NaCl 3% Bolus Therapy as Emergency Treatment for Severe Hyponatremia: Comparison of 100 mL vs 250 mL.

CONTEXT: The aim of initial treatment of severe hyponatremia is to rapidly increase serum sodium to reduce the complications of cerebral edema. The optimal strategy to achieve this goal safely is still under debate. OBJECTIVE: To compare the efficacy and safety of 100 and 250 mL NaCl 3% rapid bolus therapy as initial treatment of severe hypotonic hyponatremia. METHODS: Retrospective analysis of patients admitted to a teaching hospital in The Netherlands between 2017 and 2019. The patients were 130 adults with severe hypotonic hyponatremia, defined as serum sodium ≤ 120 mmol/L. A bolus of either 100 mL (n = 63) or 250 mL (n = 67) NaCl 3% was the initial treatment. Successful treatment was defined as a rise in serum sodium ≥ 5 mmol/L within the first 4 hours after bolus therapy. Overcorrection of serum sodium was defined as an increase of more than 10 mmol/L in the first 24 hours. RESULTS: The percentage of patients with a rise in serum sodium ≥5 mmol/L within 4 hours was 32% and 52% after a bolus of 100 and 250 mL, respectively (P = .018). Overcorrection of serum sodium was observed after a median of 13 hours (range 9-17 hours) in 21% of patients in both treatment groups (P = .971). Osmotic demyelination syndrome did not occur. CONCLUSION: Initial treatment of severe hypotonic hyponatremia is more effective with a NaCl 3% bolus of 250 mL than of 100 mL and does not increase the risk of overcorrection.

[Various manifestations of calcium pyrophosphate-associated arthritis]. / De diverse uitingen van calciumpyrofosfaat-artritis.

In calcium pyrophosphate (CPP)-associated arthritis, deposits of calcium pyrophosphate lead to acute attacks of painful joint inflammation. The disease may present with signs of systemic inflammation such as fever, mimicking an infectious disease. Early recognition and treatment of this disease can prevent overdiagnosis and joint damage. In this article we describe three different patient cases of CPP-associated arthritis. The diversity of clinical presentation in CPP-associated arthritis can be of interest to different medical specialties who will occasionally encounter them in daily practice.

Abatacept and tocilizumab tapering in rheumatoid arthritis patients: results of SONATA-a retrospective, exploratory cohort study.

OBJECTIVES: As data on disease-activity-guided dose optimization of abatacept and tocilizumab are scarce, we explored the feasibility, effectiveness and safety of dose optimization of these biological DMARDs in RA patients in daily practice. METHODS: RA patients who had been treated with abatacept or tocilizumab for ≥6 months, with DAS28 <3.2, were included. Four groups were identified: abatacept dose reduction (DR) and usual care (UC), and tocilizumab DR and UC. Successful DR and discontinuation entailed being on a lower dose than at baseline or having discontinued abatacept or tocilizumab, while maintaining disease activity score with ESR using 28 joint count (DAS28) <3.2. Proportions of patients with successful DR or discontinuation at 12 months were described. Maintenance of DR was investigated using Kaplan-Meier curves. Between-group differences in mean DAS28 and Health assessment questionnaire disability index (HAQ-DI) change (Δ) over 6 and 12 months were estimated. RESULTS: One hundred and nineteen patients were included. DR was attempted in 13 of 28 (46%; 95% CI: 28, 66%) abatacept and 64 of 91 (70%; 95% CI: 60, 79%) tocilizumab patients. At 12 months, 3 of 11 (27%; 95% CI: 6, 61%) abatacept and 20 of 48 (42%; 95% CI: 28, 57%) tocilizumab patients were successfully tapered. One of 11 (9%; 95% CI: 0, 41%) abatacept and 5 of 48 (10%; 95% CI: 3, 23%) tocilizumab patients were successfully discontinued. Mean ΔDAS28 and ΔHAQ-DI at months 6 and 12 were not significantly different between DR and UC. For tocilizumab, DAS28 was significantly higher in the DR compared with the UC group at 6 months. Adverse events were comparable between groups. CONCLUSION: Abatacept and tocilizumab DR appears to be feasible and safe in clinical practice. No benefits in terms of fewer adverse events in the DR group were observed. Furthermore, DR was suboptimal, because all patients were eligible for DR, but in a substantial number of patients no DR was attempted.