Hyponatraemia: Mechanisms and Management

Flear, CecilT.G.; Gill, G. V.; Burn, J. H.

doi:10.1016/s0140-6736(81)90261-0

Cited by 137 publications

(63 citation statements)

References 35 publications

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“…According to the multivariate model, about 13% of all hospitalized patients are expected to have hyponatremia irrespective of other variables, which corresponds with frequencies cited in the literature [18,19]. The probability for hyponatremia in patients not labeled as such increases in patients having one or more risk factors for hyponatremia.…”

Section: Discussionsupporting

confidence: 67%

Validity of hospital discharge International Classification of Diseases (ICD) codes for identifying patients with hyponatremia

Movig

Leufkens

Lenderink

et al. 2003

Journal of Clinical Epidemiology

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Medical diagnosis can be studied using various sources of information, such as medical and hospital discharge records and laboratory measurements. These sources do not always concur. The objective of the present study was to assess the sensitivity, specificity, and positive and negative predictive values of hospital discharge diagnosis compared with clinical laboratory data for the identification of hyponatremia. Patients with hyponatremia were selected from a hospital information system determined by the International Classification of Diseases, 9th edition (ICD-9). The validity parameters for hyponatremia (ICD code 276.1) were estimated by comparison with accurate serum sodium (Na ϩ ) levels. A total of 2632 cases of hyponatremia were identified using laboratory measurements (Na ϩ р 135 mmol/L). The sensitivity of ICD coding for hyponatremia was maximally about 30% for patients with very severe hyponatremia (Na ϩ р 115 mmol/L). Corresponding specificities were high (Ͼ 99%). In 87% of the cases with severe hyponatremia (Na ϩ р 125 mmol/L), other discharge ICD codes reflecting severe morbidity were found. This study suggests that ICD codes for hyponatremia represent only one third of the patients admitted to the hospital and experiencing hyponatremia. About two thirds of the patients with hyponatremia were classified as hospitalized for other reasons. To assess the validity of case finding of patients with hyponatremia, the use of analytical techniques, such as certain laboratory measurements, is advisable. Ć

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Section: Discussionsupporting

confidence: 67%

Validity of hospital discharge International Classification of Diseases (ICD) codes for identifying patients with hyponatremia

Movig

Leufkens

Lenderink

et al. 2003

Journal of Clinical Epidemiology

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“…1 Over the peri-operative period, it can be aggravated by: (i) the injudicious prescription of hypotonic dextrose-containing intravenous fluids causing water overload; and (ii) the patient's normal physiological response to surgical stress causing an increased antidiuretic hormone secretion. Patients with a low plasma sodium may exhibit signs of water excess such as confusion, fits, hypertension, cardiac failure, oedema, anorexia, nausea and muscle weakness.…”

Section: Discussionmentioning

confidence: 99%

“…1 The symptoms can be caused by local pressure effects, hormone secretion or hypopituitarism. Local pressure effects can cause headache, visual field defects (bilateral hemianopia initially of the superior quandrants), cranial nerve palsy of III, IV, VI, occasionally disturbance of temperature, sleep and feeding and, in extreme cases, erosion through the floor of the sella leading to CSF rhinorhea.…”

Section: Discussionmentioning

confidence: 99%

Hyponatraemia after orthopaedic surgery – a case of pituitary apoplexy

Thomason

MacLeod²,

Eyres³

2009

Ann R Coll Surg Engl

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Case reportFour days after an elective total hip replacement, a previously fit and healthy 70-year-old man complained of a headache before collapsing on the ward with a Glasgow Coma Score of 5. His blood pressure was recorded at 80/45 and his temperature was 38ºC. No fit was witnessed; although his conscious level improved, he remained confused with slurred speech. His new patient finger prick capillary glucose was 4.7. A right-sided sixth cranial nerve palsy was noted causing paralysis of the lateral rectus with diplopia. His blood sodium concentration was recorded as 117 mmol/l. Treatment was instigated immediately with fluid restriction to 750 ml per 24 h and appropriate biochemical investigations were requested. A short synacthen test revealed a baseline serum cortisol level of 160 nmol/l at 09:30 (normal morning range, 450-700 nmol/l), rising to 461 nmol/l 60 min after administration of 250 µM tetracosactrin. Random serum sodium osmolality was recorded as 245 mOsmol/kg (normal range, 275-295 mOsmol/kg) and urine osmolality was 417 mOsmol/kg. A chest radiograph and ECG were requested and antibiotics were commenced for basal pneumonia. Hydrocorticone (100 mg i.v.) was administered. Serum prolactin, follicle stimulating hormone (FSH), luteinising hormone (LH), testosterone, thyroid stimulating hormone (TSH), T3 and T4 levels were checked and urgent imaging of the pituitary fossa was arranged. A computed tomography scan revealed an enlargement of the sella turcica with a low density mass arising from the pituitary fossa into the supraseller cistern extending a little to the left of the mid-line with lateral extension into the cavernous sinus. The mass abutted both internal carotid vessels and the optic chiasm was significantly elevated and displaced. Appearances were suggestive of a pituitary macro-adenoma.Hormone assays revealed a low FSH level at 1.5 mIU/l (normal range, 1.5-12.5 mIU/l); a low LH level at 1.6 mIU/l (normal range, 1.7-8.4 mIU/l); low TSH at 0.12 (normally, 0.3-4.5); low free T4 level 9.7 pmol/l (11-24 pmol/l); low prolactin at 25 mIU/l (normal range, 98-450 We describe a case of profound hyponatraemia in a postoperative patient after total hip replacement caused by corticosteroid insufficiency due to a non-functioning pituitary macroadenoma diagnosed by dynamic endocrine tests and radiological imaging. Adopting a multidisciplinary approach, successful diagnosis and management lead to a complete recovery without any long-term sequelae.

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“…The cause of hyponatremia should be determined from the patient's history and physical exam and should be managed based on volume status. 2,3 We found one preliminary RCT comparing the oral and intravenous administration of hypertonic saline (3%) in ultramarathon runners with asymptomatic exercise-associated hyponatremia. 36 This study found that prompt intravenous administration of a 100 mL bolus of 3% saline was associated with normalization of serum sodium concentration, whereas no similar effect was seen for the same dose given orally.…”

Section: E284mentioning

confidence: 99%

Management of hyponatremia

Lee

Kilonzo

Nistico

et al. 2013

CMAJ

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H yponatremia, defined as a decrease in serum sodium below 136 mmol/L, is a common occurrence in both inpatients and outpatients and can be found in up to 15% of the general hospital populations.1,2 Acute hyponatremia (duration < 48 h) and its management can be a cause of major morbidity and mortality among patients in hospital.3 Chronic hyponatremia (duration > 48 h), which is typically seen among older (≥ 65 yr) outpatients, also contributes to morbidity because it is often unrecognized.3,4 Typically, correction of serum sodium concentration in patients with acute hyponatremia should occur at a more rapid rate than in patients with chronic hyponatremia because the symptoms are usually more severe when serum sodium rapidly decreases over a short period. 1It is essential to determine the underlying cause of hyponatremia because the type of hyponatremia dictates the approach to therapy. Once the type is determined, clinicians need to weigh the evidence to determine what treatment will be the most effective. This can prove confusing and challenging for both primary care physicians and specialists because there are a myriad of treatment-related reviews and publications with no clear guide as to what the best evidence suggests for the treatment of hyponatremia in each setting.In this review, we discuss the evidence for the management of hyponatremia. A variety of management approaches (both pharmacologic and nonpharmacologic) exist in clinical practice. We set out to review the evidence from randomized controlled trials (RCTs) for strategies to treat hyponatremia. Not surprisingly, most RCT-level evidence comes from industry-sponsored trials of newer pharmacologic agents. 5,6 Our review was performed systematically; our methods are described in Box 1. After completing the review, it became clear that to provide the reader with a clinical ap proach that could be applied in practice, we also needed to review and discuss management strategies that are well established in practice but are not supported by RCT-level evidence. The clinical application of our results is shown in Box 2. How does the type of hyponatremia affect treatment?Although there are many approaches to the management of hyponatremia, one of the most common approaches used by nonexpert clinicians begins with an assessment of extracellular fluid (ECF) volume status. Because diabetes mellitus is becoming more prevalent in the adult population, clinicians should be mindful of ruling out hyperosmolar hyponatremia caused by hyperglycemia as a potential cause of hyponatremia. The clinical history and physical examination provide important diagnostic clues that help to classify the cause of hyponatremia as hypovolemic, euvolemic or hypervolemic. Hypovolemic hyponatremiaHypovolemic hyponatremia occurs in cases of volume contraction, such as is seen with vomiting and diarrhea, excessive sweating and use of diuretics.1 A patient may present with frank hypotension or with postural hypotension or tachycardia. In this setting, release of both antidiuretic hormone (...

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Hyponatraemia: Mechanisms and Management

Cited by 137 publications

References 35 publications

Validity of hospital discharge International Classification of Diseases (ICD) codes for identifying patients with hyponatremia

Validity of hospital discharge International Classification of Diseases (ICD) codes for identifying patients with hyponatremia

Hyponatraemia after orthopaedic surgery – a case of pituitary apoplexy

Management of hyponatremia

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