Hyponatremia as a complication of cardiac catheterization: A prospective study

Aronson, Doron; Dragu, Robert; Nakhoul, Farid; Hir, Jamal; Miller, Asaf; Boulos, Monther; Zinder, Oren; Green, Jacob; Mittleman, Murray A.; Markiewicz, Walter

doi:10.1053/ajkd.2002.36324

Cited by 24 publications

(9 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is possible that osmotic diuresis secondary to contrast medium may contribute to the development of hyponatremia since urine osmolarity at hour 6 was increased in the CIAKI group compared to the control group. The administration of hypotonic fluids appears to be one of the causes of an acute reduction in serum sodium levels, together with an impaired urinary dilutional capacity (Aronson et al 2002). In our study, none of the enrolled patients received hypotonic saline.…”

Section: Discussionmentioning

confidence: 69%

Increased Plasma Osmolar Gap Is Predictive of Contrast-Induced Acute Kidney Injury

Kim

Sung

Kang

et al. 2012

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

Contrast-induced acute kidney injury (CIAKI) is a common complication after percutaneous coronary artery intervention (PCI). It is urgent to find a novel, easily measurable and accurate predictor for the early detection of CIAKI. Hyperosmolarity and large amounts of contrast media are risk factors for CIAKI. However, there is no study on plasma osmolar gap as a predictor of CIAKI. We enrolled 89 patients undergoing elective PCI and tested changes of serum sodium, osmolar gap, and renal function at 0, 6, 12 and 24 hours. Plasma osmolar gap was calculated using the following formula: measured plasma osmolarity -[2(Na) + serum urea nitrogen/2.8 + glucose/18]. CIAKI was defined as follows: increase in serum creatinine of ≥ 50%, increase in serum creatinine of ≥ 0.3 mg/dL, or decrease in estimated glomerular filtration rate of ≥ 25% within 24 hours after PCI. The incidence of CIAKI was 13.5% (12/89 patients). The CIAKI group had higher plasma osmolar gaps 6 hours after PCI. The adjusted hazard ratio of the plasma osmolar gap from hour 6 (1-mOsm/L increments) to the development of CIAKI was 1.12 (95% confidence interval [CI], 1.01-1.26; P = 0.041). Sensitivity and specificity of 7 mOsm/L or higher plasma osmolar gap at hour 6 were 70.0% and 76.6%, respectively (area under the ROC curve = 0.77 [95% CI, 0.65-0.89]). Increased plasma osmolar gap may precede the development of CIAKI in patients undergoing PCI. In conclusion, plasma osmolar gap may be a useful predictor for the development of CIAKI.

show abstract

Section: Discussionmentioning

confidence: 69%

Increased Plasma Osmolar Gap Is Predictive of Contrast-Induced Acute Kidney Injury

Kim

Sung

Kang

et al. 2012

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

show abstract

“…In consequence, the access of water cannot be excreted. In such circumstances the infusion of hypotonic fluids leads to the development of acute hyponatraemia and decreased plasma osmolality which causes the shifting of water into the cell and results in brain oedema [11,14].…”

Section: Discussionmentioning

confidence: 99%

Płynoterapia śródoperacyjna w praktyce pediatrycznej — porównanie wybranych płynów infuzyjnych

Mierzewska-Schmidt¹

2015

Anaesthesiol Intensive Ther

View full text Add to dashboard Cite

Background: Fluid therapy is essential for safe perioperative management. Numerous reports of serious complications as a result of inappropriate fluid management, including brain damage and death of children, have been published. The aim of this study was to assess the effects of intraoperative fluids on serum glucose and electrolyte concentrations as well as serum osmolality. Methods: 91children, ASA I and II, undergoing elective ENT surgery were enrolled to this prospective, randomized, open-label study. They were randomly assigned to receive: group G5W: 5% glucose in water solution, group GNaCl: 3.33% glucose in 0.3% NaCl, and group RA: Ringer's acetate. Serum glucose, sodium, potassium, phosphate concentrations and serum osmolality were analysed before the induction of anaesthesia, immediately following the completion of surgery and 60 minutes after that. Results: Postoperative hyperglycaemia was observed in 94% of children in group G5W and in 37% of group GNaCl. In all the groups glucose concentration increased significantly after surgery. Postoperative hyponatraemia occurred in 36% of patients in the group G5W, and in 3.7% in the group GNaCl. Neither hyperglycaemia nor hyponatraemia occurred in group RA. Postoperative osmolality decreased significantly in groups G5W and GNaCl and remained unchanged in group RA. Conclusions: As Ringer's acetate did not cause significant changes in glucose and electrolyte concentrations, it seems to be the safest for intraoperative use in children undergoing elective surgery. As hypotonic fluids may cause hyperglycaemia and hyponatraemia, they should be avoided intraoperatively.

show abstract

“…41 A prospective study by Aronson and colleagues showed that the amount of electro lyte-free water administered was the most predictive factor for the development of clinically significant hypo natremia following cardiac catheterization. 42 The odds ratio for developing hyponatremia was 3.7 for each liter of electrolyte-free water administered to a 70 kg patient.…”

Section: Hypotonic Fluid Administration and Hyponatremiamentioning

confidence: 97%

“…[42][43][44][45][46][47][48][49] Even in patients with SIADH and hyponatremia, admin istration of normal saline does not aggravate hypo natremia. 50 We conducted a meta-analysis of 550 postoperative patients, 50 of whom were children, managed with either 0.9% NaCl or a more-hypotonic fluid.…”

Section: 9% Nacl As Prophylaxis Against Hyponatremiamentioning

confidence: 99%

Hospital-acquired hyponatremia—why are hypotonic parenteral fluids still being used?

2007

View full text Add to dashboard Cite

Hospital-acquired hyponatremia can be lethal. There have been multiple reports of death or permanent neurological impairment in both children and adults. The main factor contributing to the development of hospital-acquired hyponatremia is routine use of hypotonic fluids in patients in whom the excretion of free water, which is retained in response to excess arginine vasopressin (AVP), might be impaired. The practice of administering hypotonic parental fluids was established over 50 years ago, before recognition of the fact that there are numerous potential stimuli for AVP production in most hospitalized patients. Virtually all neurological morbidity resulting from hospital-acquired hyponatremia has been associated with administration of hypotonic fluids. Multiple prospective studies have shown that 0.9% NaCl is effective prophylaxis against hyponatremia. There is not a single report in the literature of neurological complications resulting from the use of 0.9% NaCl in non-neurosurgical patients. Patients at greatest risk of developing hyponatremic encephalopathy following hypotonic fluid administration are children, premenopausal females, postoperative patients, and those with brain injury or infection, pulmonary disease or hypoxemia. When hyponatremic encephalopathy develops, immediate administration of 3% NaCl is essential. In this Review, we discuss the question of why administering hypotonic fluids is unphysiologic and potentially dangerous, the settings in which isotonic fluids should be administered to prevent hyponatremia, and the appropriate treatment of hyponatremic encephalopathy.

show abstract

Hyponatremia as a complication of cardiac catheterization: A prospective study

Cited by 24 publications

References 19 publications

Increased Plasma Osmolar Gap Is Predictive of Contrast-Induced Acute Kidney Injury

Increased Plasma Osmolar Gap Is Predictive of Contrast-Induced Acute Kidney Injury

Płynoterapia śródoperacyjna w praktyce pediatrycznej — porównanie wybranych płynów infuzyjnych

Hospital-acquired hyponatremia—why are hypotonic parenteral fluids still being used?

Contact Info

Product

Resources

About