Correction of Hypernatremia Due to Pure Dehydration Could Be a Potential Risk Factor for Transient Atrial Fibrillation

Abstract

Although atrial fibrillation (AF) has been correlated with hyponatremia, it has not been described in association with the correction of chronic hypernatremia in previous studies.Here, we describe three elderly patients who had hypernatremia on presentation, most likely secondary to dehydration. Their electrocardiogram (EKG) on presentation was normal, and they had no known history of AF but developed transient AF during the course of hypernatremia correction. Similar occurrences have not been reported previously though there have been studies showing the relation between hyponatremia and AF. It is known that atrial stretch can increase the propensity of rapid firing from the pulmonary veins as a result of stretch-sensitive ion channels. Therefore, the occurrence of AF in these patients could be explained by the phenomenon of increase in right atrial diameter, i.e atrial stretch, in response to the increase in preload during the course of treatment. However, there are many other clinical scenarios where boluses of fluid are given during treatment but no occurrences of AF have been reported so far. So, we put forward the possibility of the occurrence of AF being independently associated with the drop in sodium level. Further studies like speckle tracking echo might shed more light on these findings.

Sudden Vasopressin Withdrawal Causing Transient Central Diabetes Insipidus: A Case Report

“…Our patient appropriately responded to exogenous administration of desmopressin, suggesting probable feedback inhibition on the release of ADH due to vasopressin infusion. Nevertheless, it is important to be aware of these manifestations as fluctuations in serum sodium are associated with morbidity, including neurological dysfunction and atrial fibrillation [ 16 ]. Furthermore, increased urine output may affect the estimation of GFR and may result in suboptimal antimicrobial dosing [ 17 ].…”

Optimization of Packet Length for MIMO systems

“…First, we noticed that the best strategy is to use the OPL and MCS using ISNR as explained in section 4. The proposed protocol offers 1.8 dB gain with respect to optimal MCS and FPL as considered in [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Fixed Packet Length N=350 : AMC using ASNR Fixed Packet Length N=590 : AMC using ASNR Fixed Packet Length N=1190 : AMC using ASNR Optimal packet length : AMC using ASNR Adaptive packet Length and Adaptive MCS using ISNR Fixed packet length and adaptive MCS using INSR Figure 10: Throughput of MIMO systems with AMC using ASNR or ISNR : fixed versus OPL.…”

Dysnatremia is associated with increased risk of all-cause mortality within 365 days post-discharge in patients with atrial fibrillation without heart failure: A prospective cohort study

“…The relationship between hypernatremia and adverse prognosis could be due to decreased left ventricular contractility ( 36 ) and/or increased peripheral insulin resistance ( 37 ). A case report showed that three hypernatremic patients incurred AF during treatment for hypernatremia ( 38 ). It is possible that hypernatremia could be a risk factor for AF-related mortality because of atrial stretch during treatment-stimulated pulmonary vein electrical activity ( 39 ).…”