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1.
Rev. cuba. med ; 60(2): e1609, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1280347

ABSTRACT

Introducción: La hiponatremia es la alteración electrolítica más frecuente en el paciente geriátrico. Existen evidencias que la asocian a un peor pronóstico en pacientes con insuficiencia cardiaca. Objetivo: Caracterizar los pacientes geriátricos ingresados con hiponatremia al ingreso e insuficiencia cardíaca. Método: Se realizó un estudio descriptivo, longitudinal y prospectivo durante el año 2018 en el Hospital Universitario Clínico Quirúrgico Calixto García que incluyó 260 pacientes con insuficiencia cardíaca e hiponatremia al ingreso. Para el análisis estadístico de los datos reutilizaron la prueba de chi cuadrada y el análisis multivariado de ANOVA para la asociación entre variables. Resultados: La edad media fue 72,6 ± 8,2, predominaron las mujeres (55,0 por ciento). Prevaleció la puntuación de Charlson 3-4 (33,8 por ciento), la fracción de eyección conservada, 70,8 por ciento; clase funcional III, 33,8 por ciento; estadía menor a 6 días, 43,1 por ciento y fallecieron 51,9 por ciento de la muestra estudiada. Se asociaron significativamente con la mortalidad al egreso, el índice de comorbilidad y la clase funcional III-IV, p< 0,05. Conclusiones: Existe una elevada mortalidad en pacientes geriátricos hospitalizados por insuficiencia cardiaca e hiponatremia al ingreso asociada a la presencia de comorbilidad y a la clasificación de la insuficiencia cardiaca(AU)


Introduction: Hyponatremia is the most frequent electrolyte alteration in geriatric patients. There is evidence that associates it with a worse prognosis in patients with heart failure. Objective: To describe geriatric patients admitted with hyponatremia on admission and heart failure. Method: A descriptive, longitudinal and prospective study was carried out in 2018 at Calixto García Surgical Clinical University Hospital, including 260 patients with heart failure and hyponatremia on admission. For the statistical analysis of the data, they reused the chi-square test and the multivariate analysis of ANOVA for the association between variables. Results: The mean age was 72.6 ± 8.2, women predominated (55.0 percent). Prevalence was observed in the Charlson score 3-4 (33.8 percent), the ejection fraction preserved (70.8 percent); functional class III was 33.8 percent; 43.1 percent stayed less than 6 days and 51.9 percent of the sample studied died. They were significantly associated with mortality at discharge, the comorbidity index and functional class III-IV, p <0.05. Conclusions: There is a high mortality in geriatric patients hospitalized for heart failure and hyponatremia on admission associated with the presence of comorbidity and the classification of heart failure(AU)


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Aged , Health Services for the Aged , Heart Failure/etiology , Hyponatremia/diagnosis , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studies
2.
Med. infant ; 28(1): 16-22, Marzo 2021. ilus, Tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1282313

ABSTRACT

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)


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Osmolar Concentration , Water-Electrolyte Balance , Child, Hospitalized , Fluid Therapy , Hospitals, Pediatric/statistics & numerical data , Hyponatremia/therapy , Hyponatremia/epidemiology , Prospective Studies , Cohort Studies
3.
In. Manzanares Castro, William; Aramendi Epstein, Ignacio; Pico, José Luis do. Disionías en el paciente grave: historias clínicas comentadas. Montevideo, Cuadrado, 2021. p.51-68, tab.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1344692
4.
In. Manzanares Castro, William; Aramendi Epstein, Ignacio; Pico, José Luis do. Disionías en el paciente grave: historias clínicas comentadas. Montevideo, Cuadrado, 2021. p.69-87, tab.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1344693
5.
In. Manzanares Castro, William; Aramendi Epstein, Ignacio; Pico, José Luis do. Disionías en el paciente grave: historias clínicas comentadas. Montevideo, Cuadrado, 2021. p.89-102.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1344694
6.
In. Manzanares Castro, William; Aramendi Epstein, Ignacio; Pico, José Luis do. Disionías en el paciente grave: historias clínicas comentadas. Montevideo, Cuadrado, 2021. p.393-406.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1344748
7.
In. Manzanares Castro, William; Aramendi Epstein, Ignacio; Pico, José Luis do. Disionías en el paciente grave: historias clínicas comentadas. Montevideo, Cuadrado, 2021. p.407-433, tab.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1344749
8.
Rev. pediatr. electrón ; 17(1): 1-12, abr 2020. tab
Article in Spanish | LILACS | ID: biblio-1099832

ABSTRACT

Los cuadros de deshidratación son frecuentes en pediatría, muchos de ellos acompañados de alteraciones electrolíticas. La deshidratación asociada a trastornos del sodio puede implicar riesgos para la salud de los pacientes pediátricos tanto en el desarrollo del cuadro como en su tratamiento. Objetivo: crear un algoritmo de manejo de los cuadros de deshidratación asociados a lateraciones del sodio para manejo de pacientes pediátricos. Métodos: se realizó revisión de la literatura disponible sobre deshidratación con hiper e hiponatremia, en inglés y español, incluyendo libros y artículos de revistas. Se presenta en el actual documento los aspectos básicos sobre la fisiopatología de la deshidratación asociada a trastornos del sodio, su clínica, diagnóstico y manejo detallado, para el uso en la práctica clínica diaria.


Dehydration is common in pediatric patients, frequently accompanied with electrolite disturbances. Dehydration associated with sodium disturbances can involve risk for pediatric patient health during the development of the disease and during its treatment. Objective: to create an algorithm of management of dehydration with sodium disturbances in pediatric patients. Methods: review of literature about dehydration with hypernatremia and hyponatremia, in english and spanish, including books and published articles. We present in this document the basic aspects of physiopathology of dehydration with sodium disturbances, clinical presentation, diagnosis and detailed management, so it can be consulted for clinical practice.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Dehydration/diagnosis , Dehydration/etiology , Dehydration/therapy , Hyponatremia/physiopathology , Diarrhea , Hypernatremia/diagnosis , Hypernatremia/prevention & control , Hyponatremia/diagnosis , Hyponatremia/prevention & control
9.
Gac. méd. Méx ; 156(1): 78-81, ene.-feb. 2020. tab
Article in Spanish | LILACS | ID: biblio-1249873

ABSTRACT

Resumen Introducción: La introducción de tolvaptan ha supuesto la principal novedad en el tratamiento de la hiponatremia en los últimos años. Objetivo: Describir la experiencia con tolvaptan en el Complejo Asistencial Universitario de León, España. Método: Estudio observacional retrospectivo de utilización ambulatoria de tolvaptan en un hospital de tercer nivel, de marzo de 2014 a agosto de 2017. Resultados: Fueron tratados con tolvaptan de forma ambulatoria nueve pacientes, 23.1 % alcanzó eunatremia en 24 horas. Posterior a la administración de tolvaptan se registró reducción en días de hospitalización (361 versus 70, p = 0.007), especialmente por hiponatremia (306 versus 49, p = 0.009). Conclusiones: El uso a largo plazo de tolvaptan parece ser seguro y se relaciona con descenso en los días de hospitalización.


Abstract Introduction: Tolvaptan introduction has constituted the main therapeutic novelty in the management of hyponatremia in recent years. Objective: To describe the experience with this drug at Complejo Asistencial Universitario de León, Spain. Method: Retrospective, observational study of tolvaptan outpatient use in a tertiary care hospital from March 2014 to August 2017. Results: A total of 9 patients were treated with tolvaptan in the outpatient setting. Eunatremia was reached in 24 h by 23.1%. After tolvaptan administration, a reduction in days of hospitalization was recorded (361 vs. 70; p = 0.007), especially in those days of hospitalization that were attributable to hyponatremia (306 vs. 49; p = 0.009). Conclusions: Long-term use of tolvaptan appears to be safe and is associated with a decrease in days of hospitalization.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Ambulatory Care , Antidiuretic Hormone Receptor Antagonists/therapeutic use , Tolvaptan/therapeutic use , Hyponatremia/drug therapy , Spain , Retrospective Studies , Antidiuretic Hormone Receptor Antagonists/economics , Tolvaptan/economics , Length of Stay/statistics & numerical data
10.
In. Verga, Federico; Burghi, Gastón. Encares de paciente crítico. Montevideo, Oficina del Libro FEFMUR, 2020. p.473-487.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1342678
11.
Braz. J. Vet. Res. Anim. Sci. (Online) ; 57(1): e159837, 2020. ilus, tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-1122150

ABSTRACT

The objectives of this retrospective study were to determine the main acid-base and electrolytes disorders in hospitalized cattle, using both Henderson-Hasselbalch and the physicochemical approach and to compare their diagnostic and therapeutic utility. A total of 31 medical records were reviewed of bovines admitted to the Large Animal Hospital at Universidad Nacional de Colombia, that met the inclusion criteria of the measurement of blood gases, blood electrolytes and plasma protein on admission before providing any treatment. Using the Henderson-Hasselbalch approach, acid base abnormalities were found in 83.3% of the patients, compared to 93.5% using the physicochemical approach. The principal acid-base disorders found were strong ion acidosis (61.29%) and weak acid acidosis (38.7%); strong ion gap (SIG) acidosis was found in 73.68% of cases showing strong ion acidosis. These results highlight the importance of the diagnosis of acid-base disorders in sick cattle for proper recognition of pathophysiological phenomena and its understanding to guide treatment decisions.(AU)


Os objetivos deste estudo retrospectivo foram determinar os principais distúrbios ácido-base e eletrolíticos em bovinos internados, utilizando a abordagem Henderson-Hasselbalch e a abordagem físico-química comparando a utilidade diagnóstica e terapêutica de tais procedimentos. Foram revisados 31 prontuários de bovinos admitidos no Hospital de Animais de Grande Porte da Universidad Nacional de Colombia, que preencheram os critérios de inclusão da medição de gases sanguíneos, eletrólitos sanguíneos e proteínas plasmáticas na admissão antes de fornecer qualquer tratamento. Com o emprego da abordagem de Henderson-Hasselbalch, as anormalidades da base ácida foram encontradas em 83,3% dos pacientes, enquanto com a abordagem físico-química o valor obtido foi de 93,5%. Os principais distúrbios ácido-base encontrados foram forte acidose iônica (61,29%) e acidose ácida fraca (38,7%). A acidose com Ion Gap Forte (SIG) foi encontrada em 73,68% dos casos com forte acidose iônica. Estes resultados destacam a importância do diagnóstico de distúrbios ácido-base em bovinos doentes para o reconhecimento adequado dos fenômenos fisiopatológicos e sua compreensão para orientar as decisões de tratamento.(AU)


Subject(s)
Animals , Cattle , Acidosis/veterinary , Electrolytes/analysis , Chemical Phenomena , Hyponatremia/veterinary , Retrospective Studies , Hospitals, Animal
12.
J. bras. nefrol ; 41(4): 501-508, Out.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1056603

ABSTRACT

Abstract Objective: To evaluate the association between dysnatremias or dyschloremias and mortality during hospitalization in patients with acute kidney injury (AKI) or chronic kidney disease (CKD) undergoing acute hemodialysis. Methods: We carried out a retrospective cohort study on adult patients undergoing acute hemodialysis with AKI or CKD diagnosis at a public hospital in Lima, Peru. Dysnatremias were categorized as hyponatremia (Na < 135mmol/L) or hypernatremia (Na > 145mmol/L), and dyschloremias were defined as hypochloremia (Cl < 98 mmol/L) or hyperchloremia (Cl > 109mmol/L). The outcome of interest was mortality during hospitalization. We performed generalized lineal Poisson family models with bias-corrected and accelerated non-parametric bootstrap to estimate the risk ratios at crude (RR) and adjusted analysis (aRR) by gender, age, HCO3 (for all patients) and Liaño score (only for AKI) with CI95%. Results: We included 263 patients (mean age: 54.3 years, females: 43%): 191 with CKD and 72 with AKI. Mortality was higher in patients with AKI (59.7%) than in patients with CKD (14.1%). In overall, patients with hypernatremia had a higher mortality during hospitalization compared to those who had normal sodium values (aRR: 1.82, 95% CI: 1.17-2.83); patients with hyponatremia did not have different mortality (aRR: 0.19, 95% CI: 0.69-2.04). We also found that hyperchloremia (aRR: 1.35, 95% CI: 0.83-2.18) or hypochloremia (aRR: 0.66, 95% CI: 0.30-14.78) did not increase mortality in comparison to normal chloride values. No association between dysnatremias or dyschloremias and mortality during hospitalization was found in CKD and AKI subgroups. Conclusions: In our exploratory analysis, only hypernatremia was associated with mortality during hospitalization among patients with AKI or CKD undergoing acute hemodialysis.


Resumo Objetivo: Avaliar a associação entre distúrbios do sódio ou do cloro e mortalidade hospitalar de pacientes com insuficiência renal aguda (IRA) ou doença renal crônica (DRC) submetidos a hemodiálise aguda. Métodos: O presente estudo de coorte retrospectiva incluiu pacientes adultos submetidos a hemodiálise aguda com diagnóstico de IRA ou DRC em um hospital público de Lima, Peru. Os distúrbios do sódio foram classificados como hiponatremia (Na < 135mmol/L) ou hipernatremia (Na > 145mmol/L), enquanto os distúrbios do cloro foram classificados como hipocloremia (Cl < 98 mmol/L) ou hipercloremia (Cl > 109mmol/L). O desfecho de interesse foi mortalidade hospitalar. Utilizamos modelos de Poisson da família de modelos lineares generalizados com bootstrap não-paramétrico e correção de viés acelerado para estimar os riscos relativos na análise bruta (RR) e ajustada (RRa) para sexo, idade, HCO3 (para todos os pacientes) e escore de Liaño (apenas para IRA) com IC 95%. Resultados: Foram incluídos 263 pacientes (idade média 54,3 anos; 43% do sexo feminino), 191 com DRC e 72 com IRA. A mortalidade foi mais elevada nos pacientes com IRA (59,7%) do que nos indivíduos com DRC (14,1%). No geral, os pacientes com hipernatremia tiveram mortalidade hospitalar mais elevada do que os indivíduos com valores normais de sódio (RRa: 1,82; IC 95%: 1,17-2,83). Os pacientes com hiponatremia não apresentaram mortalidade diferente (RRa: 0,19; IC 95%: 0,69-2,04). Também identificamos que hipercloremia (RRa: 1,35; IC 95%: 0,83-2,18) e hipocloremia (RRa: 0,66; IC 95%: 0,30-14,78) não elevaram a mortalidade em comparação a indivíduos com níveis normais de cloro. Não foi encontrada associação entre distúrbios do sódio ou do cloro e mortalidade hospitalar nos subgrupos com DRC e IRA. Conclusões: Em nossa análise exploratória, apenas hipernatremia apresentou associação com mortalidade hospitalar em pacientes com IRA ou DRC submetidos a hemodiálise aguda.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Sodium/blood , Chlorides/blood , Renal Dialysis/adverse effects , Renal Insufficiency, Chronic/mortality , Acute Kidney Injury/mortality , Peru/epidemiology , Bicarbonates/blood , Renal Insufficiency, Chronic/blood , Acute Kidney Injury/diagnosis , Acute Kidney Injury/blood , Acute Kidney Injury/therapy , Hospitalization/statistics & numerical data , Hypernatremia/complications , Hypernatremia/mortality , Hyponatremia/complications , Hyponatremia/mortality
13.
J. bras. nefrol ; 41(4): 518-525, Out.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1056611

ABSTRACT

ABSTRACT Introduction: Proximal femur fractures affect the mortality and morbidity of elderly individuals. Recent studies have shown an association between fragility fractures and hyponatremia, a common fluid and electrolyte balance disorder. Objectives: This study aimed to investigate the occurrence of hyponatremia in patients with fragility fractures of the proximal femur. Methods: The authors looked into the data from the medical records of patients admitted to the emergency unit of the Real Hospital Português for fragility fractures of the proximal femur from 2014 to 2017. The study included patients with serum sodium levels recorded in their charts. Results: Fourteen of 69 (20.3%) patients with proximal femur fractures had hyponatremia. The main factors linked to hyponatremia were lung disease, and prescription of amiodarone and/or antidepressants. Conclusion: In elderly individuals, fragility fractures of the proximal femur may correlate with hyponatremia, particularly among patients on amiodarone or antidepressants.


RESUMO Introdução: Fratura de fêmur proximal tem impacto na mortalidade e morbidade de idosos. Estudos recentes vêm demonstrando associação entre fratura por fragilidade e hiponatremia, um distúrbio hidroeletrolítico comum na prática médica. Objetivos: Investigar a ocorrência de hiponatremia em pacientes com fratura proximal de fêmur por fragilidade. Metodologia: Foram coletados dados a partir de prontuários de pacientes admitidos na emergência do Real Hospital Português devido à fratura proximal de fêmur por fragilidade, entre 2014 e 2017, e aqueles com natremia disponível no prontuário eletrônico foram incluídos no estudo. Resultado: Dentre os 69 pacientes com fratura de fêmur proximal, houve uma ocorrência de 14 pacientes com hiponatremia, o que corresponde a 20,3%. Os principais fatores associados à hiponatremia no estudo foram doença pulmonar, uso de amiodarona e antidepressivos. Conclusão: Em idosos, a fratura de fêmur proximal por fragilidade pode estar correlacionada com hiponatremia, principalmente quando estão sob uso de amiodarona ou antidepressivos.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Fractures, Bone/blood , Femoral Fractures/blood , Hyponatremia/complications , Water-Electrolyte Balance/physiology , Brazil/epidemiology , Comorbidity , Cross-Sectional Studies , Fractures, Bone/epidemiology , Femoral Fractures/epidemiology , Amiodarone/adverse effects , Hyponatremia/diagnosis , Hyponatremia/etiology , Lung Diseases/complications , Anti-Arrhythmia Agents/adverse effects , Antidepressive Agents/adverse effects
14.
Rev. méd. Chile ; 147(7): 935-939, jul. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058625

ABSTRACT

Phyllomedusa bicolor or Kambo is a frog that lives in the Amazon rainforest. It can release through its skin a substance used in healing rituals that are common among South-American tribes, as well as in urban people of America and Europe. We report a 41-year-old female patient who, during a healing ritual consumed ayahuasca (a drink obtained from the mixture of Banisteriopsis caapi, Psychotria viridis and Mimosa hostilis) and 12 hours later received the poison of Kambo Frog (Phyllomedusa bicolor) on superficial right shoulder skin burns. The ritual included a minimum of six-liter water intake over a few hours period. She evolved with clouding of sensorium, motor agitation, frequent vomiting, and generalized tonic-clonic seizures. She presented lethargic to the emergency room, with a weak pupillary light reflex, generalized stiffness, moving all four limbs. Laboratory showed severe hyponatremia (120 mEq/L) and a creatine kinase level of 8,479 UI/L, that increased 107,216 IU/L within few days. An admission CT Brain scan was normal. The toxicological screening did not identify the presence of other substances. During hospitalization the patient developed severe psychomotor agitation controlled by a dexmedetomidine infusion, hyponatremia, low plasma osmolality (248 mOsm/kg), and disproportionately high urinary osmolality (448 mOsm/kg), suggestive of inappropriate antidiuretic hormone secretion syndrome (SIADH). With correction of hyponatremia, the patient gradually recovered consciousness. Rhabdomyolysis was assumed to be secondary to seizure and managed by volume and bicarbonate infusions with a positive response.


Subject(s)
Humans , Animals , Female , Adult , Anura , Venoms/toxicity , Hyponatremia/chemically induced , Severity of Illness Index , Ceremonial Behavior
15.
Article in English | AIM, AIM | ID: biblio-1272775

ABSTRACT

Background: Traumatic brain injury (TBI) is a one of the commonest injuries treated at the Neurosurgery Department. The incidence rate is approximately 3% in the general population and the mortality rate is about 30% of all injury deaths. Hyponatremia leads to high morbidity and/or mortality in TBI patients. Our study discusses the epidemiology of TBI associated with hyponatremia. Methods: Retrospective analysis of 80 patients with TBI between February 2017 and November 2018 was performed. The relationship between the incidence of hyponatremia in TBI patients and age, sex, GCS, type, severity of injury and whether the patient was submitted to surgery or not. Results: Out of 80 TBI patients recruited for the study, 25 of them suffered from hyponatremia. Hyponatremia following TBI wasn't related to age, sex but it was related to the type of injury, the Glasgow Coma Scale (GCS) score ≤ 8, surgical history. TBI with hyponatremia usually had longer stay in the hospital and bad outcome. Conclusions: Sever TBI patients (GCS score ≤ 8), intracranial hemorrhage and/or skull base fracture are susceptible to developing hyponatremia and require additional treatment aiming to normalization of serum sodium levels to prevent deterioration of their condition. Abbreviations: ANP, Atrial natriuretic peptide; CSWS, Cerebral salt wasting syndrome; SIADH, Syndrome of inappropriate secretion of antidiuretic hormone; TBI, Traumatic brain injury


Subject(s)
Antidiuretic Hormone Receptor Antagonists , Brain Injuries, Traumatic , Hormones , Hyponatremia , Inappropriate ADH Syndrome , Wasting Syndrome
16.
MedUNAB ; 22(3): 294-303, 29-11-2019.
Article in Spanish | LILACS | ID: biblio-1026847

ABSTRACT

Introducción. La hiponatremia es la alteración electrolítica más frecuente en pacientes con falla cardíaca crónica, que afecta hasta el 28% de pacientes en el ingreso hospilatario. Se ha demostrado que es un predictor independiente de mortalidad, estancia prolongada y rehospitalización. El objetivo es describir la frecuencia de hiponatremia en pacientes con falla cardíaca descompensada y su relación con la estancia hospitalaria y mortalidad. Metodología. Cohorte prospectiva en pacientes hospitalizados por el servicio de Medicina Interna en un hospital de cuarto nivel de Bogotá, Colombia, con diagnóstico de falla cardíaca descompensada entre abril de 2011 y marzo de 2012. Se midió el sodio al ingreso, a las 72 horas y al día séptimo de hospitalización. Se evaluó la relación de la hiponatremia al ingreso con la estancia hospitalaria y la mortalidad intrahospitalaria a 30 días. Resultados. Se incluyeron 162 pacientes, con promedio de edad de 72 años, 52.5% hombres. Cuarenta y uno (25.3%) presentaron hiponatremia al ingreso. Entre los pacientes que presentaron sodio normal al ingreso, 6 presentaron hiponatremia a las 72 horas y 2 a los 7 días. La mortalidad intrahospitalaria en la población total fue 9.2%, en el grupo de hiponatremia 12.2%, y 8.2% en los que no la tuvieron (p= 0.45). El promedio de estancia hospitalaria fue superior en los pacientes con hiponatremia, 6.6 vs. 8.4 días (p= 0.12). Discusión. La incidencia de hiponatremia al ingreso en este grupo de pacientes fue semejante a la reportada en la literatura. Conclusiones. Existe una tendencia hacia una mayor mortalidad y estancia hospitalaria en pacientes con hiponatremia, aun cuando no fue estadísticamente significativa. Cómo citar. Diaztagle-Fernández JJ, Chaves-Saltiago WG, Sprockel-Díaz JJ, Acevedo-Velasco AD, Rodríguez-Benítez FH, Benavides-Solarte MF, et al. Asociación entre hiponatremia, mortalidad y estancia hospitalaria en pacientes con falla cardíaca descompensada. MedUNAB. 2019;22(3), 294-303. doi: 10.29375/01237047.3497


Introduction. Hyponatremia is the most common electrolyte disorder in patients with chronic heart failure affecting up to 28% of patients at admission. It has been shown to be an independent predictor of mortality, extended length of hospital stay and rehospitalization. The objective is to evaluate the presence of hyponatremia in patients with decompensated heart failure and describe its relationship with length of hospital stay and mortality. Methodology. A prospective cohort study in patients hospitalized at internal medicine service at a high level of complexity hospital in Bogotá, Colombia diagnosed with decompensated heart failure between April 2011 and March 2012. Sodium was measured on admission, 72 hours and at the seventh day of hospitalization. We evaluated the association between hyponatremia at hospital admission, mortality at 30 days and length of hospital stay. Results. 162 patients were included with an average age of 72 years, 52.5% male. Forty-one (25.3%) had hyponatremia at admission. Among the patients with normal sodium at admission, 6 had hyponatremia at 72 hours and 2 at the seventh day. Inhospital mortality in the total population was 9.2%, in the hyponatremia group 12.2%, and 8.2% in those who did not have it (p = 0.45). The average length of hospital stay was higher in patients with hyponatremia, 6.6 vs 8.4 days (p = 0.12). Discussion. The incidence of hyponatremia at admission in this group of patients was similar to that reported in the literature. Conclusions. The results showed a trend towards higher mortality and hospital stay in patients with hyponatremia, even though it was not statistically significant. Cómo citar. Diaztagle-Fernández JJ, Chaves-Saltiago WG, Sprockel-Díaz JJ, Acevedo-Velasco AD, Rodríguez-Benítez FH, Benavides-Solarte MF, et al. Asociación entre hiponatremia, mortalidad y estancia hospitalaria en pacientes con falla cardíaca descompensada. MedUNAB. 2019;22(3), 294-303. doi: 10.29375/01237047.3497


Introdução. A hiponatremia é o desequilíbrio hidroeletrolítico mais frequente em pacientes com insuficiência cardíaca crônica, que afeta até 28% dos pacientes internados. Demonstrou ser um preditor independente de mortalidade, permanencia prolongada e re-internação. O objetivo é descrever a frequência de hiponatremia em pacientes com insuficiência cardíaca descompensada e sua relação com internação hospitalar e mortalidade. Metodologia. Coorte prospectiva em pacientes internados pelo serviço de Medicina Interna em um hospital de quarto nível em Bogotá, Colômbia, com diagnóstico de insuficiência cardíaca descompensada, entre abril de 2011 e março de 2012. Foi medido o sódio na admissão, às 72 horas e no sétimo dia de internação. Foi avaliada a relação de hiponatremia na admissão com internação e a mortalidade hospitalar aos 30 dias. Resultados. Foram incluídos 162 pacientes, com idade média de 72 anos, 52,5% homens. Quarenta e um (25,3%) apresentaram hiponatremia na admissão. Entre os pacientes que apresentaram sódio normal na admissão, seis apresentaram hiponatremia às 72 horas, e dois aos sete dias. A mortalidade hospitalar na população total foi de 9,2%, no grupo de hiponatremia 12,2% e 8,2% naqueles que não apresentaram (p = 0,45). O tempo médio de internação foi maior nos pacientes com hiponatremia, 6,6 vs. 8,4 dias (p = 0,12). Discussão. A incidência de hiponatremia na admissão nesse grupo de pacientes foi semelhante à relatada na literatura. Conclusões. Existe uma tendência de maior mortalidade e permanência hospitalar em pacientes com hiponatremia, mesmo que não tenha sido estatisticamente significante. Cómo citar. Diaztagle-Fernández JJ, Chaves-Saltiago WG, Sprockel-Díaz JJ, Acevedo-Velasco AD, Rodríguez-Benítez FH, Benavides-Solarte MF, et al. Asociación entre hiponatremia, mortalidad y estancia hospitalaria en pacientes con falla cardíaca descompensada. MedUNAB. 2019;22(3), 294-303. doi: 10.29375/01237047.3497


Subject(s)
Heart Failure , Prognosis , Mortality , Hospitalization , Hyponatremia
17.
Article in Korean | WPRIM | ID: wpr-786517

ABSTRACT

Although foreign body ingestion is relatively common in children aged 6 months-3 years, small bowel obstruction rarely develops, and few cases require surgical interventions. We report a case of 12-month-old girl who presented to the emergency department with new-onset seizure after projectile bilious vomiting. The initial diagnosis was seizure caused by hyponatremia based on laboratory findings, plain abdominal radiograph, brain magnetic resonance imaging, and electroencephalography. Despite fluid resuscitation, clinical manifestations did not improve, and severe ileal obstruction was found on computed tomography. Emergency laparoscopy showed a foreign body (a water bead [superabsorbent polymer], 3 cm in diameter) that was subsequently removed by enterotomy. After the surgery, bilious vomiting continued, and gastrografin did not pass on fluoroscopy. The second laparoscopy showed a residual foreign body that was crushed and then removed by minimal enterotomy. She was discharged in good condition 5 days after the second surgery. This case suggests a particular danger of water beads as foreign bodies and the need for differential diagnosis of multiple foreign bodies in children with poor communication skills.


Subject(s)
Brain , Child , Diagnosis , Diagnosis, Differential , Diatrizoate Meglumine , Eating , Electroencephalography , Emergencies , Emergency Service, Hospital , Female , Fluoroscopy , Foreign Bodies , Humans , Hyponatremia , Infant , Intestinal Obstruction , Laparoscopy , Magnetic Resonance Imaging , Resuscitation , Seizures , Vomiting , Water
18.
Article in Chinese | WPRIM | ID: wpr-781660

ABSTRACT

To summarize and analyze the causes of hyponatremia in patients with brucellosis and explore the clinical manifestations of syndrome of inappropriate antidiuresis(SIAD)in patients with brucellosis. The clinical data of 111 patients with acute brucellosis who were treated in Peking Union Medical College Hospital from September 2011 to December 2017 were retrospectively reviewed.Hyponatremia was defined by serum sodium level lower than 135 mmol/L.Clinical characteristics including medical histories,vital signs,and laboratory test findings were collected and analyzed. Hyponatremia was found in 14(12.6%)of 111 patients with brucellosis,among whom 3 patients were confirmed to be with SIAD,10 were suspected as SIAD,and 1 was diagnosis as hypopituitarism.Hypoalbuminemia,elevation of erythrocyte sedimentation rate,and high sensitivity C reactive protein were found in brucellosis patients with SIAD,along with severe complications such as infective endocarditis,septic shock,and anemia. Hyponatremia is not a rare condition in brucellosis patients and may be caused by SIAD.


Subject(s)
Brucellosis , Humans , Hyponatremia , Inappropriate ADH Syndrome , Retrospective Studies
19.
Article in Korean | WPRIM | ID: wpr-766817

ABSTRACT

Extrapontine myelinolysis is a demyelinating disorder usually caused by rapid correction of chronic hyponatremia. We present an 82-year-old female patient with general weakness, and severe hyponatremia (103 mEq/L) which was corrected 14 mEq/L during 21 hours. She was stuporous and presented status epilepticus. Brain T2-weighted image showed high signal intensities of bilateral thalami and electroencephalogram monitoring indicated right hemisphere lateralized periodic discharges, maximal in the right frontal region. This case shows that status epilepticus can occur in a patient of extrapontine myelinolysis involved bilateral thalami without pontine lesions.


Subject(s)
Aged, 80 and over , Brain , Demyelinating Diseases , Electroencephalography , Female , Humans , Hyponatremia , Myelinolysis, Central Pontine , Status Epilepticus , Stupor
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