Dysnatremias are among the most common mineral imbalances encountered in clinical practice. Both hyponatremia and hypernatremia are associated with increased morbiditidy and mortality and represent negative prognostic factors regardless of their cause. Serum osmolality, extracellular fluid volume and sodium urine concentration are important parameters for evaluation the cause and differential diagnosis. The rate of onset of ionic disorder and severity of clinical symptoms are essential. While acute disorders with symptoms are treated immediately, in chronic disorders, thorough diagnostic evaluation and a careful approach to their correction are necessary. Especially with rapid substitution of chronic hyponatremia, there is a risk of osmotic demyelination syndrome. Therefore, a slow correction of the serum sodium level with frequent mineralogram checks is required.
- Klíčová slova
- SIADH, hypernatremia, hyponatremia, osmolality, osmotic demyelination syndrome,
- MeSH
- chronická nemoc MeSH
- diferenciální diagnóza MeSH
- hypernatremie * komplikace diagnóza MeSH
- hyponatremie * komplikace diagnóza MeSH
- lidé MeSH
- sodík MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- sodík MeSH
INTRODUCTION: Hyponatraemia is associated with increased mortality in patients undergoing maintenance haemodialysis. In anuric patients, hyponatraemia development depends on the water-sodium ratio in retained fluid within the interdialysis interval (IDI). OBJECTIVE: This study aimed to calculate the retained sodium-retained water ratio in patients on maintenance haemodialysis and make a differential diagnosis of hyponatraemia according to these data. METHODS: The amount of retained water was determined as body weight gain (ΔBW) within the IDI. Sodium retention was calculated using our formula: eRNa+ = ΔBW × (SNa+)t2 - total body water (TBW)t1 × ([SNa+]t1 - [SNa+]t2), where TBW represents the calculated volume of the total body water and (SNa+)t1 and (SNa+)t2 represent the sodium concentration at the beginning and at the end of the IDI, respectively. We performed 89 measurements in 32 anuric patients on maintenance haemodialysis. RESULTS: Hyponatraemia was detected in 13 measurements at the end of the IDI. The ΔBW had no statistically significant difference between normonatraemic and hyponatraemic patients. Hyponatraemic patients had significantly lower levels of retained sodium. The retained water--retained sodium ratio facilitated in differentiating dilution hyponatraemia, nutritional hyponatraemia, depletion hyponatraemia, and dilution hyponatraemia associated with sodium wasting or malnutrition. CONCLUSION: The composition of retained fluid during the IDI may be hypotonic, hypertonic, or isotonic in relation to the extracellular fluid. Most of the hyponatraemic patients had hypotonic fluid retained during the IDI because of dilution as well as gastrointestinal sodium loss and/or malnutrition.
- Klíčová slova
- Hyponatraemia, Interdialysis interval, Maintenance haemodialysis, Pathophysiology,
- MeSH
- algoritmy MeSH
- anurie komplikace terapie MeSH
- dialýza ledvin * MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- hyponatremie komplikace diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- sodík analýza MeSH
- vodní a elektrolytová rovnováha MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- sodík MeSH
INTRODUCTION: The aim of this study was to evaluate the prognostic value of hyponatremia in patients with castration-resistant prostate cancer (CRPC) undergoing docetaxel chemotherapy. PATIENTS AND METHODS: We retrospectively assessed 186 patients who received docetaxel chemotherapy in addition to androgen deprivation for CRPC between 2005 and 2015. We stratified the patients according to their pre-chemotherapy serum sodium level. Hyponatremia was defined as sodium < 135 mmol/L. A Cox proportional regression model was used to estimate overall survival (OS). RESULTS: The median sodium level was 139 mmol/L (interquartile range, 137-141 mmol/L). Hyponatremia was detected in 13 (6.9%) patients. One-half of the patients died during the studied period. The presence of hyponatremia was associated with a decreased probability of OS (hazard ratio, 2.5; 95% confidence interval, 1.0-6.3; P = .04) in univariate analysis. These findings could not be confirmed in the multivariable OS model (P = .21). CONCLUSION: We observed an association between hyponatremia and worse survival outcomes in our patients with CRPC undergoing docetaxel chemotherapy. However, further well-designed studies with full workup of hyponatremia are needed to validate these findings and to identify the underlying causes for this association in patients with CRPC.
- Klíčová slova
- Hyponatremia, Prognostic, Prostate cancer, Survival,
- MeSH
- antitumorózní látky terapeutické užití MeSH
- docetaxel terapeutické užití MeSH
- hyponatremie krev diagnóza epidemiologie MeSH
- Kaplanův-Meierův odhad MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory prostaty rezistentní na kastraci krev farmakoterapie mortalita MeSH
- následné studie MeSH
- prognóza MeSH
- proporcionální rizikové modely MeSH
- retrospektivní studie MeSH
- senioři MeSH
- sodík krev MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- antitumorózní látky MeSH
- docetaxel MeSH
- sodík MeSH
Hyponatremia defined as serum sodium lower than 135 mmol/L is the most common electrolyte abnormality in outpatients and also in hospitalized patients. It has been documented that hyponatremia is associated with significantly higher morbidity, mortality and longer hospitalization stay. Hyponatremia is manifested by variety of symptoms, from mild up to life threatening conditions. Syndrome of inappropriate antidiuresis (SIAD) is the most common type of hyponatremia. This article presents new aspects in the etiology, diagnosis, differential diagnosis ant treatment of the SIAD according to European guidelines.Key words: arginin-vasopressin-syndrome of inappropriate antidiuresis - diagnosis - hyponatremia - treatment.
- MeSH
- diferenciální diagnóza MeSH
- hyponatremie diagnóza terapie MeSH
- lidé MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- syndrom nepřiměřené sekrece ADH diagnóza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Terlipressin is a vasopressin analogue used for its vasoconstrictor effect in the treatment of variceal bleeding. Despite its good safety profile compared to vasopressin, some adverse reactions may occur during its use - e.g. hyponatremia. We describe a case of a cirrhotic patient with active variceal bleeding treated during two separate hospitalizations with terlipressin. In both drug treatment periods, severe laboratory hyponatremia developed. After terlipressin discontinuation, mineral disbalance corrected rapidly. Positive dechallenge and rechallenge corresponding to the drug administration schedule confirms the causality between terlipressin administration and hyponatremia. Hyponatremia was preceded with substantial fluid retention in both episodes. In this case report we want to highlight the need for fluid balance monitoring immediately after first terlipressin dose, which may individually predict the patient risk for the development of hyponatremia as other risk factors have rather limited predictive value in real clinical settings.
- Klíčová slova
- Adverse drug reaction, Fluid balance, Hyponatremia, Terlipressin, Vasopressin receptor,
- MeSH
- dospělí MeSH
- ezofageální a žaludeční varixy komplikace MeSH
- hematemeze farmakoterapie etiologie patofyziologie MeSH
- hyponatremie * chemicky indukované diagnóza terapie MeSH
- jaterní cirhóza komplikace MeSH
- lidé MeSH
- lypresin aplikace a dávkování škodlivé účinky analogy a deriváty MeSH
- terlipresin MeSH
- vazokonstriktory aplikace a dávkování škodlivé účinky MeSH
- vodní a elektrolytová nerovnováha diagnóza etiologie prevence a kontrola MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
- Názvy látek
- lypresin MeSH
- terlipresin MeSH
- vazokonstriktory MeSH
This present review analyzes the etiology, diagnostics and management of conditions associated with hyponatremia. Excess water and/or sodium wasting lead to the development of hyponatremia in children. There are diverse etiologies associated with hyponatremia, correct diagnosis is based on detailed history, physical examination and basic laboratory tests. Symptomatic hyponatremia can be a life threatening emergency and thus requires fast and vigorous management. Inappropriate treatment may cause fatal consequences.
- Klíčová slova
- children, hyponatremia, hyponatremic encephalopathy, inappropriate ADH syndrome, renal salt wasting syndrome.,
- MeSH
- dítě MeSH
- hyponatremie komplikace diagnóza terapie MeSH
- lidé MeSH
- osmolární koncentrace MeSH
- syndrom nepřiměřené sekrece ADH etiologie MeSH
- vodní a elektrolytová rovnováha * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Changes to the overall volume of body water and acid base equilibrium can be reflected in the values of differences and ratios relating to serum concentrations of natrium and chlorides. Both these quantities can be used for patients with hyponatremia in the hyponatremia differential diagnosis. This paper presents a case study which is an example of the clinical use of differences in and ratios of serum concentrations of natrium and chlorides when monitoring effectiveness of the therapy.Key words: acid base equilibrium - depletion hyponatremia - differential diagnosis of hyponatremia - dilution hyponatremia.
OBJECTIVES: Osmotic demyelination syndrome (ODMS) is a rare and serious neurologic disorder with acute myelin disintegration, usually in the pontine area (central pontine myelinolysis) and to a lesser extent, even in other areas of the central nervous system (extrapontine myelinolysis). The main underlying mechanism is the change of serum osmolality with quick correction of low mineral levels, mainly hyponatraemia. Clinical manifestation is various and depends on the localization. DESIGN: We describe an acute isolated extrapontine myelinolysis causing acute onset of parkinsonism in a 61-year-old man who developed quickly progressing parkinsonian syndrome after the rapid correction of hyponatraemia. RESULTS: Brain MRI revealed lesions only in the striatum, sparing the globus pallidus. Substitution therapy with high doses of levodopa significantly improved his clinical condition. CONCLUSION: Extrapontine myelinolysis with isolated affection of basal ganglia is extremely rare. In such case, clinical manifestation of acute severe parkinsonism could be successfully treated by high dose of levodopa.
- MeSH
- akutní nemoc MeSH
- bazální ganglia patologie MeSH
- centrální pontinní myelinolýza diagnóza terapie MeSH
- hyponatremie diagnóza farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- parkinsonské poruchy diagnóza terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- MeSH
- hyponatremie krev diagnóza MeSH
- lidé MeSH
- poranění míchy komplikace MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- dopisy MeSH
- komentáře MeSH
BACKGROUND: Dysnatremias are common and prognostically serious in neurocritical care. We studied whether a standardized sodium protocol would improve our neurocritical care of dysnatremias. METHODS: A 5-year prospective study of a standardized sodium protocol for 1,560 patients admitted with various brain diseases in an adult neurologic-neurosurgical intensive care unit (NNICU) was compared with a 5-year retrospective analysis of 1,440 patients without the sodium protocol. Hyponatremia was defined as serum sodium (SNa(+)) < 135 mmol/L and hypernatremia SNa(+ )> 150 mmol/L. The sodium protocol involved measuring SNa(+), serum, and urine osmolality, measured and calculated renal function parameters, fluid intake 40 mL/kg weight/day without hypotonic saline, thiazide, and desmopressin acetate in all normonatremic NNICU patients. RESULTS: In the protocol study, hyponatremia occurred slightly less often (15.7 versus 16.3% of patients; p = 0.684), hypernatremia was significantly higher (respectively 8.5% versus 5.2% of patients; p < 0.001), and no differences were noted in hypo/hypernatremia (p = 0.483). There were no differences in the incidence of hypo-osmolal hyponatremia (respectively 3.5% versus 3.5% of patients; p = 0.987), cerebral salt wasting (CSW; respectively 1.7% versus 1.7% of patients; p = 0.883), syndrome of inappropriate secretion of antidiuretic hormone (SIADH; respectively 0.1% versus 0.3% of patients; p = 0.152), central diabetes insipidus (CDI; respectively 1.0% versus 0.6% of patients; p = 0.149). In hyponatremia there were no differences in the Glasgow Coma Scale (GCS) score upon onset of hyponatremia (p = 0.294), NNICU mortality (respectively 1.0% versus 0.4% patients; p = 0.074), and bad outcome upon discharge from NNICU (respectively 5.1% versus 6.5% of patients; p = 0.101), but in hypernatremia GCS score upon onset (p < 0.001), mortality (respectively 2.8% versus 1.0%; p < 0.001), and bad outcome from NNICU (respectively 6.7% versus 2.7% patients; p < 0.001) were significantly higher. Multivariate logistic regression analysis showed that hypernatremia, compared with hyponatremia, was a significant predictor of mortality during NNICU stay (respectively odds ratio [OR]: 1.14; p = 0.003 versus OR; 5.3; p = 0.002). CONCLUSIONS: The standard sodium protocol lowered the frequency of SIADH, which was encountered in only one patient over 5 years. However, it did not significantly reduce the incidence and improve the outcome of hyponatremia. Hypernatremia occurred more often and had a higher mortality and worse outcome than hyponatremia, but these patients were neurologically worse upon its onset. The prospective study confirmed that CSW, SIADH, and CDI were not common in our neurocritical care.
- MeSH
- desmopresin terapeutické užití MeSH
- diuretika terapeutické užití MeSH
- hypernatremie diagnóza farmakoterapie epidemiologie MeSH
- hyponatremie diagnóza farmakoterapie epidemiologie MeSH
- hypotonické roztoky terapeutické užití MeSH
- iatrogenní nemoci MeSH
- incidence MeSH
- ledvinné látky terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci nervového systému komplikace terapie MeSH
- osmolární koncentrace MeSH
- péče o pacienty v kritickém stavu metody MeSH
- prospektivní studie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- sodík aplikace a dávkování krev terapeutické užití MeSH
- thiazidy terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- desmopresin MeSH
- diuretika MeSH
- hypotonické roztoky MeSH
- ledvinné látky MeSH
- sodík MeSH
- thiazidy MeSH
