Clinical relevance and management of the major electrolyte abnormalities in congestive heart failure: Hyponatremia, hypokalemia, and hypomagnesemia

Toward a broader understanding of aldosterone in congestive heart failure

“…In patients with CHF treated with a loop diuretic, there exists an independent stimulus to urinary Mg 2+ excretion and the potential for exaggerated Mg 2+ loss. 34,35 Detection of biologically active, cytosolic free [Mg 2+ ] i (vis-à-vis its concentration in serum, which does not reflect intracellular Mg 2+ ) hinders the detection and assessment of this important clinical problem. Intracellular Mg 2+ deficiency may contribute to morbid and mortal events, such as sudden cardiac death, that occurs in 50% of patients with CHF.…”

Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers

“…However, many patients do not respond to intravenous furosemide unless very high doses are used, a situation usually referred to as diuretic resistance. Several potential causes may underlie this important problem, such as magnesium or potassium deficiency (due to chronic loss from diuretics), severe reduction in GFR leading to excessive sodium resorption in the distal tubule, poor renal perfusion and reduced cardiac output, anemia and excessive vasodilation (85,86,90,91). To combat this, several strategies have been developed, such as repeated administration (often better than a large single dose) or addition of a thiazide-type diuretic to inhibit distal sodium resorption (92)(93)(94)(95)(96)(97)(98).…”

“…This particularly occurs in elderly population. Measurement of renal function and electrolytes is therefore suggested in the setting of any acute dehydrating illness (85,(89)(90)(91). Patients who improve with evidence-based heart failure therapy, especially with betablockers, may experience diminishing requirements for diuretics.…”

Correction of Hyponatremia by Tolvaptan Before Left Ventricular Assist Device Implantation

“…3) In patients with stage D heart failure in particular, almost all patients cannot help depending on diuretics, which facilitate hyponatremia due to increased excretion of sodium and stimulation of renin/angiotensin and norepinephrine secretion as well as inappropriate AVP secretion against low or normal serum osmolality. 4) We here experienced 2 patients with stage D heart failure, who were in progressive decline with severe hyponatremia despite optimal medication and intravenous catecholamine infusion. Since both patients were indicated for left ventricular assist device (LVAD) implantation, we were afraid that osmotic demyelination syndrome (ODS) would emerge after rapid correction of hyponatremia through stabilization of hemodynamic state after surgery.…”