A case–control study of hyponatraemia as an independent risk factor for inpatient mortality

Tzoulis, Ploutarchos; Bagkeris, Emmanouil; Bouloux, Pierre-Marc

doi:10.1111/cen.12429

Cited by 39 publications

(50 citation statements)

References 30 publications

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“…Given that reported mortality rates vary according to the cutoff point used to define HN, it is difficult to compare the mortality rates observed in our study to the rates described by other authors. Patients with SNa levels ranging from 128 to 138 mmol/L reported mortality rates ranging from 3.4 to 17.3% [3,6,7,10]. In contrast with other studies, we found no significant association between HN and mortality in the PNG after adjusting for confounding factors.…”

Section: Discussioncontrasting

confidence: 99%

“…However, we found that the mortality rate in patients with sustained HN (75% of all intraindividual SNa measurements < 135 mmol/L) was up to 7 times greater than that in patients without HN, and independent of age, gender, CCI, or BMI. This finding is of interest given that, to date, none of the studies that have examined mortality rates in hyponatremic patients [3,6,7,8,9,10] have analyzed the effect of sustained HN versus single SNa values.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have found a high mortality rate in hospitalized hyponatremic patients as compared with those presenting a normal SNa [1,3,4,5,6,7,8,9,10]. In fact, even minor descents in SNa of the order of 4-5 mmol/L are already accompanied by an increased mortality rate [8].…”

Section: Introductionmentioning

confidence: 99%

“…Some authors have detected a minimum mortality rate in patients with SNa between 138 and 142 mmol/L, which suggests that these levels could represent strict eunatremia [7]. Hyponatremic patients also have longer hospital lengths-of-stay (LOS) than their eunatremic counterparts, as well as a higher readmissions rate [7,9,10,11,12,13]. …”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Hyponatremia and Its Associated Morbimortality in Hospitalized Patients Receiving Parenteral Nutrition

et al. 2017

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Background: The objective of the study was to determine the prevalence of hyponatremia (HN) and its associated morbimortality in hospitalized patients receiving parenteral nutrition (PN). Methods: A retrospective study including 222 patients receiving total PN (parenteral nutrition group [PNG]) over a 7-month period in a tertiary hospital and 176 matched to 179 control subjects without PN (control subjects group [CSG]). Demographicdata, Charlson Comorbidity Index (CCI), date of HN detection-(serum sodium or SNa <135 mmol/L)-intrahospital mortality, and hospital length-of-stay (LOS) were registered. In the PNG, body mass index (BMI) and SNa before, during, and after PN were recorded. Results: HN was more prevalent in the PNG: 52.8 vs. 35.8% (p = 0.001), and independent of age, gender, or CCI (OR 1.8 [95% CI 1.1-2.8], p = 0.006). In patients on PN, sustained HN (75% of all intraindividual SNa <135 mmol/L) was associated with a higher mortality rate independent of age, gender, CCI, or BMI (OR 7.38 [95% CI 1.07-50.8], p = 0.042). The absence of HN in PN patients was associated with a shorter hospital LOS (<30 days) and was independent of other comorbidities (OR 3.89 [95% CI 2.11-7.18], p = 0.001). Conclusions: HN is more prevalent in patients on PN. Sustained HN is associated with a higher intrahospital mortality rate. Absence of HN is associated with a shorter hospital LOS.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence of Hyponatremia and Its Associated Morbimortality in Hospitalized Patients Receiving Parenteral Nutrition

et al. 2017

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“…Furthermore, our case further highlighted the contrarian observation that with a high index of suspicion for CSW and its early diagnosis, volume depletion and hypovolemia from polyuria may not be a distinguishing presenting factor, when contrasted with SIADH (7-9). Moderate to severe hyponatremia is acknowledged to increase inpatient mortality (12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

Sequential cerebral salt wasting complicating SIADH in a patient following head trauma

Onuigbo¹,

Agbasi²,

Amadi³

et al. 2018

J Renal Inj Prev

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We report a 67-year-old female who presented with progressively symptomatic hyponatremia due to the SIADH secretion complicating TBI and neurosurgical intervention. She responded initially to fluid restriction, 3% NaCl infusion and oral NaCl tablets. Nevertheless, by hospital day 8, she had quickly developed polyuria, dumping over 3 liters of urine in the first 4-6 hours of that morning with rapid recurrence of hyponatremia, again. She was, this time, diagnosed with CSW and was managed differently with 0.9% NaCl volume expansion. To our knowledge, this is the first case of the sequential development of symptomatic hyponatremia from SIADH followed by the development of hyponatremia from CSW in the same patient during the same admission. Furthermore, our case further highlighted the contrarian observation that with a high index of suspicion for CSW and its early diagnosis, volume depletion and hypovolemia from polyuria may not be a distinguishing presenting factor, when contrasted with SIADH.Please cite this paper as: Onuigbo MAC, Agbasi N, Amadi EJ, Okeke UC, Khan A. Sequential cerebral salt wasting complicating SIADH in a patient following head trauma. J Renal Inj Prev. 2018;7(1):49-52. DOI: 10.15171/jrip.2018.12. Hyponatremia is the most commonly encountered dyselectrolytemia following head trauma. The two main mechanisms responsible for non-iatrogenic hyponatremia are cerebral salt wasting (CSW) syndrome and the syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH is the commonest dyselectrolytemia cause of hyponatremia following traumatic brain injury (TBI) whereas CSW is the most elusive and challenging diagnosis of the causes of hyponatremia from intracranial causes. The need to distinguish between CSW and SIADH is critical because the management of CSW is volume restitution and sodium restoration whereas for SIADH, the management is exact opposite -water restriction. Our recent experience with a 67-year old Caucasian female post-TBI illustrated very interesting observations. To our knowledge, this is the first case of the sequential development of symptomatic hyponatremia from SIADH followed by the development of hyponatremia from CSW in the same patient during the same admission. Furthermore, our case further highlighted the contrarian observation that with a high index of suspicion for CSW and its early diagnosis, volume depletion and hypovolemia from polyuria may not be a distinguishing presenting factor, when contrasted with SIADH.

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Sodium and Water Balance

Ueda

Hopper

2018

Textbook of Small Animal Emergency Medicine

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A case–control study of hyponatraemia as an independent risk factor for inpatient mortality

Abstract: This study showed that hyponatraemia is an independent predictor of mortality, and hyponatraemia per se is likely to contribute to excess mortality. Further studies are needed to examine whether correction of hyponatraemia can reduce mortality.

Cited by 39 publications

References 30 publications

Prevalence of Hyponatremia and Its Associated Morbimortality in Hospitalized Patients Receiving Parenteral Nutrition

Prevalence of Hyponatremia and Its Associated Morbimortality in Hospitalized Patients Receiving Parenteral Nutrition

Sequential cerebral salt wasting complicating SIADH in a patient following head trauma

Sodium and Water Balance

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