equilibration and correction of the serum [Na⁺]. To correct hyponatraemia safely, pre-calculated amounts of sterile water can be added in a step-wise manner to achieve a fluid [Na⁺] that equals the desired target serum [Na⁺]. Conclusion: During continuous RRT, the step-wise adjustment of [Na⁺] of dialysate/replacement fluids offers a safe and reliable method to correct sodium disorders.

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“…Wegen des beschriebenen Transaminasenanstiegs unter höheren Tolvaptan-Dosen empfiehlt der Autor dieses Beitrags allerdings bei vorbestehenden Lebererkrankungen Zurückhaltung -in Analogie zu den Empfehlungen der U.S. Food and Drug Administration. [22]. Allerdings geht die Leitlinie nicht darauf ein, dass es auch unter Harnstoff zu überschie-ßenden Anstiegen des Serumnatriumspiegels kommen kann [7], auch ist die Langzeittoxizität von oral verabreichtem Harnstoff unbekannt.…”

Section: Tolvaptan Bei Hypervolämer Hyponatriämieunclassified

“…Die Liste der Symptome nach der ERBP-Leitlinie (. Infobox 1; [22]) ist nicht vollständig, z. B. sind klinisch äußerst relevante Zeichen und Symptome, wie Gangunsicherheit, Fallneigung und damit die Frakturneigung, nicht aufgeführt.…”

Section: Wie Soll Heute Die Diagnostik Und Behandlung Der Hyponatriämunclassified

Hyponatriämie und Tolvaptan

Hensen

2015

Internist

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The diuretic tolvaptan has been approved for more than 5 years for the indications of euvolemic hyponatremia due to syndrome of inappropriate antidiuretic hormone (SIADH) secretion. In recent years many patients have been treated with tolvaptan and many physicians could gather practical experience. Other countries, such as the USA had already gained greater experience, also in the indications for hypervolemic hyponatremia. After approval was granted more than 5000 patients worldwide were included in the so-called hyponatremia register and 22 active centers in Germany with 317 patients participated. Although some details from this now concluded register have been published, the final publication of the multinational post-authorization safety study on tolvaptan in the treatment of SIADH has not yet been published. In the years 2012 and 2013 two warning letters were issued on tolvaptan. The first letter warned of the risk of a faster increase in serum sodium using tolvaptan and provided detailed information on how the risk of osmotic demeyelination can be minimized. So far only one proven case of osmotic demelination syndrome (ODS) is known; however, this occurred following incorrect use of tolvaptan in a monotherapy. The second warning letter provided information on the potential risk (reversible) of liver damage by tolvaptan, which resulted from the TEMPO 3:4 study. In this study tolvaptan was used in a higher dosage for therapy of autosomal dominant polycystic kidney disease. Although the European renal best practice (ERBP) guidelines from 2014 did not recommend tolvaptan for the indications of SIADH, other guidelines came to different conclusions. In summary, 5 years after the approval of tolvaptan there is still no consensus. At the current time many questions still remain unanswered. Initiation of therapy with tolvaptan remains reserved for experienced physicians in hospitals. Treatment must be adapted on the basis of a clinical estimation of the individual situation of each patient.

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Clinical practice guideline on diagnosis and treatment of hyponatraemia

Cited by 532 publications

References 44 publications

Die häufigsten Elektrolytstörungen in der Notaufnahme

Die häufigsten Elektrolytstörungen in der Notaufnahme

Correction of Hyper- and Hyponatraemia during Continuous Renal Replacement Therapy

Hyponatriämie und Tolvaptan

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