Quality and cost considerations in hyponatraemic patients needing hospitalisation

Althaus, Annina Eva; Krapf, Reto

doi:10.4414/smw.2018.14662

Cited by 5 publications

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“…Similarly, hyponatraemia also comes with a risk to patient morbidity and mortality and financial cost. It has been associated with longer inpatient stay, poorer outcomes in terms of intensive care admission and mortality 12 14–16…”

Section: Lessons and Limitationsmentioning

confidence: 99%

A quality improvement project reducing adverse events and improving adherence to guidelines surrounding VRIII usage

et al. 2022

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Variable rate intravenous insulin infusions (VRIII) are frequently used in hospitals and incorrect use can lead to electrolyte imbalance, hypoglycaemia and adverse outcomes. The Joint British Diabetes Societies (JDBS) published guidelines in 2014 and recommended the use of a balanced fluid as substrate. There was no published data to demonstrate the superiority of this fluid in reducing adverse events. This quality improvement project aimed to review the existing practice at our Trust in accordance with JDBS guidelines. We predicted introducing this fluid would reduce adverse events and demonstrating this was a prerequisite condition from our Trust Medicines Management Committee to approve its long-term availability. We carried out an audit of our practice in 2015, at which time the JBDS recommended fluid (0.45% sodium chloride/5% dextrose with 0.15% potassium chloride) was not available in our Trust. Our VRIII guideline was re-written with recommendation for use of the balanced fluid, after procurement from pharmacy. Our primary areas for improvement as highlighted from the 2015 audit were correct substrate prescription and rate reduction of hypokalaemia (potassium <3.5 mmol/L) and hypoglycaemia (glucose <4 mmol/L) during VRIII use. Analysis of the pre-intervention (December 2016) and post-intervention (September–November 2017) data showed a significant increase in correct fluid use; 11% pre-intervention to 76% post-intervention (χ2, p<0.0001). The number of hypoglycaemic events per VRIII reduced from 0.73 (±1.78) to 0.28 (±0.84) (p<0.05) peri-intervention. Similarly, the number of hypokalaemic events per VRIII reduced from 0.15 (±0.54) pre-intervention to 0.05 (±0.25) post-intervention. There was also a significant reduction in number of VRIII episodes associated with a hyponatraemia event from 26% at baseline to 12% post-intervention (p<0.01). Some of these marked improvements were not sustained at 1-year post follow-up. We reduced adverse outcomes with a substantial net-cost saving during this period, through implementation of new and accessible guidelines, trust-wide education programmes and posters to raise awareness.

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Section: Lessons and Limitationsmentioning

confidence: 99%

A quality improvement project reducing adverse events and improving adherence to guidelines surrounding VRIII usage

et al. 2022

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“…Hyponatremia is the most common electrolyte disorder encountered in the clinical setting and is a common complication in patients undergoing neurosurgery. Hyponatremia results in higher mortality, readmission rates and longer hospital stay [ 1 ] . Among the broad etiological spectrum, the two dominant causes include the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and the cerebral salt wasting syndrome (CSWS) that occur more frequently in response to subarachnoid haemorrhage and brain injury [ 2 ] .…”

Section: Introductionmentioning

confidence: 99%

The never-ending story of hyponatremia: a current problem to overcome

Marigliano,

Scuro

2024

European Journal of Case Reports in Internal Medicine

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Hyponatremia is a common complication in patients undergoing neurosurgery. If undiagnosed, it has a negative prognostic impact. The two dominant causes of refractory hyponatremia include syndrome of inappropriate ADH secretion (SIADH) and cerebral salt wasting syndrome (CSWS). Discrimination between the two types of disease is not always obvious. We present a case of undiagnosed chronic hyponatremia caused by CSWS after neurosurgery, which not only resulted in a longer hospital stay but also slowed the patient’s postoperative recovery. Meticulous clinical evaluation and the performance of appropriate laboratory tests are therefore essential not only for decisive treatment, but also for the establishment of comprehensive diagnostic algorithms that allow timely diagnosis and decisive therapy.

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Нарушение Осмотического Баланса В Условиях Нетравматического Субарахноидального Кровоизлияния

Buchakchyska¹,

Polkovnikova²

2021

INJ

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Актуальность. Аневризматическое субарахноидальное кровоизлияние является распространенным и серьезным заболеванием, которое может приводить к летальным последствиям. Цель исследования: изучить динамику натриемии в контексте ее клинико-патогенетического значения у пациентов с субарахноидальным кровоизлиянием. Материалы и методы. Обследовано 87 пациентов с субарахноидальным кровоизлиянием, из них 38 (43,68 %) — с изолированным субарахноидальным кровоизлиянием, 14 (16,09 %) — с субарахноидально-паренхиматозным, 29 (33,33 %) — с субарахноидально-желудочковым, 6 (6,9 %) — с субарахноидально-паренхиматозно-желудочковым кровоизлиянием, общее количество смешанных кровоизлияний составляло 56,32 %. Для проведения полного ангиографического исследования использовали ангиографический комплекс AXIOM Artis MP «Siemens». Результаты. Исследование SIADH-синдрома (синдром неадекватной секреции антидиуретического гормона) с развитием гипонатриемии у пациентов с субарахноидальным кровоизлиянием нетравматического генеза свидетельствует о тесной ассоциации между выраженностью нарушений осмотического гомеостаза и тяжестью клинического течения субарахноидального кровоизлияния согласно модифицированной шкале Fisher, шкале WFNS, шкале Нunt & Неss, шкале результатов GOSE (Glasgow Outcome Scale Extended) и обобщающей классификационной шкале для оценки прогноза исхода субарахноидального кровоизлияния (Ogilvy C.S. et Carter B.S.). У лиц с гипонатриемией на фоне субарахноидального кровоизлияния сопряженность сывороточного уровня натрия и показателя сывороточного уровня копептина адекватно и достоверно аппроксимируется уравнением регрессии логарифмического характера (по основанию 10), при значениях копептина более 0,70 нг/мл в более чем 50 % случаев регистрировалась натриемия средней тяжести. Выводы. Была обнаружена достоверная тесная взаимосвязь между уровнем данного пептида с нейроэндокринными свойствами — копептина и нарушением осмотического гомеостаза ионов натрия на фоне субарахноидального кровоизлияния с различной тяжестью клинического течения.

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Quality and cost considerations in hyponatraemic patients needing hospitalisation

Cited by 5 publications

References 0 publications

A quality improvement project reducing adverse events and improving adherence to guidelines surrounding VRIII usage

A quality improvement project reducing adverse events and improving adherence to guidelines surrounding VRIII usage

The never-ending story of hyponatremia: a current problem to overcome

Нарушение Осмотического Баланса В Условиях Нетравматического Субарахноидального Кровоизлияния

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