Impairment of Neurocognitive Functioning, Motor Performance, and Mood Stability in Hospitalized Patients With Euvolemic Moderate and Profound Hyponatremia

Suárez, Víctor; Norello, Dario; Sen, Emel; Todorova, Polina; Hackl, Matthias J.; Hüser, Christoph; Grundmann, Franziska; Kubacki, Torsten; Becker, Ingrid; Peri, Alessandro; Burst, Volker

doi:10.1016/j.amjmed.2019.12.056

Cited by 31 publications

(27 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is indicative of a disturbed water homeostasis that can occur secondary to a broad spectrum of diseases (e.g., heart failure, liver insufficiency, central nervous system disorders) 1 , medications (e.g., diuretics, antiepileptics) 3 , or in stress situation such as in the postoperative period 4 or after extreme sport performances 5 . The awareness by physicians tends to be low 6 although hyponatremia is associated with increased mortality and morbidity 2 such as gait instability 7,8 , falls 7 , osteoporosis 9,10 , fractures 9,10 and attention deficit 7,8,11 . More specifically, hyponatremia is highly relevant in patients with respiratory tract infections because of its high prevalence (8.1%-44.4%) and its prognostic significance [12][13][14][15][16][17] , especially in patients with COVID-19 18 .…”

Section: Introductionmentioning

confidence: 99%

Inverse relationship between IL-6 and sodium levels in patients with COVID-19 and other respiratory tract infections: data from the COVIVA study

Atila

Monnerat

Bingisser

et al. 2022

Endocrine Connections

View full text Add to dashboard Cite

OBJECTIVE: Hyponatremia in COVID-19 is often due to the syndrome of inadequate antidiuresis (SIAD), possibly mediated by interleukin-6 (IL-6) induced non-osmotic arginine vasopressin (AVP) secretion. We hypothesized an inverse association between IL-6 and plasma sodium concentration, stronger in COVID-19 compared to other respiratory infections. DESIGN: Secondary analysis of a prospective, cohort study including patients with COVID-19 suspicion admitted to the Emergency Department, University Hospital of Basel, Switzerland, between March and July 2020. METHODS: We included patients with PCR-confirmed COVID-19 and patients with similar symptoms, further subclassified in bacterial and other viral respiratory infections. The primary objective was to investigate the association between plasma sodium levels and IL-6 levels. RESULTS: 500 patients were included, 184 (37%) with COVID-19, 92 (18%) with bacterial respiratory infections, 224 (45%) with other viral respiratory infections. In all groups, median [IQR] IL-6 levels were significantly higher in hyponatremic compared to normonatremic patients (COVID-19: 43.4 [28.4, 59.8] vs 9.2 [2.8, 32.7] pg/ml, p<0.0001; bacterial: 122.1 [63.0, 282.0] vs 67.1 [24.9, 252.0] pg/ml, p<0.05; viral: 14.1 [6.9, 84.7] vs 4.3 [2.1, 14.4] pg/ml, p<0.05). IL-6 levels were negatively correlated with plasma sodium levels in COVID-19, whereas the correlation in bacterial and other viral infections was weaker (COVID-19: R= −0.48, p<0.001; bacterial: R= −0.25, p=0.05, viral: R= −0.27, p<0.001). CONCLUSIONS: IL-6 levels were inversely correlated with plasma sodium levels, with a stronger correlation in COVID-19 compared to bacterial and other viral infections. IL-6 might stimulate AVP secretion and lead to higher rates of hyponatremia due to the SIAD in these patients.

show abstract

Section: Introductionmentioning

confidence: 99%

Inverse relationship between IL-6 and sodium levels in patients with COVID-19 and other respiratory tract infections: data from the COVIVA study

Atila

Monnerat

Bingisser

et al. 2022

Endocrine Connections

View full text Add to dashboard Cite

show abstract

“…It has been well shown that chronic hyponatremia is associated with sarcopenia particularly in the elderly [2][3][4][5][6][7]. In a recent article, Fujisawa et al [6] demonstrated in 75 elderly patients that mild hyponatremia, 130-135 mEq/L, was associated with a lower skeletal muscle mass index (OR 2.2), slower walking speed (OR 5.3), and shorter 1-leg standing test time (OR 2.25).…”

Section: Discussionmentioning

confidence: 99%

“…[1]. Many articles have shown the association of chronic hyponatremia with sarcopenia, particularly in the elderly [2][3][4][5][6][7]. We observed that many patients with chronic euvolemic hyponatremia have frequently a lower solute output (and thus intake) [8,9], which could also contribute to sarcopenia and this particularly if there is a decrease in protein intake [10].…”

Section: Introductionmentioning

confidence: 86%

Low Creatininuria due to Hyponatremia Is Reversible in Many Patients

Decaux

2021

Nephron

View full text Add to dashboard Cite

Background: Chronic hyponatremia has been reported to be associated with low solute intake and low creatinine excretion (reflecting likely sarcopenia). We wanted to study the effect, on the long term, of correction of hyponatremia on solute and creatinine excretion in chronic SIADH. Methods: We made a retrospective review of clinical and biochemical data of patients with euvolemic hyponatremia. We analyzed 24-h urine solute and creatinine excretion in volunteers with hyponatremia induced by dDAVP over 4 days, in 12 patients with chronic SIADH (>1 month) before and after a few days of SNa correction and in 12 patients (6 women and 6 men) before and after 3 months of SNa correction by a vaptan or urea. Results: We confirm a low urine creatinine and solute excretion only in patients with chronic hyponatremia (>1 month). Correction of SNa (from 127 ± 2.3 mEq/L to 139 ± 2.8 mEq/L) for >3 months, in the 12 patients (mean age 58 ± 18), was associated with an increase in 24-h creatinine excretion (from 986 ± 239 to 1,238 ± 220 mg; p < 0.02) and in patients treated with a vaptan (n = 5) solute excretion increased from 656 ± 207 mmol/24 h to 960 ± 193 mmol/24 h (p < 0.02). Sodium excretion increased also in the 12 patients (from 100 ± 53 mEq/24 h to 169 ± 38 mEq/24 h; p < 0.01). Conclusion: Chronic hyponatremia (>1 month) is associated with a decrease in solute output (or intake) and in creatinine excretion. In many patients, these abnormalities are reversible in the long term.

show abstract

“…While chronic hyponatremia has been traditionally defined as asymptomatic because of cell volume adaptation, in the last decade several studies demonstrated that even a mild chronic reduction of [Na + ] may be associated with neurological signs and symptoms, i.e. gait impairment, attention and memory deficit, and increased risk of falls [ 3 , 9 , 28 , 76 , 77 ]. Accordingly, the correction of low [Na + ] may effectively counteract the reduced cognitive performances observed in hyponatremic patients compared to normonatremic subjects [ 37 , 38 , 76 ].…”

Section: Osmotically-induced Oxidative Stressmentioning

confidence: 99%

Hyponatremia and Oxidative Stress

et al. 2021

Self Cite

View full text Add to dashboard Cite

Hyponatremia, i.e., the presence of a serum sodium concentration ([Na+]) < 136 mEq/L, is the most frequent electrolyte imbalance in the elderly and in hospitalized patients. Symptoms of acute hyponatremia, whose main target is the central nervous system, are explained by the “osmotic theory” and the neuronal swelling secondary to decreased extracellular osmolality, which determines cerebral oedema. Following the description of neurological and systemic manifestations even in mild and chronic hyponatremia, in the last decade reduced extracellular [Na+] was associated with detrimental effects on cellular homeostasis independently of hypoosmolality. Most of these alterations appeared to be elicited by oxidative stress. In this review, we focus on the role of oxidative stress on both osmolality-dependent and -independent impairment of cell and tissue functions observed in hyponatremic conditions. Furthermore, basic and clinical research suggested that oxidative stress appears to be a common denominator of the degenerative processes related to aging, cancer progression, and hyponatremia. Of note, low [Na+] is able to exacerbate multiple manifestations of senescence and to decrease progression-free and overall survival in oncologic patients.

show abstract

Impairment of Neurocognitive Functioning, Motor Performance, and Mood Stability in Hospitalized Patients With Euvolemic Moderate and Profound Hyponatremia

Cited by 31 publications

References 23 publications

Inverse relationship between IL-6 and sodium levels in patients with COVID-19 and other respiratory tract infections: data from the COVIVA study

Inverse relationship between IL-6 and sodium levels in patients with COVID-19 and other respiratory tract infections: data from the COVIVA study

Low Creatininuria due to Hyponatremia Is Reversible in Many Patients

Hyponatremia and Oxidative Stress

Contact Info

Product

Resources

About