Hyponatremia in a Patient with Chronic Inflammatory Disease.

Murakami, Tohru; Matoba, Hana; Kuga, Yoshihiro; Ozawa, Sachihiko; Kubota, Ken; Yoshida, Sho

doi:10.2169/internalmedicine.37.792

Cited by 18 publications

(11 citation statements)

References 13 publications

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“…This link is explained by the fact that hemoglobin level is inversely correlated with aging [35], and both anemia and hyponatremia may be accompanied by chronic inflammation [36]. The secretion of AVP can be stimulated by inflammatory processes through the activation of interleukin-6 [36]. …”

Section: Discussionmentioning

confidence: 99%

The Risk of Hyponatremia with Desmopressin Use for Nocturnal Polyuria

Choi¹,

Park²,

Kim

et al. 2015

Am J Nephrol

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Background: Desmopressin is used for treating nocturnal polyuria, but hyponatremia is an associated concern in the elderly due to impaired urinary dilution. This study was undertaken to characterize hyponatremia occurring in adults using desmopressin for nocturnal polyuria. Methods: Data from 172 patients who were prescribed desmopressin for nocturnal polyuria at a urology clinic from September 2010 through February 2013 were retrospectively analyzed. Demographic and laboratory parameters were investigated to examine the risk factors for desmopressin-associated hyponatremia. Results: The average follow-up serum sodium measured 21 ± 22 days after using desmopressin was 138 ± 5 mmol/l. Hyponatremia (<135 mmol/l) was found in 24 patients (14%), and it was severe in 7 (<126 mmol/l). In the hyponatremic patients, serum sodium decreased by 11 ± 6 mmol/l. Patients with hyponatremia were older than those with normonatremia (78 ± 7 vs. 68 ± 9 years, p < 0.0001). The presence of either hyponatremia-predisposing comorbidities or concurrent medications was associated with hyponatremia. Patients with hyponatremia had lower basal hemoglobin (11 ± 2 vs. 13 ± 2 g/dl, p < 0.001) and serum sodium (139 ± 2 vs. 140 ± 2 mmol/l, p < 0.05) than those with normonatremia. Multivariate logistic regression after adjustment for basal serum sodium showed that advanced age (OR 1.15; 95% CI 1.03-1.27) and lower hemoglobin level (OR 0.64; 95% CI 0.43-0.94) were independently associated with hyponatremia. Conclusion: Hyponatremia is not infrequently associated with desmopressin use. Those with advanced age (≥65 years) and lower hemoglobin are at risk of desmopressin-associated hyponatremia and need to be carefully monitored.

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Section: Discussionmentioning

confidence: 99%

The Risk of Hyponatremia with Desmopressin Use for Nocturnal Polyuria

Choi¹,

Park²,

Kim

et al. 2015

Am J Nephrol

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“…The widespread and intensive inflammatory state involving the lungs, the liver, the kidneys, the intestines and the lymphatic ganglia induced to increase production of plasma prostaglandins and renin 9,29,33,34 . High serum levels of interleukin-6 have been detected in visceral leishmaniasis 3,32 and can act as a potent stimulus of the hypothalamicpituitary-adrenal axis and to arginine vasopressin(ADH) release too 14,22 .…”

Section: Discussionmentioning

confidence: 99%

Hyponatremia in visceral leishmaniasis

Verde

Veronese

et al. 2010

Rev. Inst. Med. trop. S. Paulo

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SUMMARYThere are few reports linking hyponatremia and visceral leishmaniasis (kala-azar). This is a study of 55 consecutive kala-azar patients and 20 normal individuals as a control group. Hyponatremia and serum hypo-osmolality were detected in 100% of kalaazar patients. High first morning urine osmolality (750.0 ± 52.0 vs. 894.5 ± 30.0mOsm/kg H 2 O, p < 0.05), and high 24-hour urine osmolality (426.0 ± 167.0 vs. 514.6 ± 132.0 mOsm/kg H 2 O, p < 0.05) demonstrated persistent antidiuretic hormone secretion. Urinary sodium was high (82.3 ± 44.2 vs.110.3 ± 34.7 mEq/L, p < 0.05). Low seric uric acid occurred in 61.8% of patients and increased fractional urinary uric acid excretion was detected in 74.5% of them. Increased glomerular filtration rate was present in 25.4% of patients. There was no evidence of extracellular volume depletion. Normal plasma ADH levels were observed in kala-azar patients. No endocrine or renal dysfunction was detected. It is possible that most hyponatremic kala-azar patients present the syndrome of inappropriate antidiuretic hormone secretion.

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“…Since this study, a number of case reports have reported elevated IL-6 concentrations during hyponatremia and inflammation. Murakami et al [37] reported a case of SIADH with increased vasopressin concentrations (7.2 pg/ml) in a 66-year-old man with inflammatory arthropathy. In this case, IL-6 concentrations were markedly increased (96 pg/ml, normal range <5.0 pg/ml), whereas plasma IL-1β and TNF-α concentrations were normal or only mildly increased.…”

Section: Clinical Examples Of Hyponatremia and Inflammationmentioning

confidence: 99%

Hyponatremia and Inflammation: The Emerging Role of Interleukin-6 in Osmoregulation

et al. 2010

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Although hyponatremia is a recognized complication of several inflammatory diseases, its pathophysiology in this setting has remained elusive until recently. A growing body of evidence now points to an important role for interleukin-6 in the non-osmotic release of vasopressin. Here, we review this evidence by exploring the immuno-neuroendocrine pathways connecting interleukin-6 with vasopressin. The importance of these connections extends to several clinical scenarios of hyponatremia and inflammation, including hospital-acquired hyponatremia, postoperative hyponatremia, exercise-associated hyponatremia, and hyponatremia in the elderly. Besides insights in pathophysiology, the recognition of the propensity for antidiuresis during inflammation is also important with regard to monitoring patients and selecting the appropriate intravenous fluid regimen, for which recommendations are provided.

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Hyponatremia in a Patient with Chronic Inflammatory Disease.

Cited by 18 publications

References 13 publications

The Risk of Hyponatremia with Desmopressin Use for Nocturnal Polyuria

The Risk of Hyponatremia with Desmopressin Use for Nocturnal Polyuria

Hyponatremia in visceral leishmaniasis

Hyponatremia and Inflammation: The Emerging Role of Interleukin-6 in Osmoregulation

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