True hyponatremia secondary to intravenous immunoglobulin

Nguyen, Minhtri K.; Rastogi, Anjay; Kurtz, Ira

doi:10.1007/s10157-006-0416-9

Cited by 37 publications

(24 citation statements)

References 12 publications

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“…9 Given this fact, it has been suggested that the term "pseudohyponatremia" no longer be used. 1 This argument is supported by recent reports on the presence of true hyponatremia in patients with multiple myeloma 10 and in those who had received in- travenous immunoglobulin infusions, 11 conditions that previously were associated with pseudohyponatremia. The exact incidence of hyponatremia in patients with INS and severe edema is not known.…”

Section: Discussionmentioning

confidence: 63%

Serum Osmolal Gap in Patients With Idiopathic Nephrotic Syndrome and Severe Edema

Kapur

Valentini²,

Imam

et al. 2007

Pediatrics

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Pseudohyponatremia in idiopathic nephrotic syndrome with severe edema is attributed to hyperlipidemia that results in displacement of a portion of water phase of plasma. Current methods of measurement of serum electrolytes are unaffected by hyperlipidemia. In this report we demonstrate that patients with idiopathic nephrotic syndrome with severe edema and true hyponatremia may have an increased rather than normal osmolal gap. We believe that this could be secondary to non-Na+ and non-K+ osmoles in response to plasma-volume contraction secondary to hypoalbuminemia. This observation has implications for management of severe edema in such patients, because fluid restriction could increase their risk for pre-renal failure.

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Section: Discussionmentioning

confidence: 63%

Serum Osmolal Gap in Patients With Idiopathic Nephrotic Syndrome and Severe Edema

Kapur

Valentini²,

Imam

et al. 2007

Pediatrics

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“…Correlation of gravimetrically determined PWC with protein/lipiddetermined PWC by linear regression. compartment to the extracellular compartment as well as the infusion of large volume of dilute fluids in patients with an underlying defect in urinary free water excretion (7). In this setting, extrapolation of the true [Na ϩ ] D-ISE from the [Na ϩ ] I-ISE can be especially helpful in the serial analysis of [Na ϩ ] p during treatment of the true hyponatremia.…”

Section: Discussionmentioning

confidence: 99%

A new method for determining plasma water content: application in pseudohyponatremia

Nguyen¹,

Ornekian²,

Butch³

et al. 2007

American Journal of Physiology-Renal Physiology

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Pseudohyponatremia is a clinical condition characterized by an increased fraction of protein or lipid in plasma, thereby resulting in an artificially low plasma sodium concentration ([Na(+)](p)). Since the automated method of measuring [Na(+)](p) in most laboratories involves the use of an indirect ion-selective electrode (I-ISE), this method does not correct for elevated protein or lipid concentrations. In I-ISE, the plasma sample is diluted before the actual measurement is obtained, and the [Na(+)](p) is determined based on the assumption that plasma is normally composed of 93% plasma water. Therefore, the [Na(+)](p) as determined by I-ISE will be artificially low in clinical conditions when the plasma water content (PWC) is <93%. In contrast, the plasma is not diluted when the [Na(+)](p) is measured using direct ISE (D-ISE). This method directly measures Na(+) activity in plasma water and is therefore unaffected by the proportion of plasma occupied by water. In this study, we report a novel quantitative method for determining the PWC utilizing I-ISE and D-ISE. To validate this new method experimentally, we altered the PWC in vitro by dissolving varying amount of salt-free albumin in human plasma. We then measured PWC gravimetrically in each sample and compared the gravimetrically determined PWC with the ISE-determined PWC. Our findings indicate that the PWC can be accurately determined based on differences in the [Na(+)](p) as measured by I-ISE and D-ISE and that this new quantitative method can be a useful adjunct in the analysis of the dysnatremias.

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“…Sucrose causes to hyponatremia by providing fluid passage from the intravascular area into the extravascular area and free water causes to hyponatremia by creating water load mostly in individuals with tubular damage (15).…”

Section: B) Thromboembolic Complicationsmentioning

confidence: 99%