ABSTRACT
BACKGROUND: Hyponatremia is one of the commonest electrolyte disturbances encountered in medical wards and contributes to substantial morbidity and mortality. However, early recognition and management drastically alters prognosis. Therefore, this observational study was taken up to explore the clinical profile of hyponatremia. AIM: To assess the incidence and clinical profile of hyponatremia in medically ill patients. MATERIALS AND METHODS: This observational study was conducted in the medical ward of a tertiary care hospital from March 2010 to April 2011. All patients underwent routine hemogram, blood biochemistry, serum electrolytes, thyroid function tests, and morning serum cortisol estimation. This was followed by a plasma and urinary osmolality determination (osmometer 800 CL) as well as urinary sodium estimation. Patients were diagnosed to have syndrome of inappropriate antidiuretic hormone secretion (SIADH) if they satisfied the Bartter and Schwartz criteria. RESULTS: 201 patients (16.4%) had a serum Na < 135 meq/l. There were 126 (62.69%) male patients and 75 (37.31%) female patients. Severe hyponatremia (Na < 120 meq/l) was detected in 30 patients (2.4%). The largest group of hyponatremic patients were euvolemic [102 (50.74%)], followed by hypervolemic [54 (26.86%)] and hypovolemic [45 (22.4%)]. Sixty-six patients fulfilled the criteria for SIADH. The most common underlying predisposing factor for hyponatremia in our case series was fluid loss by vomiting/diarrhea. During the hospital stay, 13.5% (15/201) hyponatremic patients died, while the corresponding figure in normonatremic patients was 8.5% (87/1020). CONCLUSION: The incidence of hyponatremia in our series was higher than values mostly reported in western literature. Euvolemic hyponatremia was the most common type, a significant fraction of which is SIADH.
ABSTRACT
BACKGROUND AND OBJECTIVE: The incidence of coronary artery disease (CAD) is increasing in India. Recent data suggesting insulin resistance can predict cardiovascular disease independently of the other risk factors, such as hypertension, visceral obesity, or dyslipidemia, so a focus on the relation between acute coronary syndrome (ACS) and insulin resistance is relevant. Several studies addressing serum lipoprotein ratios as surrogates for insulin resistance have found promising results. We analyzed the association of lipoprotein ratios with the homeostatic model assessment of insulin resistance (HOMA-IR). METHODS: One hundred non-diabetic patients with impaired fasting glucose admitted with a diagnosis of ACS were included in the study. Admission fasting glucose and insulin concentrations were measured. The HOMA-IR was used to calculate insulin resistance. The fasting serum total cholesterol (TC), triglycerides (TG), and high-density lipoprotein (HDL-C) levels are used to calculate following lipid ratios: TC/HDL-C and TG/HDL-C. The areas under the curves (AUC) of the receiver operating characteristic curves (ROC) were used to compare the power of these serum lipoprotein ratio markers. RESULTS: Lipoprotein ratios were significantly higher in patients with HOMA Index >2 as compared to patients with Index <2. TG/HDL-C ratio and TC/HDL-C ratio were significantly correlated with HOMA-IR (P < 0.05) as obtained by Pearson's correlation analysis (r = 0.4459, P = 0.0012; r = 0.4815, P = 0.0004; r = 0.3993; P = 0.0041, respectively). The area under the ROC curve of the TG/HDL-C and TC/HDL-C ratios for predicting insulin resistance was 0.80 (95% CI, 0.67-0.93), 0.78 (95% CI, 0.65-0.91), respectively. CONCLUSION: A plasma TG/HDL-C ratio and TC/HDL-C ratio provide a simple means of identifying insulin resistant and can be used as the markers of insulin resistance and cardiovascular diseases risk in adult non-diabetic patients.
ABSTRACT
To document clinical, serum and urinary parameters in patients with features of diabetic nephropathy in type 2 diabetes mellitus and to correlate light microscopical findings of the renal biopsy specimen with the clinical, serum and urinary parameters, a study was conducted among 30 patients of type 2 diabetes mellitus with features of nephropathy attended Medical College, Kolkata with special emphasis given on neurological and fundoscopic examination. The patients were investigated with fasting and postprandial venous plasma glucose, glycosylated haemoglobin (HbA1c), serum urea, creatinine, sodium, potassium, 24-hour urinary protein/micro-albumin and lipid profile. Percutaneous renal biopsy was performed after taking informed consent from the patients and sent for histopathological examination. Obtained data were tabulated and analysed. Among 30 patients (male-16; female-14; proteinuric-23, micro-albuminuric-6) diabetic nephropathy was detected in 28 patients (diffuse-15, nodular-9, 4 had focal segmental glomerulosclerosis) and 2 had normal renal biopsy. Retinopathy was detected in 16 patients; 12 had autonomic neuropathy and 3 had peripheral neuropathy.
