Diagnosis and Management of Hyponatremia

Adrogué, Horacio J.; Tucker, Bryan M.; Madias, Nicolaos E.

doi:10.1001/jama.2022.11176

Cited by 142 publications

(84 citation statements)

References 97 publications

(332 reference statements)

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“…Despite the well‐known role of PE in the differentiation of hypovolemic, euvolemic, and hypervolemic hyponatremia, it is flawed by a low sensitivity (50%–70%) and specificity (30%–50%) for detecting hypovolemic hyponatremia. Therefore, measurement of urinary sodium level and osmolality or determination of urine specific gravity has been used to make a volume status‐based differential diagnosis 1 . In addition, the European guidelines make the recommendation of measuring urine osmolality and urinary sodium level prior to extracellular fluid volume measurement, 2 although this approach has some disadvantages.…”

Section: Discussionmentioning

confidence: 99%

“…Hyponatremia, defined as a serum sodium level below 135 mEq/L, constitutes the most common electrolyte abnormality, affecting nearly 5% of adult population and 35% of hospitalized individuals, and is a result of water retention in most cases such that even mild, hyponatremia leads to prolonged hospitalization and increased mortality 1 . American Hyponatremia Guidelines published in 2013 and European Hyponatremia Guidelines published in 2014 outline the definition, management, and treatment principles of hyponatremia 2,3 .…”

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confidence: 99%

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The Role of Ultrasonographic Inferior Vena Cava Measurement in the Volume‐Based Classification of Patients With Hyponatremia

Şirin,

Çığşar,

Sönmez

2023

J of Ultrasound Medicine

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ObjectivesTo demonstrate the role of inferior vena cava (IVC) collapsibility in the assessment of volume status in hyponatremic critically ill patients in the emergency department (ED) with bedside IVC imaging and to predict volume status with response to fluid therapy.MethodsA prospective 110 hypotonic hyponatremic patients aged >18 years with a serum sodium level under 125 mEq/L and at least one symptom of hyponatremia, who presented or referred to the ED was conducted. Demographical, clinical, and laboratory characteristics with bedside measurement of IVC diameter of patients were recorded. Volume status was divided into 3 subgroups: hypovolemic‐G1, euvolemic‐G2, and hypervolemic‐G3. An ED trainee with a certification to perform basic and advanced ultrasonography (USG) training carried out the USG examinations. A diagnostic algorithm approach was made according to the results.ResultsSymptom severity was significantly greater in the hypervolemic group than the other groups (P = .009 and P = .034, respectively). Systolic blood pressure (SBP) and mean arterial pressure (MAP) were significantly lower in the hypovolemic group compared with the other groups (P < .001 and P = .003, respectively). There was a significant difference between the ultrasonographically measured IVC min, IVC max, and mean IVC values across the three volume‐based groups (P < .001).ConclusionConsidering the diversity of physical examination (PE) findings, with the highly heterogenous nature of hyponatremia, a new measurable algorithm can be developed on the basis of contemporary hyponatremic patient management guidelines.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The Role of Ultrasonographic Inferior Vena Cava Measurement in the Volume‐Based Classification of Patients With Hyponatremia

Şirin,

Çığşar,

Sönmez

2023

J of Ultrasound Medicine

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“…Perhaps the most essential electrolyte to manage is sodium as hyponatremia supports cerebral edema and increased ICP, while hypernatremia supports cellular dehydration and sluggish flow. Hyponatremia diagnostic and therapeutic algorithms help guide accurate diagnosis and therapy (31). Hypernatremia nearly uniformly reflects a water deficit that is formulaically estimable.…”

Section: Methodsmentioning

confidence: 99%

“…Excessively rapid hypernatremia correction may induce cerebral edema and DoC. Acute hyponatremia (< 125 mEq/L) is associated with DoC and seizure threshold reduction (31).…”

Section: Concise Definitive Reviewmentioning

confidence: 99%

State-of-the-Art Evaluation of Acute Adult Disorders of Consciousness for the General Intensivist

Chang¹,

Provencio²,

Pascual

et al. 2023

Critical Care Medicine

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Objectives: To provide a concise review of knowledge and practice pertaining to the diagnosis and initial management of unanticipated adult patient disorders of consciousness (DoC) by the general intensivist. Data Sources: Detailed search strategy using PubMed and OVID Medline for English language articles describing adult patient acute DoC diagnostic evaluation and initial management strategies including indications for transfer. Study Selection: Descriptive and interventional studies that address acute adult DoC, their evaluation and initial management, indications for transfer, as well as outcome prognostication. Data Extraction: Relevant descriptions or studies were reviewed, and the following aspects of each manuscript were identified, abstracted, and analyzed: setting, study population, aims, methods, results, and relevant implications for adult critical care practice. Data Synthesis: Acute adult DoC may be categorized by etiology including structural, functional, infectious, inflammatory, and pharmacologic, the understanding of which drives diagnostic investigation, monitoring, acute therapy, and subsequent specialist care decisions including team-based local care as well as intra- and inter-facility transfer. Conclusions: Acute adult DoC may be initially comprehensively addressed by the general intensivist using an etiology-driven and team-based approach. Certain clinical conditions, procedural expertise needs, or resource limitations inform transfer decision-making within a complex care facility or to one with greater complexity. Emerging collaborative science helps improve our current knowledge of acute DoC to better align therapies with underpinning etiologies.

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“…The Adrogué-Madias equation, which represents a conceptual improvement in the prediction of changes in serum sodium after infusion of 1 L of infusate, is currently the preferred and widely used fluid prescription for adult patients with dysnatremias, but its efficacy has not been validated in pediatric patients. [20][21][22]…”

mentioning

confidence: 99%

Validity of the Adrogué-Madias Formula for the Management of Acute Dysnatremias in Critically Ill Children

Moghtaderi

Basiratnia

Asl³

2023

Pediatr Emer Care

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Validity of the Adrogué-Madias formula for the management of acute dysnatremias in critically ill children: a prospective multicenter analysis.Objective: Current conventional formulas do not predict the expected changes in serum sodium after administration of various fluids to correct serum sodium abnormalities. The Adrogué-Madias formula is currently the preferred and widely used fluid prescription for adult patients with dysnatremias, but its therapeutic efficacy has not been validated in pediatric patients. Methods:In this prospective study, we used the Adrogué-Madias formula for calculating the appropriate rate of various fluids administration to correct serum sodium abnormalities in 7 critically ill children with acute dysnatremias.Results: After administration of various intravenous fluids using the Adrogué-Madias formula, the anticipated as well as the achieved sodium concentrations were almost similar.Conclusions: This study demonstrates that the use of the Adrogué-Madias quantitative formula allows to calculate the appropriate rate of administration of various fluids. The calculated fluid administration resulted in the subsequent actual laboratory values and clinical changes.

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Diagnosis and Management of Hyponatremia

Cited by 142 publications

References 97 publications

The Role of Ultrasonographic Inferior Vena Cava Measurement in the Volume‐Based Classification of Patients With Hyponatremia

The Role of Ultrasonographic Inferior Vena Cava Measurement in the Volume‐Based Classification of Patients With Hyponatremia

State-of-the-Art Evaluation of Acute Adult Disorders of Consciousness for the General Intensivist

Validity of the Adrogué-Madias Formula for the Management of Acute Dysnatremias in Critically Ill Children

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