Neurological symptoms in hospitalised patients: do we assess hyponatraemia with sufficient care?

Rodríguez, Miguel; Romero, Andrés J. Alcaraz; Solana, María José; García, Arístides Rivas

doi:10.1111/apa.12439

Cited by 9 publications

(9 citation statements)

References 30 publications

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“…When participants were asked to mark severe symptoms of hyponatraemia requiring acute treatment from a list of six options including three distractors, less than half of the respondents answered all six correctly. Consistent with studies conducted in UK, Spain, and the Netherlands, our results suggest that severe symptoms may not be recognised and treated properly [39][40][41]. In contrast, an Australian study showed that hypertonic (3%) saline was appropriately used in cases of severe symptomatic hyponatraemia [42].…”

Section: Treatment Of Hyponatraemia With Severe Symptomssupporting

confidence: 70%

Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices

Sindahl

Overgaard-Steensen

Kildemoes

et al. 2020

JCM

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Background: Hyponatraemia is associated with increased morbidity, increased mortality and is frequently hospital-acquired due to inappropriate administration of hypotonic fluids. Despite several attempts to minimise the risk, knowledge is lacking as to whether inappropriate prescribing practice continues to be a concern. Methods: A cross-sectional survey was performed in Danish emergency department physicians in spring 2019. Prescribing practices were assessed by means of four clinical scenarios commonly encountered in the emergency department. Thirteen multiple-choice questions were used to measure knowledge. Results: 201 physicians responded corresponding to 55.4% of the total population of physicians working at emergency departments in Denmark. About a quarter reported that they would use hypotonic fluids in patients with increased intracranial pressure and 29.4% would use hypotonic maintenance fluids in children, both of which are against guideline recommendations. Also, 29.4% selected the correct fluid, a 3% hypertonic saline solution, for a patient with hyponatraemia and severe neurological symptoms, which is a medical emergency. Most physicians were unaware of the impact of hypotonic fluids on plasma sodium in acutely ill patients. Conclusion: Inappropriate prescribing practices and limited knowledge of a large number of physicians calls for further interventions to minimise the risk of hospital-acquired hyponatraemia.

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Section: Treatment Of Hyponatraemia With Severe Symptomssupporting

confidence: 70%

Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices

Sindahl

Overgaard-Steensen

Kildemoes

et al. 2020

JCM

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“…NaD may manifest as overt hyponatremia (hyponatremic sodium depletion, HNaD) or - especially during the early phase of AG -as normonatremic sodium depletion (NNaD). Both types of NaD may be associated with rather nonspecific symptomatology including a decrease in general wellbeing, listlessness, fatigue, low blood pressure and anorexia [7,8,16,18] but may also lead to serious disease complications such as muscle cramps, cerebral edema, seizures, coma and even death [2,5,11,15,16,18]. Early diagnosis of sodium depletion is therefore particularly warranted to avoid unnecessary, invasive investigations of vague symptoms as well as further progression of the disorder with potentially serious sequelae.…”

mentioning

confidence: 99%

“…This deranged state of fluid and electrolyte balance is often associated with nonspecific and variable symptomatology sometimes leading to inappropriate diagnostic and therapeutic measures. In addition, lack of correction of the acute fluid/electrolyte disorder may rapidly be followed by serious complications such as muscle cramps, cerebral edema, epileptic seizures, coma and even death [2,16]. Particularly during the early phase of AG plasma sodium concentrations may remain in the normal range despite already existing sodium depletion.…”

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confidence: 99%

Decreased Urinary Sodium-to-urinary Creatinine Ratio Identifies Sodium Depletion in Pediatric Acute Gastroenteritis

et al. 2015

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“…It may be found incidentally on a routine electrolyte panel in otherwise asymptomatic patients. However, when there is an abrupt change in the serum sodium concentration or as levels fall below 125 mEq/L, non-specific symptoms such as nausea, headache, malaise and even neurologic symptoms including seizures may occur [ 2 ]. When hyponatremia is detected, determining the etiology and identifying the appropriate treatment plan can prevent further decreases in serum and end-organ consequences including seizures.…”

Section: Introductionmentioning

confidence: 99%

Hyponatremia and Hyporeninemic-Hypoaldosteronism in a Pediatric Intensive Care Unit Patient

Lemus

Tobias

2020

J Med Cases

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Hyponatremia is one of the most commonly encountered electrolyte abnormalities encountered in the pediatric world. Defined as a serum or plasma sodium less than 135 mEq/L, the etiology of hyponatremia is one that can typically be determined by performance of a thorough history. However, occasionally the etiology of a patient's hyponatremia is more elusive and determined only after laboratory evaluation. We present a 6-year-old girl with a complex medical history including spinal muscular atrophy, tracheostomy and ventilator dependence, who was admitted to the pediatric intensive care unit for treatment and evaluation of seizures with hyponatremia that was initially thought to be due to syndrome of inappropriate anti-diuretic hormone or cerebral salt wasting. However, during her hospital course, it was determined that the hyponatremia was more indicative of a rarer and much less common cause of hyponatremia, hyporeninemic-hypoaldosteronism. The physiological factors controlling serum sodium are reviewed, the etiologies of hyponatremia are presented and the treatment of hyporeninemic-hypoaldosteronism is discussed.

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Neurological symptoms in hospitalised patients: do we assess hyponatraemia with sufficient care?

Abstract: Hyponatraemia should always be considered a cause of neurological symptoms in hospitalised patients. Treatment should be prompt to prevent neurological sequelae and death. Current recommendations for fluid management in hospitalised children should be reviewed.

Cited by 9 publications

References 30 publications

Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices

Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices

Decreased Urinary Sodium-to-urinary Creatinine Ratio Identifies Sodium Depletion in Pediatric Acute Gastroenteritis

Hyponatremia and Hyporeninemic-Hypoaldosteronism in a Pediatric Intensive Care Unit Patient

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