CRITICAL CARE ISSUES FOR THE NEPHROLOGIST: Electrolyte Disturbances in the Intensive Care Unit

Sedlacek, Martin; Schoolwerth, Anton C.; Remillard, Brian D.

doi:10.1111/j.1525-139x.2006.00212.x

Cited by 91 publications

(69 citation statements)

References 59 publications

(63 reference statements)

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“…These patients usually develop intravascular volume depletion along with a delayed recovery of renal function because of the induction of a pre-renal azotemia [4]. Most hypernatremias are thought to be associated with hypovolemia with a low total body sodium content [5][6][7] but hypervolemic hypernatremia is thought to be rare [5,8].…”

Section: Introductionmentioning

confidence: 99%

Hypervolemic hypernatremia in patients recovering from acute kidney injury in the intensive care unit

et al. 2011

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The hypernatremia is believed to be due to post-AKI diuresis in the face of inability to maximally concentrate the urine because of renal failure. The diuresis caused a disproportionate loss of water in excess of that of sodium in the absence of replenishment of the water loss. Additionally, the patients were hypervolemic due to the retention of large quantities of sodium and water as a result of infusion of substantial volumes of physiological saline prior to the development of hypernatremia.

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Section: Introductionmentioning

confidence: 99%

Hypervolemic hypernatremia in patients recovering from acute kidney injury in the intensive care unit

et al. 2011

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“…[3][4][5][6][7][8][9] Other complications include seizures and tetany, as well as impairment of diaphragmatic contractility. [4][5][6]10 Conversely, correction of electrolyte abnormalities in critically ill patients has been shown to reduce complications. For instance, correction of intraoperative hypomagnesemia in cardiac surgery patients undergoing extracorporeal circulation can reduce the incidence of ventricular tachyarrhythmia.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an Electrolyte Repletion Protocol for Cardiac Surgery Intensive Care Patients

Couture

Létourneau²,

Dubuc

2013

CJHP

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“…Indeed, close monitoring is mandatory in symptomatic cases of hyponatremia, as they can rapidly progress to hyponatremic encephalopathy [95][96][97][98][99][100] . This complex problem remains an ongoing clinical challenge and deserves more attention by clinicians, not only in an academic context, but in clinical settings where there is ample evidence to support fluid therapy strategies that can reduce the risk of serious consequences for children.…”

Section: Resultsmentioning

confidence: 99%

Impact of perioperative hyponatremia in children: A narrative review

Andersen

Afshari

2014

WJCCM

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For more than 50 years, hypotonic fluids (crystalloids) have been the standard for maintenance fluid used in children. In the last decade, several studies have evaluated the risk of hyponatremia associated with the use of hypotonic vs isotonic fluids, which has lead to an intense debate. Children undergoing surgery have several stimuli for release of antidiuretic hormone, which controls renal water handling, including pain, nausea, vomiting, narcotic use and blood loss. The body's primary defense against the development of hyponatremia is the ability of the kidneys to excrete free water and dilute urine. Increased levels of antidiuretic hormone can result in hyponatremia, defined as a plasma sodium level < 136 mmol/L, which causes cells to draw in excess water and swell. This manifests as central nervous system symptoms such as lethargy, irritability and seizures. The risk for symptomatic hyponatremia is higher in children than in adults. It represents an emergency condition, and early diagnosis, prompt treatment and close monitoring are essential to reduce morbidity and mortality. The widespread use of hypotonic fluids in children undergoing surgery is a matter of concern and more focus on this topic is urgently needed. In this paper, we review the literature and describe the impact of perioperative hyponatremia in children. Key words: Children; Fluid; Hyponatremia; Pediatric; Perioperative Core tip: Hospital-acquired hyponatremia is common, particularly among children undergoing surgery. These children tend to develop hyponatremic encephalopathy at higher serum sodium concentrations than adults and they have a poorer prognosis. As the risk is increased by the use of hypotonic fluids, intraoperative fluids for children should be isotonic. Symptomatic hyponatremia should be corrected with 3% sodium chloride and close monitoring of the patient and serum sodium level is mandatory to prevent brain herniation and neurologic damage from cerebral ischemia.Andersen C, Afshari A. Impact of perioperative hyponatremia in children: A narrative review. World J Crit Care Med 2014; 3(4): 95-101 Available from:

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CRITICAL CARE ISSUES FOR THE NEPHROLOGIST: Electrolyte Disturbances in the Intensive Care Unit

Cited by 91 publications

References 59 publications

Hypervolemic hypernatremia in patients recovering from acute kidney injury in the intensive care unit

Hypervolemic hypernatremia in patients recovering from acute kidney injury in the intensive care unit

Evaluation of an Electrolyte Repletion Protocol for Cardiac Surgery Intensive Care Patients

Impact of perioperative hyponatremia in children: A narrative review

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