Diagnostic Workup and Outcome in Patients with Profound Hyponatremia.

Hyponatremia is the most common electrolyte disorder. A proper diagnosis is important for its successful management, especially in profound hyponatremia. The European hyponatremia guidelines point at sodium and osmolality measurement in plasma and urine, and the clinical evaluation of volume status as the minimum diagnostic workup for the diagnosis of hyponatremia. We aimed to determine compliance with guidelines and to investigate possible associations with patient outcomes. In this retrospective study, we analysed the management of 263 patients hospitalised with profound hyponatremia at a Swiss teaching hospital between October 2019 and March 2021. We compared patients with a complete minimum diagnostic workup (D-Group) to patients without (N-Group). A minimum diagnostic workup was performed in 65.5% of patients and 13.7% did not receive any treatment for hyponatremia or an underlying cause. The twelve-month survival did not show statistically significant differences between the groups (HR 1.1, 95%-CI: 0.58-2.12, p-value 0.680). The chance of receiving treatment for hyponatremia was higher in the D-group vs. N-Group (91.9% vs. 75.8%, p-value < 0.001). A multivariate analysis showed significantly better survival for treated patients compared to not treated (HR 0.37, 95%-CI: 0.17-0.78, p-value 0.009). More efforts should be made to ensure treatment of profound hyponatremia in hospitalised patients.

Pharmacokinetics of oxycodone/naloxone and its metabolites in patients with end-stage renal disease during and between haemodialysis sessions.

BACKGROUND: The pharmacokinetics of oxycodone in patients with end-stage renal disease (ESRD) requiring haemodialysis are largely unknown. Therefore, we investigated the pharmacokinetics of oxycodone/naloxone prolonged release and their metabolites in patients with ESRD during and between haemodialysis sessions. METHODS: Single doses of oxycodone/naloxone (5/2.5 or 10/5 mg) were administered in nine patients with ESRD using a cross-over design on the day of dialysis and on a day between dialysis sessions. Plasma, dialysate and urine concentrations of oxycodone, naloxone and their metabolites were determined up to 48 h post-dosing using a liquid chromatography-tandem mass spectrometry system. RESULTS: Haemodialysis performed 6-10 h after dosing removed ∼10% of the administered dose of oxycodone predominantly as unconjugated oxycodone and noroxycodone or conjugated oxymorphone and noroxymorphone. The haemodialysis clearance of oxycodone based on its recovery in dialysate was (mean ± SD) 8.4 ± 2.1 L/h. The geometric mean (coefficient of variation) plasma elimination half-life of oxycodone during the 4-h haemodialysis period was 3.9 h (39%) which was significantly shorter than the 5.7 h (22%) without haemodialysis. Plasma levels of the active metabolite oxymorphone in its unconjugated form were very low. CONCLUSIONS: Oxycodone is removed during haemodialysis. The pharmacokinetics including the relatively short half-life of oxycodone in patients with ESRD with or without haemodialysis and the absence of unconjugated active metabolites indicate that oxycodone can be used at usual doses in patients requiring dialysis.

Glycaemic control in hospitalised diabetic patients at the University Hospital Basel in 2002 and in 2005.

INTRODUCTION: Hyperglycaemia has been shown to be detrimental in severely ill patients. Prospective randomized controlled trials in ICU patients demonstrated the benefit of near-normoglycaemia in reducing morbidity and mortality. Recommendations of professional societies (e.g., the American Diabetes Association) on glycaemic control in hospitalised patients have recently been published. It was therefore of interest to assess whether glycaemic control of diabetic subjects in our hospital adhered to these guidelines. No recent data are available on the glycaemic control of hospitalised diabetic patients in Switzerland. METHODS: Medical records of 580 hospitalised patients with type 1 and type 2 diabetes (290 from 2002, 290 from 2005) were extracted from the internal data base of the University Hospital Basel. The selection was based on the charts of successive admissions each month of the year. From these 290 records, 100 records were from the medical and surgical wards, respectively, and 30 from the medical ICU (MICU), 30 from the surgical ICU (SICU) and 30 from the coronary care unit (CCU), respectively. Thereby, the quality of glycaemic control was assessed within and between the wards. RESULTS: HbA1c of all diabetic patients with available measurements was 7.6 +/- 1.8% (mean +/- SD). HbA1c in medical wards was higher in 2005 than in 2002 (8.5 +/- 1.9% vs 7.5 +/- 2.8%; p = 0.014), and higher compared to surgical wards (8.5 +/- 1.9 % vs 6.7 +/- 1.1%; p <0.0001). On admission 60% of the plasma glucose concentrations (PGC) in medical and surgical wards were above the recommended limit of 8 mmol/l (10.8 +/- 7.5 mmol/l); in 63% of the measurements in the MICU, SICU and CCU the values were above 6.8 mmol/l. In 2005, PGC in medical wards on admission was higher than in surgical wards (13.5 +/- 9.9 vs 9.4 +/- 9.9 mmol/l, p <0.0001); in the MICU PGC was lower than in the SICU (9.7 +/- 1.5 vs 19.5 +/- 13.9 mmol/l; p <0.0001) and in the CCU (9.7 +/- 1.5 vs 14.1 +/- 12.1 mmol/l; p = 0.038). PGC decreased on day 4 compared to admission in the medical wards in 2005 (p = 0.024). In the other wards PGC in 2005 failed to decrease during hospitalisation. CONC:LUSION: Most diabetic patients admitted to the hospital remained distinctly hyperglycaemic during hospitalisation. This was the case even in intensive care units, where equipment and staff for improved glycaemic control were available and where strict glycaemic control has recently been demonstrated to result in decreased complications, mortality and length of stay.