Improved hyponatremia after pericardial drainage in patients suffering from cardiac tamponade

Abstract

BackgroundSome case reports showed unexplained hyponatremia in patients with cardiac tamponade. Reversible hyponatremia was observed in these patients who received pericardial drainage. The occurrence rate of hyponatremia in patients of cardiac tamponade is not clearly known. The objective of this study was to identify the relationship between hyponatremia, cardiac tamponade and their underlying diseases.MethodsWe reviewed the clinical data of patients with cardiac tamponade and receiving pericardial drainage between January 2000 and January 2012 in our hospital. Cardiac tamponade was diagnosed by clinical presentation: hypotension, pulsus paradoxus, and increased jugular vein pressure. We used paired T test to compare the sodium change before and after pericardial drainage. Pearson’s chi-square test was used to analyze the relationship of hyponatremia with malignancy and cardiac chamber compression proved by echocardiography.ResultsFor the 48 patients, the mean pre-drainage sodium level was 129.1 ± 7.1 mEq/L and the mean post-drainage sodium level was 130.4 ± 5.6 mEq/L (p = 0.06). Among the 48 patients, 31 (65 %) had hyponatremia. For the 31 hyponatremia patients, the mean pre-drainage sodium level was 124.8 ± 4.9 mEq/L and the mean post drainage sodium level was 127.5 ± 4.5 mEq/L (p = 0.003). Hyponatremia was significantly associated with malignancy (p = 0.038). There was no significant change of pre-drainage and post-drainage sodium level in patients without malignancy. The post-drainage sodium level in the malignant patients significantly increased from 125.5 ± 8.0 to 129.1 ± 5.5 mEq/L (p = 0.017). The presence of hyponatremia was strongly associated with the cardiac tamponade sign (p < 0.001). After pericardial drainage, the sodium level significantly increased in patients with chamber compression than in patients without compression.ConclusionHyponatremia is associated with cardiac tamponade especially for malignant pericardial effusion and for patients with cardiac chambers compression signs. Hyponatremia can be improved after pericardial effusion drainage.

Cardiac tamponade causing severe reversible hyponatraemia

“…All cases had mild to moderate hyponatraemia (>120 mmol/L) 77. However, in non-malignant cases they did not find any significant improvement in serum sodium levels postpericardiocentesis 7.…”

“…Among these, 35% cases were of malignant pericardial effusion and were strongly associated with hyponatraemia and showed significant improvement following pericardiocentesis 7. However, in non-malignant cases they did not find any significant improvement in serum sodium levels postpericardiocentesis 7. In contrast, Chang et al showed significant improvement in hyponatraemia in both malignant and benign cases of cardiac tamponade.…”

Pericardial Effusion-Associated Hyponatremia

“…Pericardial effusion-associated hyponatremia has been described in previous case reports [ 2 – 6 ] and retrospective studies [ 7 , 8 ]. In most patients, hyponatremia resolves following medical management or pericardiocentesis.…”

“…Pericardial effusion represents a rare cause of reversible hyponatremia; this has been described in several case reports [ 2 – 6 , 9 ] and two retrospective reviews [ 7 , 8 ]. Our patient presented with progressively worsening hyponatremia in the setting of pericardial effusion with early tamponade and experienced rapid and complete normalization of serum sodium concentration following pericardiocentesis.…”

“…Resolution of hyponatremia following pericardiocentesis has been described in case reports by other authors [ 2 – 6 ]. In addition, in a recent review of 31 patients, Jong et al found that individuals with cardiac tamponade-related hyponatremia demonstrated a statistically significant increase in serum sodium levels within 48 hours of pericardiocentesis [ 7 ]. Similar findings were reported in an article by Chang et al [ 8 ].…”