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 Results: Thiazide was withdrawn immediately after hyponatremia was diagnosed only in 57% of TAH; in these patients, the median rate of [Na+] change (Δdaily[Na+]) was significantly higher than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.

scholarly journals Tolvaptan Use to Treat SIADH in a Child

2018 ◽  
Vol 23 (6) ◽  
pp. 494-498
Author(s):  
Adem Yasin Koksoy ◽  
Meltem Kurtul ◽  
Aslı Kantar Ozsahin ◽  
Fatma Semsa Cayci ◽  
Meltem Tayfun ◽  
...  
Keyword(s):  
Hypertonic Saline ◽  
Treatment Option ◽  
Pediatric Patients ◽  
Hormone Secretion ◽  
Saline Infusion ◽  
Fluid Restriction ◽  
Effective Treatment Option ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Electrolyte Abnormalities ◽  
Hypertonic Saline Infusion

Hyponatremia is one of the most common electrolyte abnormalities encountered in the clinical setting in hospitalized patients. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the leading cause of hyponatremia in most of these cases. While fluid restriction, hypertonic saline infusion, diuretics, and the treatment of underlying conditions constitute the first line of treatment of SIADH, in refractory cases, and especially for pediatric patients, there seems not to be any other choice for treatment. Tolvaptan, although its use in pediatric patients is still very limited, might be an attractive treatment option for correction of hyponatremia due to SIADH. Here we present a pediatric case of SIADH that was resistant to treatment with fluid restriction and hypertonic saline infusion and was treated successfully with tolvaptan. Tolvaptan could be a good, safe, and effective treatment option in pediatric SIADH cases that are resistant to treatment. However, the dosage should be titrated carefully.

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 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.

Rapid Correction of Hyponatraemia with Urea may Protect against Brain Damage in Rats

1989 ◽  
Vol 77 (3) ◽  
pp. 351-355 ◽  
Author(s):  
O. Van Reeth ◽  
G. Decaux
Keyword(s):  
Brain Damage ◽  
Hypertonic Saline ◽  
Hormone Secretion ◽  
Central Pontine Myelinolysis ◽  
Saline Group ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Group I ◽  
Severe Hyponatraemia ◽  
Pontine Myelinolysis ◽  
Rapid Correction

1. Rapid correction of hyponatraemia in humans has been reported to be associated with central pontine myelinolysis (CPM). In patients with hyponatraemia related to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) we have rapidly corrected hyponatraemia by using urea, without observing clinical CPM. This led us to analyse the brain damage induced by hypertonic saline and by urea when used for the correction of hyponatraemia in a rat model of SIADH. 2. Severe hyponatraemia (serum Na+ < 115 mmol/l) was produced in 28 rats. Seven rats were excluded from statistical analysis because they died during the correction of hyponatraemia, or because they were under- or over-corrected. Normalization of serum Na+ (135–146 mmol/l) was obtained in 48 h by hypertonic saline (group I, n = 7) or urea (group II, n = 8). 3. Despite similar correction of serum Na+ at 24 h and 48 h, all the rats treated with hypertonic saline presented severe brain damage, whereas those treated with urea were free of any brain damage. A third group of rats (n = 6) who spontaneously corrected their serum sodium level and presented mild hyponatraemia at 48 h (129 ± 5.2 mmol/l) were also free of any brain damage.

scholarly journals SIADH in COVID 19 infection, an association or cause : A case report

2020 ◽  
Vol 8 (2) ◽  
pp. 126-128
Author(s):  
Karishma Shamarukh ◽  
Sharmin Rahman ◽  
Umme Kulsum Chy ◽  
Amina Sultana ◽  
Mohammad Omar Faruq
Keyword(s):  
Case Report ◽  
Antidiuretic Hormone ◽  
Hypertonic Saline ◽  
Sodium Level ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Laboratory Parameters ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Low Sodium

One of the leading cause of hyponatremia is syndrome of inappropriate antidiuretic hormone secretion (SIADH). Various etiologies of hyponatraemia have been observed till today but its association with Covid leading to SIADH is rare. Therefore, we present a case where SIADH was associated with Covid-19 pneumonia. This was a case of a 66 years old male with multiple co-morbidities presenting with symptoms of Covid infection including generalized weakness. After confirming Covid 19 infection management was started accordingly but patient’s weakness seemed to increase. He was found to have low sodium level of 105 mmol /L and investigations confirmed that he was having SIADH. He was treated with hypertonic saline, fluid restriction and his symptoms and laboratory parameters gradually improved. Bangladesh Crit Care J September 2020; 8(2): 126-128

scholarly journals Hyperchloremic metabolic acidosis during bipolar transurethral resection of the prostate: a report of two cases

2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110244
Author(s):  
Ann Hee You ◽  
Ji Yoo Lee ◽  
Jeong-Hyun Choi ◽  
Mi Kyeong Kim
Keyword(s):  
Metabolic Acidosis ◽  
Transurethral Resection ◽  
Normal Saline ◽  
Isotonic Saline ◽  
Hemodynamic Instability ◽  
Acid Base ◽  
Electrolyte Disturbance ◽  
Irrigation Fluid ◽  
Laboratory Test Results ◽  
Hyperchloremic Metabolic Acidosis

Compared with monopolar transurethral resection of the prostate (TURP), which requires electrolyte-free irrigation fluid, normal saline can be used as the irrigation solution in bipolar and laser TURP. The risk of TURP syndrome and severe electrolyte disturbance is minimized when normal saline is used as the irrigation fluid. However, the use of isotonic saline also causes acid-base imbalance and electrolyte disturbance. We experienced two patients who developed hyperchloremic metabolic acidosis during bipolar TURP. After proper intervention, hemodynamic instability resolved, and laboratory test results normalized. Anesthesiologists must pay attention to acid-base and electrolyte status when rapid absorption of excessive isotonic solution is suspected, even during bipolar and laser TURP, which use normal saline as the irrigation fluid.

scholarly journals Efficacy of nebulised L-adrenaline with 3% hypertonic saline versus normal saline in bronchiolitis

2016 ◽  
Vol 7 (1) ◽  
pp. 15
Author(s):  
Shabnam Sharmin ◽  
Laila Helaly ◽  
Zakir Hossain Sarker ◽  
Ruhul Amin ◽  
Shafi Ahmed ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Hypertonic Saline ◽  
Normal Saline ◽  
Severity Score ◽  
Saline Group ◽  
Clinical Severity ◽  
Clinical Severity Score ◽  
Group I ◽  
Group Ii

<p><strong>Background:</strong> Bronchiolitis is one of the most common respiratory diseases requiring hospitalization. Nebulized epineph­rine and salbutamol therapy has been used in different centres with varying results. <strong></strong></p><p><strong>Objective:</strong> The objective of the study was to compare the efficacy of nebulised adrenaline diluted with 3% hypertonic saline with nebulised adrenaline diluted with normal saline in bronchiolitis. <strong></strong></p><p><strong>Methods:</strong> Fifty three infants and young children with bronchiolitis, age ranging from 2 months to 2 years, presenting in the emergency department of Manikganj Sadar Hospital were enrolled in the study. After initial evaluation, patients were randomized to receive either nebulized adrenaline I .5 ml ( 1.5 mg) diluted with 2 ml of3% hypertonic saline (group I) ornebulised adrenaline 1.5 ml (1.5 mg) diluted with 2 ml of normal saline (group II). Patients were evaluated again 30 minutes after nebulization. <strong></strong></p><p><strong>Results:</strong> Twenty eight patients in the group I (hypertonic saline) and twenty five in groupII (normal saline) were included in the study. After nebulization, mean respiratory rate decreased from 63.7 to 48.1 (p&lt;.01), mean clinical severity score decreased from 8.5 to 3.5 (p&lt;.01) and mean oxygen satw·ation increased 94.7% to 96.9% (p&lt;.01) in group I. In group II, mean respiratory rate decreased from 62.4 to 47.4 (p&lt;.01), mean clinical severity score decreased from 7.2 to 4.1 (p&lt;.01) and mean oxygen saturation increased from 94. 7% to 96. 7% (p&lt;.01). Mean respiratory rate decreased by 16 in group I versus 14.8 (p&gt;.05) in group 11, mean clinical severity score decreased by 4.6 in group versus 3 (p&lt;.05) in group, and mean oxygen saturation increased by 2.2% and 1.9% in group and group respectively. Difference in reduction in clinical severity score was statistically significant , though the changes in respiratory rate and oxygen saturation were not statistically significant. <strong></strong></p><p><strong>Conclusion:</strong> The study concluded that both nebulised adrenaline diluted with 3% hypertonic saline and nebulised adrenaline with normal saline are effective in improving respiratory rate, clinical severity score and oxygen saturation in infants with bronchiolitis; and nebulised adrenaline with hypertonic saline is more effective than nebulised adrenaline with normal saline in improving clinical severity score in bronchiolitis.</p>

Differential blockade of cat dorsal root C fibers by various chloride solutions

1972 ◽  
Vol 36 (5) ◽  
pp. 569-583 ◽  
Author(s):  
J. Stovall King ◽  
Don L. Jewett ◽  
Howard R. Sundberg
Keyword(s):  
Hypertonic Saline ◽  
Choline Chloride ◽  
Isotonic Saline ◽  
Chloride Ion ◽  
Content Type ◽  
Persistent Effect ◽  
C Fibers ◽  
C Fiber ◽  
Intrathecal Infusion

✓ A possible mechanism by which intrathecal infusion of partially frozen saline might relieve patients of chronic pain has been studied by applying hypertonic saline to the dorsal rootlets of cats in vitro. The supernatant of partially thawed normal saline was found to be hypertonic. Persistent block of C fibers, detected by a collision method, occurred after the rootlets had been exposed to saline from 500 to 2500 mOsm/L for 15 min followed by 15 min of isotonic saline. Few of the A fibers were blocked by this procedure, but both A and C fibers were blocked when solutions of 3500 mOsm/L were used. Differential blockage of C fibers could also be produced with hypotonic saline and with distilled water. Localized cooling, to 2°C for 25 min, had no persistent effect on C fiber conduction, and when cooling was combined with hypertonic saline there was no potentiation of the differential blockade caused by the saline. Hypertonic solutions of sucrose or sodium nitrate produced no persistent differential block; most A and C fibers recovered. However, choline chloride was as effective as sodium chloride in giving a differential blockade. It seems that chloride ion plays a major role in establishing the persistent C fiber blockade observed when dorsal rootlets are exposed to hypertonic saline.

Sign in / Sign up

Export Citation Format

Share Document