COVID-19: hypernatremia is a significant predictor of mortality

Introduction: Coronavirus disease 2019 (COVID-19) pandemic spread rapidly, creating a worrisome scenario worldwide. In hospitalized patients, dysnatremia (hyponatremia and/or hypernatremia) is the most common electrolyte disturbance, reported in 30­40% of cases and associated with a poor prognosis. This study aimed to evaluate the association between dysnatremia and mortality in hospitalized patients infected with SARS-COV-2. Methods: Retrospective longitudinal study that analyzed data from hospital records of 1,000 patients with COVID-19 (median age, 62.5 years; 57.1% men), including 109 (10.9%) deaths. Kaplan-Meier survival curves and Cox proportional hazard models with Hazard Ratio (HR) with 95% confidence intervals (95%CI) were applied to confirm the association between dysnatremia (hyponatremia and/or hypernatremia) and death. Results: Hypernatremia was detected in 83 (76.1%) of the patients who died, with a cumulative reduction in survival (p < 0.01) and a 2.42-fold increased mortality risk (95%CI: 1.45­2.91). In the multivariable analysis, hypernatremia was the main factor associated with increased mortality (HR: 1.50; 95%CI: 1.23­1.81). Long length of stay (LOS) (HR: 1.54; 95%CI: 1.21­1.78), old age (HR: 1.63; 95%CI: 1.28­1.88), and chronic kidney disease (HR: 1.77; 95%CI: 1.21­3.30) were also associated with death. Conclusion: Hypernatremia during hospitalization is an important risk factor for poor prognosis and an increased mortality risk. LOS, old age, and chronic kidney disease could also be used for risk stratification in patients with COVID-19.

Prevalencia y severidad de Hiponatremias en niños internados en el Hospital Pediátrico: estudio de cohorte / Prevalence and severity of hyponatremia in children admitted to a pediatric hospital: a cohort study

Introducción: Para disminuir la aparición de hiponatremias en los últimos años se aumentaron las concentraciones de sodio en las soluciones de mantenimiento, llegando a recomendarse las isotónicas, con mejoras de laboratorio pero con dudoso impacto clínico. En el Hospital Garrahan se utiliza una solución estándar hipotónica con cloruro de sodio 0,45%. Antes de reemplazar la solución según recomendaciones internacionales se decidió establecer la prevalencia de hiponatremia en pacientes internados, y su asociación con la solución estándar de hidratación. Población y métodos: Pacientes de 1 mes a 18 años, internados en el Hospital Garrahan. Estudio prospectivo y observacional. Se registró si el paciente recibía hidratación parenteral y la concentración de sodio. Se consideró hiponatremia significativa la presencia de sodio sérico menor a 130 mEq/L. y/o la presencia de síntomas compatibles con hiponatremia. Resultados: En 3003 internaciones la prevalencia global de hiponatremias diagnosticadas fue 4.4%, y asciende a 6.3% si se consideran solo los pacientes que fueron estudiados con ionograma (se le extrajo ionograma al 70,6% de los pacientes internados). La prevalencia de hiponatremias significativas fue de 1.5% (n=44) de los internados, y las hiponatremias significativas en internados que recibían la solución hipotónica estándar de mantenimiento fue de 0.3% (n=9). Conclusiones: En una población donde se utiliza una solución estándar con cloruro de sodio 0,45% -pero se modifica individualmente para las necesidades de cada paciente- la prevalencia de hiponatremias totales y significativas fue similar e incluso inferior a la publicada en otras series. (AU)

Introduction: To reduce the appearance of hyponatremia, in recent years, sodium concentrations were increased in maintenance solutions, and isotonic solutions were recommended, leading to improvements in laboratory studies, but with a doubtful clinical impact. A standard hypotonic solution with 0.45% sodium chloride is used at Garrahan Hospital. Before replacing the solution according to international recommendations, it was decided to determine the prevalence of hyponatremia in inpatients and its association with the standard hydration solution. Population and methods: Patients from 1 month to 18 years old, hospitalized at Garrahan Hospital. Prospective and observational study. Parenteral hydration of the patient and the sodium concentration were recorded. Significant hyponatremia was defined as serum sodium less than 130 mEq/L, and/or the presence of symptoms of hyponatremia. Results: In 3003 hospitalizations, the overall prevalence of diagnosed hyponatremia was 4.4%, increasing to 6.3% if only patients in whom a ionogram was performed were included (a ionogram was performed in 70.6% of the inpatients). Of all inpatients, 1.5% (n=44) had significant hyponatremia, and 0.3% (n=9) of the patients receiving the standard maintenance hypotonic solution had significant hyponatremia. Conclusions: In a population in whom a standard solution with 0.45% sodium chloride is used - but which is individually modified according to the needs of each patient - the prevalence of total and significant hyponatremia was similar and even lower than that reported in other series (AU)

Hiponatremia em pacientes internados / Hyponatremia in hospitalized patients

Objetivo: Avaliar a prevalência de hiponatremia em pacientes internados, determinando seu perfil epidemiológico. Métodos: Estudo prospectivo, observacional e longitudinal. Utilizou-se o banco de dados do hospital no período entre março e maio de 2017, com total de 320 indivíduos. A análise estatística foi rea- lizada por meio do Statistical Package for Social Science, versão 24.0. Resultados: Do total de 320 pacientes avaliados, 51,6% deles eram do sexo masculino. A idade média foi de 62,73 anos, e a maior parte era da cor parda. Desenvolveram hiponatremia no decorrer do estudo 135 (42,18%) pacientes. Diabéticos tiveram maior predisposição a desenvolver hiponatremia (57,7%). Outras comorbidades também foram frequentes, como hipertensão ar- terial sistêmica (61,9%) e doenças neurodegenerativas (23,3%). Conclusão: Houve maior prevalência de hiponatremia nos pa- cientes do sexo feminino, acima dos 60 anos e pardos. O diabetes mellitus foi considerado fator de risco para o desenvolvimento da hiponatremia. Os resultados visam ampliar a percepção a respeito desse distúrbio hidroeletrolítico tão encontrado na clínica médica e que, muitas vezes, não recebe a devida importância.

Objective: to evaluate the prevalence of hyponatremia in hos- pitalized patients, determining their epidemiological profile. Me- thods: This is a prospective, observational and longitudinal study. The hospital database was used from March to May 2017, with a total of 320 individuals. The statistical analysis was done by means of the Statistical Package for Social Science, version 24.0. Results: Of the 320 patients evaluated, 51.6% were male. The mean age was 62.73 years old, with most of them being brown-skinned. A total of 135 (42.18%) of the patients developed hyponatremia over the course of the study. Diabetics had greater predisposition to de- velop hyponatremia (57.7%). Other frequent comorbidities were systemic arterial hypertension (61.9%) and neurodegenerative diseases (23.3%). Conclusion: There was a higher prevalence in females, those above 60 years old, and brown-skinned. Diabetes mellitus was considered a risk factor for the development of hypo- natremia. The results aim to increase the perception regarding this hydroelectrolytic disorder frequently found in internal medi- cine practice, and that does not receive the proper importance.

Hiponatremia em idosos internados está associada à polifarmácia, maior permanência hospitalar e maior mortalidade / Hyponatremia in hospitalized older adults is associated with polypharmacy, longer hospital stay, and higher mortality

OBJETIVO: Avaliar a hiponatremia em pacientes idosos durante o período de internação e sua associação com polifarmácia, permanência hospitalar e mortalidade. MÉTODO: Estudo observacional, transversal e analítico, de pacientes com mais de 65 anos de idade durante o período de internação. A primeira amostra de sódio solicitada pelo médico foi considerada para análise. A hiponatremia foi classificada quanto à gravidade em: leve (130 ­ 135 mEq/L), moderada (125 ­ 129 mEq/L) e grave (< 125 mEq/L); quanto à osmolaridade em: isotônica (275 ­ 295 mOsm/L), hipotônica (< 275 mOsm/L) e hipertônica (> 295 mOsm/L). Empregamos o teste do χ2 e a análise de variância (ANOVA a uma via), com teste post hoc de Tukey, para analisar o período de permanência entre os grupos (normonatremia, hiponatremia leve/moderada e grave), e o teste do χ2, para comparar a mortalidade entre os grupos. RESULTADOS: Cento e setenta e quatro pacientes com idade média de 74 ± 7 anos (65 ­ 95 anos), sendo 52,3% do sexo masculino, foram avaliados. Do total, 44,8% apresentaram normonatremia; 37,8%, hiponatremia leve; 9,2%, hiponatremia moderada; e 8%, hiponatremia grave. Houve aumento do período de permanência hospitalar nos pacientes com hiponatremia, sendo mais acentuado em portadores de hiponatremia grave. Polifarmácia esteve presente em 39,3% dos pacientes. Entre aqueles com hiponatremia grave, 71,4% apresentavam polifarmácia (p = 0,01). CONCLUSÕES: Idosos hospitalizados apresentam alta frequência de hiponatremia e associação importante com polifarmácia e prolongamento da permanência hospitalar

OBJECTIVE: To evaluate hyponatremia in older patients during hospital stay and determine its association with polypharmacy, length of hospital stay, and mortality. METHOD: This was an observational, analytical, cross-sectional study of patients aged 65 years and older during hospitalization. The first sodium sample requested by the physician was considered for analysis. Hyponatremia was classified according to severity as mild (130­135 mEq/L), moderate (125­129 mEq/L), or severe (< 125 mEq/L) and according to osmolarity as isotonic (275­295 mOsm/L), hypotonic (< 275 mOsm/L), or hypertonic (> 295 mOsm/L). The χ2 test and oneway analysis of variance followed by Tukey's post hoc test were used to analyze length of hospital stay between the groups (normonatremia and mild, moderate, and severe hyponatremia). The χ2 test was also used to compare mortality between the groups. RESULTS: We included 174 patients, with a mean age of 74 (SD, 7; range, 65­95) years; 52.3% were men. Overall, 44.8% had normonatremia, 37.8% had mild hyponatremia, 9.2% had moderate hyponatremia, and 8.0% had severe hyponatremia. Increased hospital stay was observed in patients with hyponatremia, being longer in those with severe hyponatremia. Polypharmacy occurred in 39.3% of patients. Of patients with severe hyponatremia, 71.4% had polypharmacy (p = 0.01). CONCLUSIONS: Hospitalized older adults showed a high rate of hyponatremia and an important association with polypharmacy and prolonged hospital stay.

Eletrólitos séricos e prognóstico em doentes submetidos a gastrostomia endoscópica / Serum electrolytes and outcome in patients undergoing endoscopic gastrostomy

ABSTRACT BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a gold standard for long term enteral feeding. Neurologic dysphagia and head/neck cancer are the most common indications for PEG as they can lead to protein-energy malnutrition and serum electrolyte abnormalities, with potential negative impact on metabolic balance. Refeeding syndrome may also be related with severe electrolyte changes in PEG-fed patients and contribute to poor prognosis. OBJECTIVE: This study aims to evaluate the changes in serum concentrations of the main electrolytes and its possible association with the outcome. METHODS: Retrospective study of patients followed in our Artificial Nutrition Clinic, submitted to PEG from 2010 to 2016, having head/neck cancer or neurologic dysphagia, who died under PEG feeding. Serum electrolytes (sodium, potassium, chlorine, magnesium, calcium and phosphorus) were evaluated immediately before the gastrostomy procedure. Survival after PEG until death was recorded in months. RESULTS: We evaluated 101 patients, 59 with electrolyte alterations at the moment of the gastrostomy. Sodium was altered in 32 (31.7%), magnesium in 21 (20.8%), chlorine in 21 (20.8%), potassium in 14 (13.8%), calcium in 11 (10.9 %) and phosphorus in 11 (10.9%). The survival of patients with low sodium (<135 mmol/L) was significantly lower when compared to patients with normal/high values, 2.76 months vs 7.80 months, respectively (P=0.007). CONCLUSION: Changes in serum electrolytes of patients undergoing PEG were very common. More than half showed at least one abnormality, at the time of the procedure. The most frequent was hyponatremia, which was associated with significantly shorter survival, probably reflecting severe systemic metabolic distress.

RESUMO CONTEXTO: A gastrostomia endoscópica percutânea (PEG) é a via de eleição preferencial para a nutrição entérica de longa duração. A disfagia neurológica e as neoplasias cervico-faciais constituem as principais indicações para PEG por poderem conduzir a desnutrição energético-proteica e alterações hidroeletrolíticas, com potencial impacto negativo no equilíbrio metabólico. A síndrome de realimentação pode também estar associada a alterações hidroeletrolíticas graves em doentes alimentados por PEG e contribuir para um mau prognóstico. OBJETIVO: Avaliar as alterações das concentrações séricas dos principais eletrólitos e a eventual associação entre os valores séricos alterados e o prognóstico dos doentes gastrostomizados. Métodos - Estudo retrospetivo realizado em doentes seguidos na Consulta de Nutrição Artificial do Hospital Garcia de Orta, propostos e submetidos a PEG, de 2010 a 2016 e que faleceram sob nutrição por PEG. Consideraram-se os valores séricos dos iões em estudo avaliados imediatamente antes do procedimento endoscópico de gastrostomia, obtidos por consulta do processo clínico. A sobrevida, após a realização da PEG até à morte foi registrada em meses. RESULTADOS: Avaliaram-se 101 doentes. A sobrevida média pós-gastrostomia foi 6,55 meses. Destes, 59 apresentaram alterações de alguns iões no momento da realização da PEG. O sódio estava alterado em 31 (30,6%), magnésio em 20 (19,8%), cloro em 19 (18,8%), potássio em 14 (13,8%), cálcio em 10 (9,9%) e o fósforo em 9 (8,9%). Quando comparada a sobrevida dos doentes com valores de sódio baixo (<135 mmol/L) com a dos doentes com valores normais/elevados, esta foi 2,76 meses vs 7,80 meses, respectivamente (P=0,007). CONCLUSÃO: As alterações dos eletrólitos séricos nos doentes submetidos a PEG foram muito frequentes, com mais de metade dos doentes a apresentarem pelo menos uma alteração aquando da realização do procedimento. A alteração mais frequente foi a hiponatrémia, associando-se a pior prognóstico com sobrevida significativamente mais curta, refletindo provavelmente um grave compromisso metabólico sistêmico.

Hiponatremia adquirida en el hospital: ¿influye el tipo de fluidoterapia en los niños ingresados a cuidados intensivos? / Hospital-acquired hyponatremia: Does the type of fluid therapy affect children admitted to intensive care?

Resumen: Introducción: Este estudio tuvo por objetivo valorar las diferencias entre el tipo de fluidoterapia ini cial utilizada (sueros isotónicos o hipotónicos) en el desarrollo de hiponatremia, valores de cloro y to lerancia de las vías venosas. Pacientes y Método: Estudio retrospectivo de cohortes en una Unidad de Cuidados Intensivos Pediátricos (UCIP) de un hospital terciario. Se incluyeron niños menores de 15 años ingresados durante el primer semestre de los años 2010 y 2013, que recibieron fluidoterapia in travenosa, excluyéndose los sometidos a cirugía cardiaca, trasplantados renales y aquellos con ingreso inferior a 24 h. Se recogieron datos epidemiológicos, de comorbilidad y relacionados con el ingreso, tipo de suero recibido, valores de sodio y cloro en las primeras 72 h y la incidencia de extravasaciones de vías periféricas. Resultados: Se incluyeron 111 niños: 68 (61,3%) recibieron líquidos hipotónicos y 43 (38,7%) isotónicos. No hubo diferencias respecto a la patología y gravedad, ni tampoco en el volumen de líquidos recibido. Entre los pacientes que recibieron sueros hipotónicos, 28 (41,2%) pre sentaron hiponatremia, siendo esta moderada (Na <130 mEq/kg) en 11 de ellos, en comparación con 8 niños (18,6%) entre los que recibieron sueros isotónicos, registrando hiponatremia moderada solo en un caso (p=0,027). No se registró ningún caso de hipernatremia, ni hubo diferencias en los valores de cloro plasmático. Tampoco se objetivó mayor frecuencia de pérdida del acceso venoso utilizando la fluidoterapia isotónica (4,7% vs. 7,4%, p=0,704). Conclusión: El uso de líquidos iniciales isotóni cos en niños hospitalizados en UCIP se asocia con menor incidencia y gravedad de hiponatremia, sin cambio en la cloremia y es bien tolerado por las vías venosas periféricas.

Abstract: Introduction: The objective of this study was to evaluate the association between the type of initial fluid therapy used (isotonic or hypotonic solutions) and the development of hyponatremia, the plas ma chlorine values and the tolerance of venous access. Patients and Method: Retrospective cohort study in a Pediatric Intensive Care Unit (PICU) of a high complexity hospital. There were included children younger than 15 years old hospitalized during the first semester of 2010 and 2013 who recei ved intravenous maintenance fluid therapy, excluding patients undergoing cardiac surgery, kidney transplant and admissions that lasted less than 24 hours. Epidemiological, comorbidity and admis sion-related data were collected, including type of solution received, sodium and chlorine values in the first 72 hours of hospitalization and the incidence of extravasation of peripheral intravenous lines. Results: 111 children were included; 68 children (61.3%) were treated with hypotonic solutions and 43 (38.7%) with isotonic solutions. There were no differences in pathology and severity, and also in the volume of fluid received. Among the patients who received hypotonic solutions, 28 (41.2%) de veloped hyponatremia, wich was moderate (Na <130 mEq/Kg) in 11 cases, compared with 8 children (18.6%) who received isotonic solutions, with only one case of moderate hyponatremia (p = 0.027). No cases of hypernatremia were recorded, and there were no differences in plasma chlorine values. There was also no increased frequency of venous access loss in patients treated with isotonic solutions (4.7% versus 7.4%, p = 0.704). Conclusion: Treatment with initial isotonic solutions in children hos pitalized in PICU is associated with a lower incidence and severity of hyponatremia, without changes in the plasma chlorine values and it is well tolerated by peripheral intravenous lines.

Fator natriurético atrial: ele é o responsável pela hiponatremia e natriurese em neurocirurgia? / Atrial natriuretic factor: is it responsible for hyponatremia and natriuresis in neurosurgery?

RESUMO Objetivo: Avaliar a presença de hiponatremia e natriurese, bem como suas associações com o fator natriurético atrial em pacientes de neurocirurgia. Métodos: Foram incluídos 30 pacientes submetidos à ressecção de tumor intracraniano e à clipagem de aneurisma cerebral. Os níveis plasmáticos e urinários de fator natriurético atrial foram medidos durante os períodos pré e pós-operatório. Resultados: Hiponatremia esteve presente em 63,33% dos pacientes, particularmente no primeiro dia pós-operatório. Observou-se natriurese em 93,33% dos pacientes, principalmente no segundo dia pós-operatório. Os níveis plasmáticos de fator natriurético atrial estavam aumentados em 92,60% dos pacientes em pelo menos um dos dias pós-operatórios, mas não houve associação estatisticamente significante entre fator natriurético atrial e sódio plasmático, e entre fator natriurético atrial e sódio urinário. Conclusão: Após neurocirurgia, na maior parte dos pacientes, estiveram presentes hiponatremia e natriurese; contudo, o fator natriurético atrial não pôde ser considerado diretamente responsável por tais alterações nos pacientes neurocirúrgicos. Provavelmente, há o envolvimento de outros fatores natriuréticos.

ABSTRACT Objective: To evaluate the presence of hyponatremia and natriuresis and their association with atrial natriuretic factor in neurosurgery patients. Methods: The study included 30 patients who had been submitted to intracranial tumor resection and cerebral aneurism clipping. Both plasma and urinary sodium and plasma atrial natriuretic factor were measured during the preoperative and postoperative time periods. Results: Hyponatremia was present in 63.33% of the patients, particularly on the first postoperative day. Natriuresis was present in 93.33% of the patients, particularly on the second postoperative day. Plasma atrial natriuretic factor was increased in 92.60% of the patients in at least one of the postoperative days; however, there was no statistically significant association between the atrial natriuretic factor and plasma sodium and between the atrial natriuretic factor and urinary sodium. Conclusion: Hyponatremia and natriuresis were present in most patients after neurosurgery; however, the atrial natriuretic factor cannot be considered to be directly responsible for these alterations in neurosurgery patients. Other natriuretic factors are likely to be involved.

Liver cirrhosis; frequency and severity of hyponatremia in patients

Liver cirrhosis results from prolonged, widespread but patchy hepato-cellular necrosis due to various reasons. To determine the frequency and severity of hyponatremia in patients with liver cirrhosis. Descriptive case series study. Six months. Liaquat University Hospital Hyderabad. The cirrhotic subjects were assessed for hyponatremia and its severity. The data was analyzed in SPSS 16 and the frequency and percentage was calculated for hyponatremia and statistically p -value

Frequency of dysnatremia and dyskalemia in cardiac surgical intensive care unit

To determine the frequency of dysnatremia and dyskalemiain cardiac surgical intensive care unit patients and to identify the factors associated with the changes in potassium and sodium levels. Cross Sectional study. Cardiac surgical intensive care unit [ICU] of Armed Forces Institute of Cardiology / National Institute of Heart Diseases [AFIC/NIHD] from July 2013 to November 2013. Post-operative patients in cardiac surgical intensive care unit were selected through non probability convenient sampling. Demographic and clinical data was collected for all patients including: age, sex etc. Additionally, laboratory data such as potassium and sodium serum concentrations were recorded of day one of the first five post operative days. Out of 100 patients, 51% had dyskalemia, 33% had episodes of hypokalemia, and 19% had hyperkalemia. On the other hand 79% patients had dysnatremia, among them 71%had hyponatremia, and 8% had hypernatremia. Dyskalemia and dysnatremia are common problems in cardiac surgical ICU with higher frequency of hyponatremia as compared to hypernatremia, and hypokalemia as compared to hyperkalemia

Incidencia y mortalidad de la hiponatremia en pacientes con cáncer / Incidence and mortality due to hyponatremia in patients with cancer

La hiponatremia es el trastorno hidroelectrolítico más común de la práctica clínica y aumenta la probabilidad de muerte en pacientes con cáncer y otras patologías.

Free water excess is not the main cause for hyponatremia in critically ill children receiving conventional maintenance fluids.

Objective: To examine occurrence of hyponatremia in critically ill children receiving conventional maintenance fluids (0.18% saline in 5% dextrose) and its relationship with electrolyte free water (EFW), sodium intake and natriuresis. Design: Prospective observational study. Setting: Pediatric Intensive Care Unit of a tertiary care teaching hospital. Subjects: Thirty eight patients, 3 months-12 years, consecutively admitted to PICU over 30 days. Main outcome measure was occurrence of hyponatremia (serum sodium £130 mEq/L). Serum and urinary sodium, and osmolality were measured, and type and volume of intravenous fluids and total urine output were recorded 12 hourly. Daily intake of sodium and EFW, urinary sodium excretion and net balance of fluid and sodium were estimated from above. Data of hyponatremic and non-hyponatremic patients was compared using ANOVA, Mann-Whitney U, and Chi-square tests. Results: Fourteen episodes of hyponatremia were recorded in 12 patients over 397 patient days (3.5 episodes/100 patient days). Their mean (SD) serum sodium dropped from 139 (9.3) at admission to 128 (1.0) mEq/L, over a median interval of 3.5 days (range 1-15 days). Net fluid and sodium balance in hyponatremic patients did not differ significantly from non-hyponatremic patients. Within the hyponatremic group, sodium intake, urinary sodium and sodium balance were similar before and after the occurrence of hyponatremia, while total fluid (P=0.009) and EFW intake (P=0.001) were lower in the days preceding hyponatremia. Conclusions: Fluid and sodium balance, magnitude of natriuresis and EFW intake alone did not explain occurrence of hyponatremia in critically ill children; contribution of other mechanisms needs to be studied.

Serum urea, creatinine and electrolyte status in patients presenting with acute gastroenteritis.

The present study was undertaken to estimate the serum urea, creatinine and electrolyte status of patients presenting with acute gastroenteritis. Sixty patients who presented to Kathmandu Medical College and Teaching hospital from 15 June to 15 July 2005 with acute diarrhea with or without associated vomiting, causing dehydration severe enough to require hospital admission were investigated for serum urea, creatinine and electrolyte level. Out of 60 patients investigated, serum sodium and potassium level were available for 34 patients. Only one (2.9%) patients had sodium level below 135mEq/l, thirty two (94.11%) had sodium level between 135-146 mEq/l and one (2.9%) had sodium level above 146mEq/l. Similarly 9 (26.47%) patients had potassium level below 3.5mEq/l, 22 (64.70%) patients had potassium level between 3.5-5 mEq/l and 3 (8.82%) patients had level above 5 mEq/l. Serum urea and creatinine level were available for 47 patients. 36 (76.59%) patients had serum urea level between 15-45mg/dl and 11 (23.40%) patients had urea level above 45 mg/dl. 35 (74.46%) patients had serum creatinine level between 0.5-1.4 mg/dl and 12 (25.53%) had serum creatinine level above 1.4 mg/dl. In this study hypokalaemia was noticed more than hyponatremia and significant number of patients also showed increased level of serum urea and creatinine. Therefore, serum urea, creatinine and electrolytes should be closely monitored in patients with acute gastroenteritis.

Frequency and etiology of hyponatremia in adult hospitalized patients in medical wards of a general hospital in Kuwait

To determine the incidence and etiology of hyponatremia in adult hospitalized patients in medical wards of a general hospital. The four medical wards comprising a total of 140 beds in a 500 bedded general hospital in Kuwait. Retrospective study of hyponatremia analyzed and reported by the biochemistry laboratory from June to December 2004. All adult patients admitted to medical wards during the six month period from June to December 2004 having serum sodium < 130 mmol/lOut of a total of 1825 patients analyzed over a six months period [from June - December 2004], 66 patients [3.6%] had hyponatremia. Of these 37 [56%] were male and 29 [44%] female. Their mean age was 57.05 years. The commonest age group was 45 - 64 years and the least affected group was 12-25 years. Their mean serum sodium level was 122 mmol/l. Among the major causes of hyponatremia was the Syndrome of inappropriate secretion of antidiuretic hormone [SIADH] with pneumonia. Next to SIADH, renal failure and cardiac failure were the two common causes. Overall incidence of hyponatremia was 3.6% in all medical patients reviewed. The commonest cause of hyponatremia was found to be SIADH due to pneumonia. Renal failure and cardiac failure were the other two common causes. Identification of the cause of hyponatremia is important in order to impart specific treatment. Correction of hyponatremia improves prognosis of the underlying disease and prevents further complications due to hyponatremia itself. It is important to be cautious not to correct hyponatremia too rapidly and also not to exceed a level of 120 to 125 mmol/l [acutely], in order to p revent the complication of osmotic demyelinating syndrome

Demographic pattern and clinical characteristics of patients with smear positive pulmonary tuberculosis in Kuwait

The aim of this study was to document various clinical factors that are likely to be of help in the control of tuberculosis in Kuwait. Details of patients with sputum positive for acid-fast bacilli in the period from January 1998 to December 2000 were collected retrospectively from the case records and population statistics from government sources. The data were then tabulated and analyzed. Of the 526 cases, 83.5% were expatriates and 16.5% Kuwaiti; 373 [70.9%] were male. Of the expatriates, 66.7% were from Asia and the Far East, 5.7% were >/= 60 years. The annual incidence was 8.34 per 100,000 population. The lowest incidence was observed in the Jahrah governorate with an overall incidence of 5 [2.0 among Kuwaitis and 6.4 among expatriates] per 100,000 population. The highest incidence overall [10.2] and among Kuwaitis [4.1] was observed in the Farwaniya governorate, while the highest incidence among expatriates was seen in the Capital governorate [13.4]. Radiologically, 94 [19.5%] had minimal, 246 [51.5%] had moderately advanced and 141 [29.3%] far-advanced disease. The majority of the patients [72%] had only + status for AFB in the smear. Hypercalcemia [25.7%], hyponatremia [22.15%] and hyperglycemia [29.9%] were common in the patients. Mean serum albumin was low [28.7 +/- 5.5 g/l]. Two hundred and forty-seven [47.2%] were declared cured while 116 [22.2%] completed treatment. Comparison between nationals and expatriates showed a significant difference only for age, smoking status, defaulter rate and place of residence. The lowest regional incidence was found in the Jahrah governorate. Both biochemical abnormalities and radiologically advanced presentations were common. Disease pattern and response to treatment was purely individual and did not differ with respect to nationality or race

Seasonal variation in the incidence of hyponatremia.

AIM: To study the seasonal variation in the incidence of hyponatremia and to correlate it with the rainfall pattern. METHOD: Retrospective analysis of patients having serum sodium of less than 120 meq/L was done during the 24 months from March, 1995. Patients with fever, renal failure, cardiac failure, cirrhosis, hyperlipidemia, hyperproteinemia, patients taking diuretics and postoperative patients were also excluded. Average inpatient number and rainfall for each month was noted. Daily incidence of hyponatremia was expressed as percentage of total inpatients for each day and was compared with the rainfall. RESULTS: A total of 353 patients had hyponatremia during the two years from March, 1995; 174 cases during the first year and 179 during the second year. Average inpatient strength was 302.17 +/- 21.41 during the first year and 313.67 +/- 12.94 during the next year. The incidence of hyponatremia was 0.24 +/- 0.096% between June and August and 0.1 +/- 0.04% between December and February (95% confidence interval 0.045-0.235, p < 0.01). Statistically significant correlation was observed between rainfall pattern and hyponatremia, r = 0.711, 95% confidence interval 0.478-0.913, p = 0.01 during 95-96 and r = 0.825, 95% confidence interval 0.478-0.949, p < 0.001, during 96-97. CONCLUSION: Incidence of hyponatremia is higher during the peak southwest monsoon season with similar pattern for the study period of two years. Humidity and temperature may have important role in the manifestation of hyponatremia.

Hiponatremia: patogenia, diagnóstico y tratamiento

La hiponatremia es quizás el trastorno electrolítico más frecuente, habitualmente es asitomática y tiene una evolución autolimitada. La honatremia es una condición comunmente observada en las unidades de cuidados intensivos. Esta ocurre cuando la concentración plasmática de sodio, es menor de 135 mEq/1. El manejo adecuado depende de la causa subyacente, de manera que un conocimiento completo de la patogenia es necesario para el diagnóstico y tratamiento correcto. Este artículo hace una revisión fisiopatológica en profundidad, analizando las diferentes causas de hiponatremia con énfasis en la secreción inadecuada de hormona antidiurética (SIHAD) y la complicación de us manejo la mielinolisis póntica central (MPC)...

Alteraçöes hidroeletrolíticas, ácido-básicas e da funçäo renal em pacientes portadores da síndrome da imunodeficência adquirida / Hydroelectrolyte changes, acid-base and renal function in patients carrier acquired immunodeficiency syndrome

OBJETIVO. Avaliar a influência no curso clínico e a prevalência de distúrbios hidroeletrolíticos, ácido-básicos e da funçäo renal em pacientes portadores da síndrome da imunodeficiência adquirida (SIDA). Casuística e Métodos. A partir de um protocolo preestabelecido, revisaram-se os prontuários da primeira internaçäo de todos os pacientes admitidos durante o primeiro semestre de 1989. RESULTADOS. Noventa e nove pacientes foram estudados. A prevalência de hiponatremia, no momento da baixa, foi de 45% e durante a internaçäo, de 80,7% dos pacientes avaliados. Hipopotassemia esteve presente em 23,1% dos pacientes e acidose metabólica e insuficiência renal em 20,1 e 28,4%, respectivamente. O risco relativo para mortalidade em pacientes com hipopotassemia foi 4,4. Acidose metabólica e insuficiência renal aguda apresentaram riscos relativos de 12,9 e 21,4. Estes fatores, hipopotassemia (p < 0,01), acidose metabólica (p < 0,001) e insuficiência renal aguda (p < 0,001), estiveram significativamente associados à mortalidade. DISCUSSÄO E CONCLUSOES. Conclui-se que existe uma elevada prevalência das alteraçöes avaliadas nos pacientes com SIDA e que o desenvolvimento de hipopotassemia, acidose metabólica e insuficiência renal aguda está significativamente associado à mortalidade nestes pacientes

Epidemiología de la hiponatremia en el Centro Médico Boliviano Belga / Epidemiology of the hyponatremia in the Medical Center Bolivian Belgian

Se revisan las historias clínicas de 139 pacientes con hiponatremia a fin de conocer la incidencia en pacientes ambulatorios y hospitalarios, tanto médicos como quirúrgicos y críticos, las circunstancias en que se presenta y sus mecanismos responsables, evaluar la morbimortalidad asociada y el impacto de su corrección en el pronóstico de los pacientes. Se concluye en que es frecuente en hospitalizados de ambos sexos y mayores, con las más variadas patologías, por lo general leve o moderada pero asociada cuando no se la corrige a una mortalidad elevada dependiente de la enfermedad primaria

Hiponatremia: estudo de sua epidemiologia e mortalidade / Hyponatremia: study of its epidemiology and mortality

Neste trabalho, 49 episódios de hiponatremia (0,78% dos casos internados no Hospital das Clínicas durante 90 dias) foram estudados. Mais de 90% dos casos foram intra-hospitalares e do tipo dilucional, sendo 34% classificados como hiponatremias graves (Na < 118 meq/1). Diuréticos, restriçäo de sal sem restriçäo de água foram os principais fatores desencadeantes. Sintomas neurológicos que poderiam ser explicados pela hiponatremia ocorreram em 10,8% dos casos, persistindo 4,3% com sintomas após o tratamento, sendo este feito com uma baixa velocidade de correçäo (0,16 ñ 0,004 meq/1 hora). Dez pacientes morreram, porém em apenas um caso o óbito poderia ter sido causado pelo distúrbio. Estes resusltados mostraram que a morbidade e a mortalidade da hiponatremia per si é baixa em nosso meio, que poucos pacientes tinham alteraçöes neurológicas e que a maioria se recuperou com o tratamento lento