Rapid correction of severe hyponatremia with intravenous hypertonic saline solution

Ayus, Juan Carlos; Olivero, Juan J.; Frommer, Jörg

doi:10.1016/0002-9343(82)90575-7

Cited by 160 publications

(40 citation statements)

References 8 publications

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“…Several early case series reported the use of i.v. hypertonic saline as treatment for hyponatraemia (119,120,121,122,123,124,125). However, settings, biochemical severity, rate of development, symptoms and co-interventions differed widely both between and within studies and were often difficult to assess.…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Spasovski

Vanholder

Allolio

et al. 2014

European Journal of Endocrinology

604

671

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Hyponatraemia, defined as a serum sodium concentration !135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution-and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association -European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.

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Section: European Journal Of Endocrinologymentioning

confidence: 99%

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Spasovski

Vanholder

Allolio

et al. 2014

European Journal of Endocrinology

604

671

View full text Add to dashboard Cite

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“…The suspension was centrifuged at 18,000 g for 6 min, and the pellet was resuspended in 400-500 Ml of preequilibrium media. The reaction was started at 25°C with the addition of 5 The zero time point Na uptake was obtained by adding 5 Ml protein suspension to 95 Ml uptake media combined with 2.5 ml ice-cold choline chloride (150 mM). The 22Na uptake with amiloride was subtracted from the mean without amiloride for each individual experiment.…”

Section: Methodsmentioning

confidence: 99%

“…Hyponatremia and hypoxia are among the most common metabolic abnormalities seen in a general hospital population (5)(6)(7). Among patients with hyponatremia, 1% develop encephalopathy, and of these, -20% die or suffer permanent brain damage (3,7).…”

Section: Introductionmentioning

confidence: 99%

Hypoxic and ischemic hypoxia exacerbate brain injury associated with metabolic encephalopathy in laboratory animals.

Vexler

Ayus²,

Roberts³

et al. 1994

J. Clin. Invest.

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Hypoxemia is a major comorbid factor for permanent brain damage in several metabolic encephalopathies. To determine whether hypoxia impairs brain adaptation to hyponatremia, worsening brain edema, we performed in vitro and in vivo studies in cats and rats with hyponatremia plus either ischemic or hypoxic hypoxia. Mortality with hypoxic hypoxia was 0%; with hyponatremia, 22%; and with hyponatremia + hypoxia, 100%. Hyponatremia in cats produced brain edema, with a compensatory decrease of brain sodium. Ischemic hypoxia also resulted in brain edema, but with elevation of brain sodium. However, when ischemic hypoxia was superimposed upon hyponatremia, there was elevation of brain sodium with further elevation of water. Outward sodium transport in cat cerebral cortex synaptosomes was measured via three major pathways through which brain osmolality can be decreased. After hyponatremia, sodium transport was significantly altered such that brain cell osmolality would decrease: 44% increase in Na+-K+-ATPase transport activity (ouabain inhibitable); 26% decrease in amiloride-sensitive sodium uptake. The change in veratridine-stimulated sodium uptake was not significant (P > 0.05). When ischemic hypoxia was superimposed upon hyponatremia, all of the cerebral adaptive changes induced by hyponatremia alone were eliminated. Thus, hypoxia combined with hyponatremia produces a major increase in brain edema and mortality, probably by eliminating the compensatory mechanisms of sodium transport initiated by hyponatremia that tend to minimize brain swelling. (J. Clin. Invest. 1994.93:256-264.)

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“…We suggest using the AdjBW to calculate the sodium deficit of patients who are significantly obese. Serum sodium concentrations should be corrected at a rate of 1-2 meq/L/hr for patients with symptomatic hyponatremia or severe acute hyponatremia (e.g., change in serum sodium concentration of >0.5 meq/L/hr or onset in less than 48 hours) 6,10,55,56,[58][59][60]71 and no faster than 0.5 meq/L/hr when hyponatremia is chronic (i.e., develops over more than two or three days) or when the time over which the hyponatremia developed is unknown. 54,55,58,61,63 The maximum recommended increase in serum sodium concentration is 8-12 meq/L per 24 hours, 9,54,55,59,[61][62][63][64][65] with complete correction over 48-96 hours.…”

Section: Sodiummentioning

confidence: 99%

Treatment of electrolyte disorders in adult patients in the intensive care unit

Kraft

Btaiche²,

Sacks³

et al. 2005

American Journal of Health-System Pharmacy

237

202

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Purpose. The treatment of electrolyte disorders in adult patients in the intensive care unit (ICU), including guidelines for correcting specific electrolyte disorders, is reviewed. Summary. Electrolytes are involved in many metabolic and homeostatic functions. Electrolyte disorders are common in adult patients in the ICU and have been associated with increased morbidity and mortality, as has the improper treatment of electrolyte disorders. A limited number of prospective, randomized, controlled studies have been conducted evaluating the optimal treatment of electrolyte disorders. Recommendations for treatment of electrolyte disorders in adult patients in the ICU are provided based on these studies, as well as case reports, expert opinion, and clinical experience. The etiologies of and treatments for hyponatremia hypotonic and hypernatremia (hypovolemic, isovolemic, and hypervolemic), hypokalemia and hyperkalemia, hypophosphatemia and hyperphosphatemia, hypocalcemia and hypercalcemia, and hypomagnesemia and hypermagnesemia are discussed, and equations for determining the proper dosages for adult patients in the ICU are provided. Treatment is often empirical, based on published literature, expert recommendations, and the patient's response to the initial treatment. Actual electrolyte correction requires individual adjustment based on the patient's clinical condition and response to therapy. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders in order to provide the optimal therapy to patients. Conclusion. Treatment of electrolyte disorders is often empirical, based on published literature, expert opinion and recommendations, and patient's response to the initial treatment. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders to provide optimal therapy for patients.

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Rapid correction of severe hyponatremia with intravenous hypertonic saline solution

Cited by 160 publications

References 8 publications

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Hypoxic and ischemic hypoxia exacerbate brain injury associated with metabolic encephalopathy in laboratory animals.

Treatment of electrolyte disorders in adult patients in the intensive care unit

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