Evidence-based hyponatremia management in liver disease

Ryu, Ji Young; Baek, Seon Ha; Kim, Sejoong

doi:10.3350/cmh.2023.0090

Cited by 7 publications

(4 citation statements)

References 123 publications

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“…Our review focused on pathophysiology, diagnosis, and treatment of hyponatremia in patients with liver diseases [ 5 ]. We were unable to discuss ODS itself thoroughly.…”

mentioning

confidence: 99%

Correspondence on Letter regarding “Evidence-based hyponatremia management in liver disease”

Ryu,

Baek,

Kim

2023

Clin Mol Hepatol

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“…Our review focused on pathophysiology, diagnosis, and treatment of hyponatremia in patients with liver diseases [ 5 ]. We were unable to discuss ODS itself thoroughly.…”

mentioning

confidence: 99%

Correspondence on Letter regarding “Evidence-based hyponatremia management in liver disease”

Ryu,

Baek,

Kim

2023

Clin Mol Hepatol

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“…In specific patients with hypokalemia, alcoholism, malnutrition, liver disease [40], and at high-risk for osmotic demyelination syndrome (ODS), a sodium correction should be limited up to 8 mEq/L, in the averaged-risk patients up to 10 mEq/L, and up to 12 mEq/L for 24 h in others. Serum sodium should be measured every 4-6 h, and if the increase has reached 8 mEq/L (8 mmol/L) in the first 12 h, measures to prevent a further increase should be instituted by matching urine output with 5% dextrose in water.…”

Section: Therapeutic Approachmentioning

confidence: 99%

Etiology, Clinical Approach, and Therapeutic Consequences of Hyponatremia

Spasovski

2024

Kidney and Dialysis

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A perturbation in the water balance rather than any change in salt content is the main cause of hyponatremia, the most frequent electrolyte abnormality, defined as a serum sodium concentration <135 mEq/L. Hyponatremia may be divided between mild (Na > 120 mEq/L) or severe (Na < 120 mEq/L) hyponatremia, and is most frequently observed in elderly ICU hospitalized patients. Based on tonicity, hyponatremia may be hypotonic (a decreased concentration of the solute), isotonic, and hypertonic (falsely low sodium). According to the volume of extracellular fluid (ECF), hyponatremia is further divided among hypovolemic, euvolemic, or hypervolemic hyponatremia. Finally, hyponatremia may develop rapidly as acute (<48 h), usually with severe symptoms, or slowly as chronic hyponatremia, usually being asymptomatic or with mild symptoms. Acute severe hyponatremia presents with severe CNS problems, increased hospitalization rates, and mortality. The treatment with 3% sodium chloride and a 100 mL IV bolus based on severity and persistence of symptoms needs careful monitoring. A non-severe hyponatremia may be treated with oral urea. In asymptomatic mild hyponatremia, an adequate solute intake with an initial fluid restriction of 500 mL/d adjusted according to the serum sodium levels is preferred. Vaptans could be considered in patients with high ADH activity regardless of whether they are euvolemic or hypervolemic. In general, the treatment of hyponatremia should be based on the underlying cause, the duration and degree of hyponatremia, the observed symptoms, and volume status of patient.

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“…In specific patients with hypokalemia, alcoholism, malnutrition, liver disease [39], and high-risk for osmotic demyelination syndrome (ODS) sodium correction should be limited up to 8 mEq/L, in the averaged-risk patients up to 10 mEq/L and up to 12 mEq/L for 24 hours in others. Serum sodium should be measured every 4-6 hours, and if the increase has reached 8 mEq/L (8 mmol/L) in the first 12 hours, measures to prevent a further increase should be instituted by matching urine output with 5% dextrose in water.…”

Section: Therapeutical Approachmentioning

confidence: 99%

Etiology, Clinical Approach, and Therapeutic Consequences of Hyponatremia

Spasovski,

Lameire

2023

Preprint

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The perturbation in water balance rather than any change in salt content is the main cause of hyponatremia, the most frequent electrolyte abnormality defined as serum sodium concentration <135 mEq/L. Hyponatremia may be divided as mild (Na>120 mEq/L) or severe (Na<120 mEq/L) hyponatremia, most frequently observed in elderly ICU hospitalized patients. Based on tonicity hyponatremia may be hypotonic (decreased concentration of solute), isotonic, and hypertonic (falsely low sodium). According to the volume of the extracellular fluid (ECF) hyponatremia is further divided as hypovolemic, euvolemic, or hypervolemic hyponatremia. Finally, hyponatremia may develop rapidly as acute (<48 h) with usually severe symptoms, or slowly as chronic hyponatremia, being usually asymptomatic or with mild symptoms. Patient’s medical history and clinical symptoms and signs could point to a certain diagnostic direction. Acute severe hyponatremia is presented with headaches, vomiting, nausea, fatigue, impaired cognition, gait with increased falls symptoms etc., while the severe symptomatology due to hyponatremic encephalopathy is presented as confusion, agitation, seizures, or even coma and death. Nevertheless, an urgent evaluation of the volume and neurological status is essential for prevention of neurological damages. The treatment of hyponatremia should of course be based on the underlying cause, the duration and degree of hyponatremia, the observed symptoms, and volume status of patient.

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Evidence-based hyponatremia management in liver disease

Cited by 7 publications

References 123 publications

Correspondence on Letter regarding “Evidence-based hyponatremia management in liver disease”

Correspondence on Letter regarding “Evidence-based hyponatremia management in liver disease”

Etiology, Clinical Approach, and Therapeutic Consequences of Hyponatremia

Etiology, Clinical Approach, and Therapeutic Consequences of Hyponatremia

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