Hyponatremia and Long-term Mortality in Survivors of Acute ST-Elevation Myocardial Infarction

Goldberg, A.; Hammerman, Haim; Petcherski, Sirouch; Nassar, Mithal; Zdorovyak, Alexander; Yalonetsky, Sergey; Kapeliovich, Michael; Agmon, Yoram; Beyar, Rafael; Markiewicz, Walter; Aronson, Doron

doi:10.1001/archinte.166.7.781

Cited by 135 publications

(118 citation statements)

References 26 publications

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“…Similar observations have been reported in other studies (7,9). Goldberg and colleagues observed that hyponatremia on admission or developing during the first 72 hours of hospitalization in STEMI was independently associated with increased 30-day mortality risk as well a higher incidence of post-discharge readmission for heart failure and death in long-term followup (7,8). Then Singla et al reported that hyponatremia was associated with adverse 30-day outcomes in patients admitted with non-ST-elevation myocardial infarction and degree of hyponatremia correlated with an increasing number of adverse events (9).…”

Section: Discussionsupporting

confidence: 83%

“…The fall in sodium concentrations in these patients is related to activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system, and neurohormone-mediated, nonosmotic release of vasopressin (AVP). Recently, some studies have shown that hyponatremia is linked to poor outcomes in patients with ST-elevation myocardial infarction (STEMI) and non-ST elevation acute coronary syndrome and the risk of mortality increased with the severity of hyponatremia (7)(8)(9). However, the influence of hyponatremia on the prevalence and prognosis in Chinese patients with STEMI has been unclarified.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between Hyponatremia and In-hospital Outcomes in Chinese Patients with ST-Elevation Myocardial Infarction

Tang

Hua

2011

Intern. Med.

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Objective This study was investigated to determine the relationship between hyponatremia and in-hospital outcomes in Chinese patients with ST-elevation myocardial infarction. Methods Plasma sodium concentration was obtained in all patients on admission and analyzed as hyponatremia versus normalnatremia. The relationships between hyponatremia and in-hospital mortality as well as heart failure were assessed. Results Of 1,620 patients, 212 (13.1%) patients had hyponatremia on presentation (sodium <135 mmol/L). Patients with hyponatremia had higher rates of in-hospital mortality (13.7% vs. 7.3%, p=0.002) and heart failure (30.2% vs. 18%, p<0.001). Patients with a sodium level of <130 mmol/L had an adverse event rate of 22.9% versus 11.0% in patients with a sodium level of 130 to 135 mmol/L (p=0.034). In multivariate logistic regression, hyponatremia was independently correlated with in-hospital mortality (OR: 1.77, 95% CI: 1.02-3.06, p=0.042) and heart failure (OR: 1.61, 95% CI: 1.06-2.43, p=0.025). Conclusion Hyponatremia is independently associated with in-hospital adverse outcomes in Chinese patients with acute ST-elevation myocardial infarction, and the risk of in-hospital mortality was increased with the severity of hyponatremia.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Relationship between Hyponatremia and In-hospital Outcomes in Chinese Patients with ST-Elevation Myocardial Infarction

Tang

Hua

2011

Intern. Med.

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“…Studies about the clinical prevalence of electrolyte imbalances often report that these disorders are frequently seen in elderly and critically ill patients, and occur in the progression of diseases such as diabetes mellitus, acute or chronic renal failures, severe cardiovascular events like myocardial infarctions, etc. [4–6] To summarize, disturbances in electrolyte balances are mathematically measurable biochemical parameters in the bloodstream that determines the clinical manifestations of interactions between metabolic events such as sepsis,[7] hormones,[8] vascular events,[9] medications,[10] hydration deficiencies,[11] and renal physiology.…”

Section: Introductionmentioning

confidence: 99%

General characteristics of patients with electrolyte imbalance admitted to emergency department

Balcı¹,

Köksal²,

Köse³

et al. 2013

World Journal of Emergency Medicine

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BACKGROUND:Fluid and electrolyte balance is a key concept to understand for maintaining homeostasis, and for a successful treatment of many metabolic disorders. There are various regulating mechanisms for the equilibrium of electrolytes in organisms. Disorders of these mechanisms result in electrolyte imbalances that may be life-threatening clinical conditions. In this study we defined the electrolyte imbalance characteristics of patients admitted to our emergency department.METHODS:This study was conducted in the Emergency Department (ED) of Uludag University Faculty of Medicine, and included 996 patients over 18 years of age. All patients had electrolyte imbalance, with various etiologies other than traumatic origin. Demographic and clinical parameters were collected after obtaining informed consent from the patients. The ethical committee of the university approved this study.RESULTS:The mean age of the patients was 59.28±16.79, and 55% of the patients were male. The common symptoms of the patients were dyspnea (14.7%), fever (13.7%), and systemic deterioration (11.9%); but the most and least frequent electrolyte imbalances were hyponatremia and hypermagnesemia, respectively. Most frequent findings in physical examination were confusion (14%), edema (10%) and rales (9%); and most frequent pathological findings in ECG were tachycardia in 24%, and atrial fibrillation in 7% of the patients. Most frequent comorbidity was malignancy (39%). Most frequent diagnoses in the patients were sepsis (11%), pneumonia (9%), and acute renal failure (7%).CONCLUSIONS:Electrolyte imbalances are of particular importance in the treatment of ED patients. Therefore, ED physicians must be acknowledged of their fluid-electrolyte balance dynamics and general characteristics.

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“…Volume overload is the main factor of HT that leads to CVD [1]. Hyponatremia is also reported to be associated with increased morbidity and mortality in various diseases, including CKD [8][9][10][11]. Therefore, both volume overload and hyponatremia should be corrected in CKD.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment with tolvaptan to control blood volume and hyponatremia in a chronic kidney disease patient

et al. 2012

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We report a case of successful treatment with tolvaptan (15 mg/day) in a 73-year-old female patient with chronic kidney disease (CKD) stage 5 due to diabetic nephropathy and renal sclerosis for volume control and loop diuretic-induced hyponatremia. Her creatinine clearance has remained at 7-10 ml/min for the last 6 months. She was treated by dietary and drug therapy, namely, antihypertensives (nifedipine: 40 mg/day, olmesartan: 20 mg/ day) and loop diuretics (azosemide: 40-120 mg/day), for CKD and concomitant diseases of hypertension and diabetic mellitus. She developed loop diuretic-induced hyponatremia (120 mmol/l) by increased sodium excretion, but the diuretic was required for the control of volume overload. Hence, azosemide was suspended and tolvaptan (15 mg/day) was administered. After tolvaptan treatment, the plasma sodium level gradually increased to a normal level (135-140 mmol/l) and volume overload was improved. Urine volume was maintained at about 1000 ml/ day with low sodium excretion (\40 mmol/day) and increased free water clearance. These results suggest that tolvaptan may be effective for volume control and diureticinduced hyponatremia in CKD patients.

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Hyponatremia and Long-term Mortality in Survivors of Acute ST-Elevation Myocardial Infarction

Cited by 135 publications

References 26 publications

Relationship between Hyponatremia and In-hospital Outcomes in Chinese Patients with ST-Elevation Myocardial Infarction

Relationship between Hyponatremia and In-hospital Outcomes in Chinese Patients with ST-Elevation Myocardial Infarction

General characteristics of patients with electrolyte imbalance admitted to emergency department

Successful treatment with tolvaptan to control blood volume and hyponatremia in a chronic kidney disease patient

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