Heparin-Induced Hyponatremia

Norman, Nils; Sneed, Angela M; Brown, Christine E.; Ellis, Cecilia A; Minard, Gayle; Brown, Rex O.

doi:10.1345/aph.1c442

Cited by 14 publications

(14 citation statements)

References 10 publications

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“…Patients received heparin and antibiotics in this study appeared to have around a three fold higher risk of developing hyponatremia during hospitalization with odds ratio 3.85 (95 % CI 1.78-8.31) and 3.08 (1.71-5.53), respectively. While heparin has been known can induce hyponatremia [ 23 ], administration of antibiotics might induce hyponatremia by involving a complex association with pathophysiological process of infection.…”

Section: Discussionmentioning

confidence: 99%

Hyponatremia during hospitalization and in-hospital mortality in patients hospitalized from heart failure

Saepudin

Ball

Morrissey

2015

BMC Cardiovasc Disord

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BackgroundTo date, the majority of studies on hyponatremia focussed on hyponatremia at admission, and came from developed countries. This study aimed to identify the prevalence of hyponatremia during hospitalization in patients hospitalized for HF and its association with in-hospital mortality.MethodsThis was an observational study using retrospective data from patients’ records between 2010–2013. It focused on those patients carrying an ICD-10 code of 150.0(Congestive Heart Failure) as their primary diagnosis.Hyponatremia during hospitalization was defined as serum sodium level lower than 135 mEq/L obtained from a blood chemistry measurement on the next days after admission. Patients’ characteristics were examined and the association between hyponatremia during hospitalization and in-hospital mortality was analyzed.ResultsAmong 464 patients hospitalized for HF, hyponatremia during hospitalization was observed in 22 % of patients with 44 % of this group had normal serum sodium level on admission.Hyponatremia during hospitalization was associated with lower blood pressure on admission, both systolic and diastolic, peripheral oedema, ascites and fatigue. Patients having history of hospitalization for cardiac diseases and renal failure were higher in patients developing hyponatremia during hospitalization. In this group, amiodarone, heparin, insulin and antibiotics were administered more frequently. Factors potentially increase the risk of hyponatremia during hospitalization include history of fatigue (OR = 3.23, 95 % CI 1.79–5.82), presence of ascites (4.14, 1.84–9.31), and administration of heparin (3.85, 1.78–8.31) and antibiotics (3.08, 1.71–5.53). Length of hospital stay was significantly longer in patients with hyponatremia during hospitalization and in-hospital mortality was also higher compared to non-hyponatremic patients, 7.7 % and 29.1 %, respectively.ConclusionThis study found that the prevalence of hyponatremia during hospitalization in patients hospitalized for HF was almost the same as hyponatremia on admission and administration of heparin and antibiotics can potentially worsen hyponatremia during hospitalization. In this study population, hyponatremia during hospitalization was found to be associated with in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Hyponatremia during hospitalization and in-hospital mortality in patients hospitalized from heart failure

Saepudin

Ball

Morrissey

2015

BMC Cardiovasc Disord

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“…She also exhibited severe hyponatremia with symptoms including nausea, headaches, and fatigue. While the cause of hyponatremia is often idiopathic, there are a host of well-described causes such as hormone imbalance [6], infections [7], heart failure, cirrhosis, syndrome of inappropriate antidiuretic hormone, and medications such as anticoagulants [8,9] that are potentially responsible. A correlation with COVID-19 is possible in this case as the patient did not have any history of low sodium levels.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Severe Hyponatremia Secondary to Coronavirus Disease 2019 Viral Pneumonia

Pillutla¹,

Patel²,

Koneru³

et al. 2021

Cureus

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As of December 2020, the coronavirus disease 2019 (COVID-19) pandemic has resulted in 82.2 million cases worldwide. We report the case of a 69-year-old South Asian female with a history of hypertension, hypothyroidism, meningiomatosis, and urinary incontinence who contracted COVID-19 and developed severe hyponatremia. She was initially medically managed with antibiotics, anti-parasitics, anti-coagulants, and steroids. After experiencing breathlessness, chest discomfort, high systolic blood pressure, and tachycardia, she was admitted and diagnosed with post-COVID pneumonia, and was conservatively treated with steroids. She showed improvement, and was discharged upon being declared hemodynamically stable. While the patient was at home, she experienced periods of breathlessness and acral edema. This case raises the question of the correlation between hyponatremia and COVID-19, especially in regards to symptomatic presentations, including altered mental status, headache, and nausea. As there are limited studies that show severe electrolyte disorders leading to mortality, more research is needed to understand hyponatremia in cases with COVID-19.

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“…Heparins, both unfractionated and LMWH, have an effect on the aldosterone metabolism resulting in electrolyte changes, especially hyperkalemia and to a lower incidence of hyponatremia resulting from natriuresis as an effect of hypoaldosteronism. [25][26][27] Although the decreased aldosterone level is reversible with short-term use of heparin, prolonged use may result in the reduction of aldosterone levels leading, or at least pre-disposing to severe hyperkalemia and hyponatremia. 27 In addition to heparin, positive inotropes are another medication-related factor associated with hyponatremia.…”

Section: Discussionmentioning

confidence: 99%

“…[25][26][27] Although the decreased aldosterone level is reversible with short-term use of heparin, prolonged use may result in the reduction of aldosterone levels leading, or at least pre-disposing to severe hyperkalemia and hyponatremia. 27 In addition to heparin, positive inotropes are another medication-related factor associated with hyponatremia. Reports on hyponatremia in association with positive inotropes have not yet been found.…”

Section: Discussionmentioning

confidence: 99%

Development of prediction model for identifying heart failure patients with high risk of developing hyponatremia

Saepudin

Ball

Morrissey

2019

JKKI

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Background: Despite its significant contribution to morbidity and mortality, studies reported that hyponatremia is still inadequately recognised and treated. Objective: To obtain a prediction model for predicting the risk of hyponatremia in patients hospitalized from heart failure. Methods: Patients included in this research were patients hospitalized from heart failure at Fatmawati Hospital in Jakarta, Indonesia during the 2011 -2014 period. Logistic regression analysis was performed for the derivation of prediction model by including variables obtained during admission as the predictors. Brier-score and Nagelkerke R 2 (NR 2 ) were measured to assess overall predictive ability and area under the curve (AUC) of the Receiver Operating Characteristics (ROC) and calibration plot along with Hosmer-Lemeshow test were measured to assess discrimination and calibration ability, respectively. Internal validation was performed using a bootstrapping approach. Results: Out of 464 patients included in the research 102 (22%) were hyponatremic during hospitalization. Accordingly, 306 non-hyponatremic patients were selected as controls matched by age and gender. Variables significantly associated with hyponatremia were serum sodium level, fatigue, ascites, positive inotropes, heparin and antibiotics. Prediction model containing those six variables exhibits good predictive ability both overall (brier-score=0.107, NR2=0.531) and specifically of discrimination (AUC of ROC curve=0.90) and calibration ability (p-value of HL test=0.899). Optimism observed from internal validation did not reduce its predictive performance. Conclusion: Risk prediction for predicting the risk of hyponatremia in patients hospitalized from heart failure can be derived by including predictors taken from information obtained during admission. Latar Belakang: Hiponatremia merupakan gangguan elektrolit yang paling sering dialami oleh pasien gagal jantung yang sedang menjalani perawatan di rumah sakit dan memberikan kontribusi yang signifikan terhadap morbiditas dan mortalitas pasien. Tujuan Penelitian: Mengembangkan model prediksi untuk mengidentifikasi pasien gagal jantung yang memiliki risiko tinggi mengalami hiponatremia selama perawatan di rumah sakit.

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Heparin-Induced Hyponatremia

Abstract: The use of UFH may result in significant hyponatremia as well as hyperkalemia. Reversal of these electrolyte disturbances occurs after discontinuation of heparin.

Cited by 14 publications

References 10 publications

Hyponatremia during hospitalization and in-hospital mortality in patients hospitalized from heart failure

Hyponatremia during hospitalization and in-hospital mortality in patients hospitalized from heart failure

A Case Report of Severe Hyponatremia Secondary to Coronavirus Disease 2019 Viral Pneumonia

Development of prediction model for identifying heart failure patients with high risk of developing hyponatremia

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