Hiponatremias en el paciente neurocrítico: enfoque terapéutico basado en la evidencia actual

Manzanares, William; Aramendi, I.; Langlois, Pascal L.; Biestro, Alberto

doi:10.1016/j.medin.2014.11.004

Cited by 15 publications

(3 citation statements)

References 61 publications

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“…Regarding hyponatremia and edema, it could be related to SIADH in the context of cerebral pathology and which worsened at the time due to fluid overload ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

Persistent dyselectrolytemia in a neonate induced by liposomal amphotericin B. A case report

et al. 2023

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BackgroundNephrotoxicity is the most frequent serious adverse effect associated with amphotericin B deoxycholate treatment, for this reason, in recent years it has been relegated from routine clinical practice and replaced by the new liposomal formulations that have less nephrotoxicity. Nevertheless, dyselectrolytemia are a frequent adverse effect of the use of liposomal amphotericin B that usually are resolved with the withdrawal of the drug.Case presentationWe present a preterm neonate of 25 weeks gestation, with preserved renal function and most electrolytes within normal limits for gestational age except for mild hyponatremia in the first month of life. Due to an infection of the central nervous system and growth of Candida albicans, he required treatment with endovenous liposomal amphotericin B as well as intrathecal amphotericin B deoxycholate showing severe hydroelectrolyte disturbances and clinical worsening compatible with possible tubulopathy showing hypokalemia and severe hyponatremia a few days after starting treatment that persisted over time even after withdrawal of both drugs. Subsequently to the main alterations described, hypomagnesemia, hypophosphatemia, glycosuria and tubular proteinuria were also observed. Calcium levels remained stable after amphotericin B administration and did not require supplementation. In preterm or low birth weight newborns who present unjustified, severe and difficult to correct hydroelectrolyte disturbances despite the usual treatment, a possible tubulopathy should be considered, whether hereditary, primary or secondary to toxins or drugs.What Is New and ConclusionWe present the first case reported in a neonate in whom dyselectrolithemia has been maintained over time after withdrawal of liposomal amphotericin B.

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“…Regarding hyponatremia and edema, it could be related to SIADH in the context of cerebral pathology and which worsened at the time due to fluid overload ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

Persistent dyselectrolytemia in a neonate induced by liposomal amphotericin B. A case report

et al. 2023

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“…Hypocalcaemia was more common in patients with SAO, but failed to be an independent predictor. Hyponatremia is not an uncommon phenomenon in the clinical course following aSAH [29,30]. It is suspected that hyponatremia in aSAH patients is usually related to cerebral salt wasting syndrome or inappropriate diuresis [29,30].…”

Section: Predictors Of Saomentioning

confidence: 99%

“…Hyponatremia is not an uncommon phenomenon in the clinical course following aSAH [29,30]. It is suspected that hyponatremia in aSAH patients is usually related to cerebral salt wasting syndrome or inappropriate diuresis [29,30]. Hyponatremia might ultimately lead to seizures, but rather in the setting of a rapid change of serum sodium levels [31].…”

Section: Predictors Of Saomentioning

confidence: 99%

Seizures at the onset of aneurysmal SAH: epiphenomenon or valuable predictor?

et al. 2020

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Objective Seizures at the onset (SAO) of aneurysmal subarachnoid hemorrhage (aSAH) occur in up to one of every five cases. To date, there is no consensus on causal background and clinical value of these early bleeding-related seizures. This study aimed to analyze the predictors and the impact of SAO in aSAH. Methods All aSAH patients from the institutional observational cohort (01/2003-06/2016) were retrospectively reviewed. Patients' charts and emergency protocols from first responders were screened for the occurrence of seizures in the first 24 h after aSAH. Patients' baseline characteristics and occurrence of post-hemorrhagic complications were analyzed. Outcome endpoints included in-hospital mortality and poor outcome at 6-month follow-up (modified Rankin Scale > 3). Results Of 984 patients included in the final analysis, SAO occurred in 93 cases (9.5%) and were independently associated with younger age (< 51 years, p < 0.001), WFNS grade ≥ 4 (p < 0.001), aneurysm characteristics (location at the proximal branch of the anterior cerebral artery [p = 0.037] and irregular sac [p = 0.019]) and admission body temperature > 38.3 ℃ (p = 0.008). There was an association between SAO and early complications (early infarcts [p = 0.004] and primary decompressive craniectomy [p = 0.024]). Only in the subgroup analysis restricted to the younger individuals, SAO independently predicted poor outcome of aSAH (p = 0.002). Significance Onset seizures following aSAH are rare and most likely related to the severity of early brain injury. Particularly, younger individuals are not only at higher risk for SAO, but are also prone to poor outcome in case of aSAH accompanied with SAO. Trial registration number German clinical trial registry (DRKS, unique identifier: DRKS00008749, 06/09/2015

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