scholarly journals Management Strategies and Outcomes for Hyponatremia in Cirrhosis in the Hyponatremia Registry

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Samuel H. Sigal ◽  
Alpesh Amin ◽  
Joseph A. Chiodo ◽  
Arun Sanyal
Keyword(s):  
Length Of Stay ◽  
Serum Sodium ◽  
Treatment Success ◽  
Management Strategies ◽  
Isotonic Saline ◽  
Sodium Concentration ◽  
Fluid Restriction ◽  
Specific Therapy ◽  
Treatment Practices ◽  
Cirrhotic Patients

Aim. Treatment practices and effectiveness in cirrhotic patients with hyponatremia (HN) in the HN Registry were assessed. Methods. Characteristics, treatments, and outcomes were compared between patients with HN at admission and during hospitalization. For HN at admission, serum sodium concentration [Na] response was analyzed until correction to > 130 mmol/L, switch to secondary therapy, or discharge or death with sodium ≤ 130 mmol/L. Results. Patients with HN at admission had a lower [Na] and shorter length of stay (LOS) than those who developed HN (P < 0.001). Most common initial treatments were isotonic saline (NS, 36%), fluid restriction (FR, 33%), and no specific therapy (NST, 20%). Baseline [Na] was higher in patients treated with NST, FR, or NS versus hypertonic saline (HS) and tolvaptan (Tol) (P < 0.05). Treatment success occurred in 39%, 39%, 52%, 78%, and 81% of patients with NST, FR, NS, HS, and Tol, respectively. Relapse occurred in 55% after correction and was associated with increased LOS (9 versus 6 days, P < 0.001). 34% admitted with HN were discharged with HN corrected. Conclusions. Treatment approaches for HN were variable and frequently ineffective. Success was greatest with HS and Tol. Relapse of HN is associated with increased LOS.

scholarly journals Baseline Renal Function Predicts Hyponatremia in Liver Cirrhosis Patients Treated with Terlipressin for Variceal Bleeding

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Sung Eun Kim ◽  
Dong Min Jung ◽  
Ji Won Park ◽  
Yeonmi Ju ◽  
Bohyun Lee ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Sodium ◽  
Variceal Bleeding ◽  
Sodium Concentration ◽  
Serum Sodium Concentration ◽  
Retrospective Case ◽  
Baseline Serum ◽  
Acute Variceal Bleeding ◽  
Cirrhotic Patients ◽  
And Gender

Objectives. Terlipressin is safely used for acute variceal bleeding. However, side effects, such as hyponatremia, although very rare, can occur. We investigated the development of hyponatremia in cirrhotic patients who had acute variceal bleeding treated with terlipressin and the identification of the risk factors associated with the development of hyponatremia. Design and Methods. This retrospective, case-control study investigated 88 cirrhotic patients who developed hyponatremia and 176 controls that did not develop hyponatremia and were matched in terms of age and gender during the same period following terlipressin administration. Results. The overall change in serum sodium concentration and the mean lowest serum sodium concentration were 3.44 ± 9.55 and 132.44 ± 8.78 mEq/L during treatment, respectively. Multivariate analysis revealed that baseline serum sodium was an independent positive predictor, and the presence of baseline serum creatinine, HBV, DM, creatinine, and shock on admission was independent negative predictors of hyponatremia (P<0.05). Conclusion. The presence of HBV, DM, the baseline serum sodium, shock on admission, and especially baseline creatinine may be predictive of the development of hyponatremia after terlipressin treatment. Therefore, physicians conduct vigilant monitoring associated with severe hyponatremia when cirrhotic patients with preserved renal function are treated with terlipressin for variceal bleeding.

scholarly journals Hyponatremia: a case report of SIAD

2013 ◽  
Vol 7 (2) ◽  
pp. 41-52
Author(s):  
Letizia Canu ◽  
Alessandro Peri ◽  
Gabriele Parenti
Keyword(s):  
Isotonic Saline ◽  
Diagnostic Algorithm ◽  
Sodium Concentration ◽  
Fluid Restriction ◽  
Osmotic Demyelination Syndrome ◽  
Significant Morbidity ◽  
Electrolyte Disorder ◽  
Hospitalised Patients ◽  
Underlying Diseases ◽  
Rapid Correction

Hyponatremia, defined as serum sodium concentration <136 mEq/l, represents one of the most frequently encountered electrolyte disorder in clinical practice. Among hospitalised patients up to 15-30% present mild hyponatremia (130-135 mEq/l), whereas moderate to severe forms are seen in up to 7% of inpatients. Hyponatremia is associated with significant morbidity and mortality especially in patients with underlying diseases. According to volume status hyponatremia can be classified as hypovolemic, hypervolemic or euvolemic. An accurate diagnostic algorithm has to be performed in order to optimize the therapeutic approach. Acute and severe forms are accompanied by neurological symptoms due to cerebral edema and can cause death if not appropriately treated. Moreover, even a too rapid correction can be associated with serious complications, such as the osmotic demyelination syndrome. Hypovolemic forms have to be treated with isotonic saline infusion, whereas eu-hypervolemic forms require hypertonic saline when symptomatic, and fluid restriction or vaptans when asymptomatic. Here, we report the case of a 79-year-old woman with hyponatremia admitted to the Emergency Department of XXX.

scholarly journals Thiazide-Associated Hyponatremia, Report of the Hyponatremia Registry: An Observational Multicenter International Study

2017 ◽  
Vol 45 (5) ◽  
pp. 420-430 ◽  
Author(s):  
Volker Burst ◽  
Franziska Grundmann ◽  
Torsten Kubacki ◽  
Arthur Greenberg ◽  
Ingrid Becker ◽  
...  
Keyword(s):  
Hypertonic Saline ◽  
Normal Saline ◽  
Management Practices ◽  
Treatment Success ◽  
Hormone Secretion ◽  
Isotonic Saline ◽  
High Rate ◽  
Adverse Side Effect ◽  
Fluid Restriction ◽  
Rapid Correction

Background: Hyponatremia is a frequent and potentially life-threatening adverse side effect of thiazide diuretics. This sub-analysis of the Hyponatremia Registry database focuses on current management practices of thiazide-associated hyponatremia (TAH) and compares differences between TAH and syndrome of inappropriate antidiuretic hormone secretion (SIADH). Methods: We analyzed 477 patients from 225 US and EU sites with euvolemic hyponatremia ([Na+] ≤130 mEq/L) who were receiving a thiazide diuretic. Of these, 118 met criteria for true thiazide-induced hyponatremia (TIH). Results: Thiazide was withdrawn immediately after hyponatremia was diagnosed only in 57% of TAH; in these patients, the median rate of [Na+] change (Δdaily[Na+]) was significantly higher than those with continued thiazide treatment (3.8 [interquartile range: 4.0] vs. 1.7 [3.8] mEq/L/day). The most frequently employed therapies were isotonic saline (29.6%), fluid restriction (19.9%), the combination of these two (8.2%), and hypertonic saline (5.2%). Hypertonic saline produced the greatest Δdaily[Na+] (8.0[6.4] mEq/L/day) followed by a combination of fluid restriction and normal saline (4.5 [3.8] mEq/L/day) and normal saline alone (3.6 [3.5] mEq/L/day). Fluid restriction was markedly less effective (2.7 [2.7] mEq/L/day). Overly rapid correction of hyponatremia occurred in 3.1% overall, but in up to 21.4% given hypertonic saline. Although there are highly significant differences in the biochemical profiles between TIH and SIADH, no predictive diagnostic test could be derived. Conclusions: Despite its high incidence and potential risks, the management of TAH is often poor. Immediate withdrawal of the thiazide is crucial for treatment success. Hypertonic saline is most effective in correcting hyponatremia but associated with a high rate of overly rapid correction. We could not establish a diagnostic laboratory-based test to differentiate TIH from SIADH.

Case Report of SIADH Associated With Escitalopram Use

2009 ◽  
Vol 22 (6) ◽  
pp. 594-599 ◽  
Author(s):  
Renee R. Koski ◽  
Jill A. Covyeou ◽  
Michelle Morissette
Keyword(s):  
Risk Factors ◽  
Antidiuretic Hormone ◽  
Serum Sodium ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Case Reports ◽  
Treatment Options ◽  
Sodium Concentration ◽  
Serum Sodium Concentration ◽  
White Female ◽  
Fluid Restriction

The authors report a case of syndrome of inappropriate antidiuretic hormone (SIADH) associated with the use of escitalopram in an elderly female patient. A 97-year-old white female was admitted to the hospital for a suspected vertebral fracture and hyponatremia. Her serum sodium concentration was 113 mEq/L (113 mmol/L) at admission. She was started on escitalopram 5 mg daily 1 week prior to admission for anxiety. During admission, her laboratory tests revealed serum hyponatremia and hypo-osmolality and urine hyperosmolality and hypernatremia. Her escitalopram was stopped, and she was diagnosed with syndrome of inappropriate antidiuretic hormone. She was treated with hypertonic (3%) saline. She was discharged 1 week later with a serum sodium concentration of 121 mEq/L (121 mmol/L). There have been hundreds of case reports of SIADH associated with selective serotonin reuptake inhibitors (SSRIs), including 5 cases associating escitalopram with syndrome of inappropriate antidiuretic hormone. The median time to onset of SIADH after initiating SSRIs is approximately 2 weeks. Risk factors include advanced age, concomitant diuretic use, low baseline sodium, and low body mass index. Treatment options include fluid restriction, normal saline, diuretics, hypertonic saline, and discontinuing the SSRI. The authors conclude that elderly patients receiving escitalopram or other SSRIs should be monitored carefully for SIADH in the first couple of weeks of treatment and with dose increases, especially if other risk factors are present.

scholarly journals Low-Dose Tolvaptan for the Treatment of Dilutional Hyponatremia in Cirrhosis: A Case Report and Literature Review

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Guo Shen ◽  
Hainv Gao
Keyword(s):  
Serum Sodium ◽  
Sodium Concentration ◽  
Serum Sodium Concentration ◽  
Decompensated Cirrhosis ◽  
History Of ◽  
V2 Receptor ◽  
Vasopressin V2 Receptor Antagonist ◽  
Cirrhotic Patients ◽  
Dilutional Hyponatremia ◽  
The Ideal

Dilutional hyponatremia is common in decompensated cirrhosis and can be successfully treated by tolvaptan, a vasopressin V2-receptor antagonist. Data were lacking regarding the effects of tolvaptan on cirrhotic patients with a Child-Pugh score of >10 and a serum sodium concentration of <120 mmol/L. We report a case of forties man with a 20-year history of chronic hepatitis B presenting with yellow urine and skin. Laboratory tests demonstrated prolonged prothrombin time, markedly elevated total bilirubin, severe hyponatremia, and a Child-Pugh score of >10. The patient was diagnosed with dilutional hyponatremia and was treated with recommended dosage tolvaptan at first. The serum concentration of sodium recover but the patient felt obviously thirsty. As the dosage of tolvaptan was decreased accordingly from 15 mg to 5 mg, the patient still maintained the ideal concentration of serum sodium. This case emphasizes that cirrhotic patient with higher Child-Pugh scores and serum sodium concentration of <120 mmol/L can be treated with lower dose of tolvaptan.

Risk factors for hepatic encephalopathy in patients with cirrhosis and refractory ascites: relevance of serum sodium concentration

2010 ◽  
Vol 30 (8) ◽  
pp. 1137-1142 ◽  
Author(s):  
Mónica Guevara ◽  
María E. Baccaro ◽  
Jose Ríos ◽  
Marta Martín-Llahí ◽  
Juan Uriz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatic Encephalopathy ◽  
Serum Sodium ◽  
Sodium Concentration ◽  
Serum Sodium Concentration ◽  
Refractory Ascites

scholarly journals Lower serum chloride concentrations are associated with increased risk of mortality in critically ill cirrhotic patients: an analysis of the MIMIC-III database

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yun Ji ◽  
Libin Li
Keyword(s):  
Critically Ill ◽  
Serum Sodium ◽  
Kidney Injury ◽  
Icu Mortality ◽  
Independent Prognostic Marker ◽  
Risk Of Mortality ◽  
Serum Chloride ◽  
Increased Risk ◽  
Cirrhotic Patients ◽  
End Stage

Abstract Background Cirrhosis can be complicated by electrolyte abnormalities, but the major focus has been concentrated on the clinical significance of serum sodium levels. Emerging studies have identified hypochloremia as an independent prognostic marker in patients with chronic heart failure and chronic kidney disease. The aim of this study was to investigate whether serum chloride levels were associated with mortality of critically ill cirrhotic patients. Methods Critically ill cirrhotic patients were identified from the Multi-parameter Intelligent Monitoring in Intensive Care III Database. The primary outcome was ICU mortality. Logistic regression was used to explore the association between serum chloride levels and ICU mortality. The area under the receiver operating characteristic curves (AUC) was used to assess the performance of serum chloride levels for predicting ICU mortality. Results A total of 1216 critically ill cirrhotic patients were enrolled in this study. The overall ICU mortality rate was 18.8%. Patients with hypochloremia had a higher ICU mortality than those with non-hypochloremia (34.2% vs. 15.8%; p < 0.001). After multivariable risk adjustment for age, gender, ethnicity, chloride, sodium, Model for End-stage Liver Disease score, Sequential Organ Failure Assessment score, Elixhauser comorbidity index, mechanical ventilation, vasopressors, renal replacement therapy, acute kidney injury, hemoglobin, platelet, and white blood cell, serum chloride levels remained independently associated with ICU mortality (OR 0.94; 95% CI 0.91–0.98; p = 0.002) in contrast to serum sodium levels, which were no longer significant (OR 1.03; 95% CI 0.99–1.08; p = 0.119). The AUC of serum chloride levels (AUC, 0.600; 95% CI 0.556–0.643) for ICU mortality was statistically higher than that of serum sodium levels (AUC, 0.544; 95% CI 0.499–0.590) (p < 0.001). Conclusions In critically ill cirrhotic patients, serum chloride levels are independently and inversely associated with ICU mortality, thus highlighting the prognostic role of serum chloride levels which are largely overlooked.

scholarly journals PCV125 EVALUATION OF THE ASSOCIATION BETWEEN SERUM SODIUM AND LENGTH OF STAY (LOS) IN PATIENTS HOSPITALIZED FOR HEART FAILURE

2009 ◽  
Vol 12 (7) ◽  
pp. A336
Author(s):  
PL Cyr ◽  
K Slawsky ◽  
N Olchanski ◽  
H Krasa ◽  
C Zimmer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Serum Sodium
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