Management of hyponatremia: causes, clinical aspects, differential diagnosis and treatment

Peri, Alessandro

doi:10.1080/17446651.2019.1556095

Cited by 28 publications

(31 citation statements)

References 55 publications

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“…In the Hyponatremia International Registry, the common initial clinical management of hyponatremia was fluid restriction (35%), followed by administration of isotonic (15%) or hypertonic saline (2%), and tolvaptan (5%) . Additionally, the majority of patients underwent withdrawal of an agent that would interfere with water excretion …”

mentioning

confidence: 99%

Severe Hyponatremia Is Often Drug Induced: 10‐Year Results of a Prospective Pharmacovigilance Program

Ramírez

Rodríguez

Queiruga

et al. 2019

Clin Pharma and Therapeutics

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We conducted a prospective evaluation of drug-induced severe hyponatremia (adverse drug reaction (ADR)) through the Prospective Pharmacovigilance Program from Laboratory Signals at Hospital over a period of 10 years. Cases of serum sodium (Na(s)) < 116 mM were recorded from July 2007 to June 2017 (first period). Also cases of Na(s) 116-122 mM were recorded from July 2012 to June 2017 (second period). Drugs were the primary cause of severe hyponatremia. The incidence rate of Na(s) < 116 mM by drugs was increased threefold over the decade. Compared with other causes of hyponatremia, patients with adverse drug reaction-serum sodium (ADR-Na(s)) in the first period were older (79 years (interquartile range (IQR) 68.6-89 vs. 65 years (IQR 48-81); P < 0.001) and were more often women (70.8% vs. 48.9% men, P < 0.001); in the second period were also older (79 years (IQR 65.3-89) vs. 63 years (IQR 46-80.6); P < 0.001) and were more often women (70% vs. 53%, P = 0.002), and ADR-Na(s) occurred more often in summer. The most frequent therapeutic groups of culprit drugs were the cardiovascular system and nervous system. The 65.3% in the first period and 71.2% in the second period of the ADR-Na(s) cases responded to hydration and had been diagnosed with hypovolemic hyponatremia.

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confidence: 99%

Severe Hyponatremia Is Often Drug Induced: 10‐Year Results of a Prospective Pharmacovigilance Program

Ramírez

Rodríguez

Queiruga

et al. 2019

Clin Pharma and Therapeutics

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“…The prevalence of hyponatremia has not significantly differed in the other subgroups either. So, in contrast to reviews [52][53] and studies about the general hospitalized populations [54][55], in lung cancer patients, the presence of hyponatremia is not associated with age or gender. In respect of ECOG performance status or disease extent, ours is the first meta-analysis to describe that the prevalence of hyponatremia is independent of these parameters in lung cancer.…”

Section: Discussionmentioning

confidence: 71%

Prevalence and Prognostic Significance of Hyponatremia in Lung Cancer Patients: Systematic Review and Meta-Analysis

Bartalis¹,

Gergics²,

Tinusz³

et al. 2020

Preprint

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Background The prevalence of hyponatremia is highly variable among lung cancer patients. It is also an important predictive factor, according to numerous studies. However, its prevalence and prognostic significance in subgroups of lung cancer patients, e.g. in small cell and non-small cell lung cancers (SCLC and NSCLC, respectively), have not yet been evaluated in a meta-analysis.Methods We report this systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2009) Statement. We have registered our meta-analysis and review’s protocol to the PROSPERO International Prospective Register of Systematic Reviews, with the following registration number: CRD42020167013. A systematic search was done in the following sources: MEDLINE, Embase, CENTRAL, Web of Science, ClinicalTrials.gov, a WHO Global Health Library. We extracted the effect measure for each outcome as the relative risk (RR) with the related 95% confidence interval (CI). Results We identified a total of 8127 potentially eligible studies and we included 25 studies in our evaluation. The prevalence of hyponatremia in lung cancer patients varied between 3% and 56.1% with an average of 23% without any significant differences between the following subgroups: cancer type (p=0.780), gender (p=0.223), age (p=0.773), ECOG state (p=0.317) and the extent of disease (p=0.999). Hyponatremia was more consistently an independent prognostic factor in NSCLC than in SCLC. The overall survival (OS) was significantly lower in hyponatremic compared to normonatremic patients at 10 months (RR: 0.59, 95% CI, 0.47 to 0.74, p<0.001) and at 20 months (RR: 0.44, 95% CI, 0.33 to 0.59, p<0.001), with worse survival rates in NSCLC than in SCLC (27% vs 42%) (p<0.001). If hyponatremia was corrected, OS at 10 months was 1.83 times higher than in the uncorrected hyponatremia group (95% CI, 1.37 to 2.44, p<0.001), but at 20 months no statistically significant difference could be found between these subgroups (p=0.067).Conclusions Low serum sodium levels have a negative impact on mortality at 10 and 20 months, which is more pronounced among NSCLC patients. The correction of hyponatremia has a positive effect on OS rates at 10 months, but this advantage disappears by 20 months.

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“…However, lower doses (e.g. 7.5 mg/day) may be effective in clinical practice to guarantee a desired serum [Na + ] increase (64). If the [Na + ] rise is less than 5 mEq/L in 24 h, the daily dose can be increased up to a maximum of 60 mg (64).…”

Section: Nervous Systemmentioning

confidence: 99%

Therapeutic strategies for acute intermittent porphyria

Zhao

Wang

Zhang

et al. 2020

IRDR

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acute intermittent porphyria, heme, carbohydrate loading, givosiran (siRNA), mRNA therapy Acute intermittent porphyria (AIP) is an autosomal dominant disease caused by mutations in porphobilinogen deaminase (PBGD), the third enzyme of the heme synthesis pathway. Symptoms of AIP usually manifest as intermittent acute attacks with occasional neuropsychiatric crises. The management of AIP includes treatment of acute attacks, prevention of attacks, long-term monitoring and treatment of chronic complications. Intravenous injection of heme is the most effective method of treating acute attacks. Carbohydrate loading is used when heme is unavailable or in the event of mild attacks. Symptomatic treatment is also needed during attacks. Prevention of attacks includes eliminating precipitating factors, heme prophylaxis and liver transplantation. New treatment options include givosiran (siRNA) to down-regulate ALA synthase-1 (ALAS1) and the messenger RNA of PBGD (PBGD mRNA) delivered to the liver cells of patients with AIP. Long-term monitoring of chronic complications includes regular liver-kidney function and hepatocellular carcinoma (HCC) screening.

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Management of hyponatremia: causes, clinical aspects, differential diagnosis and treatment

Cited by 28 publications

References 55 publications

Severe Hyponatremia Is Often Drug Induced: 10‐Year Results of a Prospective Pharmacovigilance Program

Severe Hyponatremia Is Often Drug Induced: 10‐Year Results of a Prospective Pharmacovigilance Program

Prevalence and Prognostic Significance of Hyponatremia in Lung Cancer Patients: Systematic Review and Meta-Analysis

Therapeutic strategies for acute intermittent porphyria

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