ABSTRACT
BACKGROUND: Hyponatremia, the most common electrolyte disorder, has been reported to be related to increased mortality. However, the association between hyponatremia and prognoses remains unclear in patients with nutrition support team (NST) intervention. This study aimed to determine the prevalence of abnormal serum sodium levels, its relation to patient data, and the impact of hyponatremia on prognosis. METHODS: Patients who received nutrition support at Tokushima University Hospital for the first time and whose serum sodium levels were measured at the start of NST intervention were enrolled. Patients were classified into three groups according to their serum Na levels at the start of NST intervention: hyponatremia group, normonatremia group, and hypernatremia group. RESULTS: In the hyponatremia group compared to the normonatremia group, body weight and body mass index were significantly lower. C-reactive protein levels and urea nitrogen/creatinine ratios were significantly higher. Meanwhile, there was no significant difference in the estimated glomerular filtration rate among the groups. The prevalence of malnutrition and anemia were the highest in the hyponatremia group. The 3-year survival rate was approximately 45% in the hyponatremia group, which was the lowest of all three groups. The mortality risk ratio of the hyponatremia group to the normonatremia group was 2.29. CONCLUSIONS: Hyponatremia in NST intervention patients is an independent prognostic predictor. Therefore, adding an assessment of serum sodium at the beginning of NST intervention can identify patients at high risk at an early stage and may improve the quality of NST activity.
Subject(s)
Hyponatremia/diet therapy , Hyponatremia/diagnosis , Nutritional Support/methods , Aged , Aged, 80 and over , Cerebrovascular Disorders/blood , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/diet therapy , Female , Heart Diseases/blood , Heart Diseases/diagnosis , Heart Diseases/diet therapy , Humans , Hyponatremia/blood , Male , Middle Aged , Neoplasms/blood , Neoplasms/diagnosis , Neoplasms/diet therapy , Nutritional Support/mortality , Prognosis , Survival Rate/trendsSubject(s)
Ambulatory Care , COVID-19 , Diet Therapy/methods , Food , Hyponatremia , Hypovolemia , Aged, 80 and over , Ambulatory Care/methods , Ambulatory Care/trends , COVID-19/epidemiology , COVID-19/prevention & control , Female , Food, Formulated , Humans , Hyponatremia/blood , Hyponatremia/diet therapy , Hypovolemia/blood , Hypovolemia/diet therapy , Nutrition Policy , SARS-CoV-2 , Telemedicine , Water-Electrolyte Imbalance/diagnosis , Water-Electrolyte Imbalance/therapyABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Anemia, Macrocytic/complications , Anemia, Macrocytic/diagnosis , Anemia, Macrocytic/drug therapy , Hyperkalemia/complications , Hyperkalemia/drug therapy , Hyponatremia/complications , Hyponatremia/diagnosis , Hyponatremia/drug therapy , Hyponatremia/diet therapy , Hyperkalemia/diet therapy , Asthenia/complications , Fatigue/complications , Anorexia/complications , Vitamin B 12 Deficiency/complications , Vitamin B 12 Deficiency/diet therapyABSTRACT
A 44-year-old woman complained of abdominal pain of 4 days' duration accompanied by vomiting and painful urination. The admitting physician noted neurologic signs consistent with axonal polyneuropathy and hyponatremia. In the absence of other explanations for the syndrome, SIADH was diagnosed. Because of the nonspecific nature of the observations, the patient was assessed by various specialists and admitted to the anesthetic recovery unit due to worsening of neurologic signs and suspicion of acute intermittent porphyria. The diagnosis was confirmed by laboratory findings of elevated d-aminolevulinic acid and porphobilinogen levels and normal stool porphyrins. The patient improved with intravenous hematin infused over 4 days.
Subject(s)
Inappropriate ADH Syndrome/etiology , Porphyria, Acute Intermittent/complications , Abdominal Pain/etiology , Adult , Aminolevulinic Acid/blood , Coproporphyrins/analysis , Delayed Diagnosis , Dietary Carbohydrates/therapeutic use , Feces/chemistry , Female , Hemin/therapeutic use , Humans , Hyponatremia/diet therapy , Hyponatremia/etiology , Paresthesia/etiology , Porphobilinogen/urine , Porphyria, Acute Intermittent/diagnosis , Porphyria, Acute Intermittent/drug therapy , Porphyria, Acute Intermittent/metabolism , Quadriplegia/etiology , Sodium Chloride, Dietary/therapeutic use , Vomiting/etiologyABSTRACT
BACKGROUND: CF infants may be at increased risk of sodium depletion which may lead to impaired growth. The objective of this study was to evaluate their sodium supplementation requirements. METHODS: Ten CF infants had serial measurements of weight and plasma/urine sodium and creatinine. Sodium supplementation was adjusted with the aim of maintaining fractional excretion (FENa) between 0.5% and 1.5% and urinary sodium > 10 mmol/L. RESULTS: Urine sodium:creatinine (UNa:Cr) ratio strongly correlated with FENa [UNa:Cr (mmol/mmol)=35.0 x FENa (r=0.99)]. The FENa target range corresponded to UNa:Cr 17-52 mmol/mmol. All infants required sodium supplementation to achieve UNa:Cr > 17 mmol/mmol. Sodium supplement requirements (mean+/-SD) at ages 0-3, 3-6, 6-9 and 9-12 months were 1.9+/-0.5, 1.8+/-0.8, 1.9+/-0.9 and 0.8+/-0.4 mmol/kg/d. No infant required calorie supplementation to achieve expected weight gain. CONCLUSIONS: Using current UK guidelines, many cases of sodium depletion may be overlooked. Some infants require more than the recommended 1-2 mmol/kg/d. UNa:Cr ratio is a useful non-invasive measure to monitor sodium supplementation.
Subject(s)
Cystic Fibrosis/diet therapy , Hyponatremia/diet therapy , Infant, Newborn, Diseases/diet therapy , Sodium Chloride, Dietary/administration & dosage , Adolescent , Body Weight , Creatinine/urine , Cystic Fibrosis/metabolism , Female , Humans , Hyponatremia/blood , Hyponatremia/urine , Infant, Newborn , Infant, Newborn, Diseases/metabolism , Male , Sodium Chloride, Dietary/pharmacokineticsABSTRACT
Polydipsia, chronic or intermittent, with or without hyponatremia, frequently occurs among chronic patients with schizophrenia. The pathogenesis of polydipsia remains poorly understood. The key assumption of our hypothesis is that in some of these patients, polydipsia and hyponatremia are consequences of patients' adjustment to a prolonged intake of an insufficient diet, dominantly poor in potassium. Deficits of potassium, without significant hypokalemia, may cause impairment of the urine-concentrating ability with polyuria-polydipsia. A fall of intracellular tonicity, dominantly due to a decreased amount of K(+) and attendant anions in cells, should be accompanied with a fall of extracellular osmolality. Because of the diminished content of ions that may diffuse out of cells and because osmotic equilibrium between the ECF and ICF compartments cannot be established in a short period of time, these patients have a diminished ability to adapt to an excessive intake of fluids. These mechanisms might be related to the development of polydipsia and water intoxication in patients with different mental and somatic disorders. The experiences with the therapeutic effects of diets containing an sufficient amount of potassium in two patients with schizophrenia are described. Further investigations are needed, and we suggest a possible approach to test our hypotheses.
Subject(s)
Hypokalemia/physiopathology , Hyponatremia/physiopathology , Malnutrition/physiopathology , Potassium/blood , Schizophrenia/physiopathology , Water Intoxication/physiopathology , Water-Electrolyte Balance/physiology , Chronic Disease , Humans , Hypokalemia/diet therapy , Hyponatremia/diet therapy , Kidney Concentrating Ability/physiology , Male , Malnutrition/diet therapy , Membrane Potentials/physiology , Polyuria/diet therapy , Polyuria/physiopathology , Potassium/administration & dosage , Schizophrenia/diet therapy , Sodium/blood , Water Intoxication/diet therapyABSTRACT
The hyponatremic hypertensive syndrome is a rare but serious complication of reno-vascular disease. The syndrome is characterized by hypertension and profound natriuresis, leading to body sodium and water depletion. Hypertension is typically refractory to treatment. We report an 82-year-old patient with this syndrome and describe the results of an audit of the clinical records of patients admitted to a teaching hospital over a two-year period with confirmed renal artery stenosis and hyponatremia. The syndrome should be suspected in patients in whom severe hypertension is associated with hyponatremia without other apparent cause, especially in the presence of reno-vascular disease.
Subject(s)
Hypertension, Renovascular/complications , Hyponatremia/complications , Renal Artery Obstruction/complications , Aged, 80 and over , Female , Humans , Hypertension, Renovascular/diagnosis , Hypertension, Renovascular/diet therapy , Hyponatremia/diagnosis , Hyponatremia/diet therapy , Renal Artery Obstruction/diagnosis , SyndromeABSTRACT
A male quadriplegic (C6--complete) with persistent chronic hyponatremia (serum sodium values ranging consistently from 117-132 mmol/L) developed acute hyponatremia with a serum sodium concentration of 98 mmol/L. This extreme hyponatremia related, in part, to a reversible defect in the excretion of a water load, while on a low (46 mmol/day) sodium diet. Subsequent ingestion of a normal sodium diet (150 mmol/day), with or without 0.1 mg of fludrocortisone (Florinef), reestablished his ability to excrete a water load normally. The etiology of this patient's hyponatremia is discussed as well as the unique concordance of factors which make hyponatremia a common occurrence among spinal-cord injured patients.
