Electrolyte Disorders in Community Subjects: Prevalence and Risk Factors

Liamis, Georgé; Rodenburg, Eline M.; Hofman, Albert; Zietse, Robert; Stricker, Bruno H.; Hoorn, Ewout J.

doi:10.1016/j.amjmed.2012.06.037

Cited by 282 publications

(256 citation statements)

References 44 publications

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“…Interestingly, Liamis et al have recently shown that diabetes mellitus per se is associated with hyponatremia, independently of the presence of hyperglycemia [2]. It has been suggested that the altered vasopressin regulation in diabetes mellitus, the increased insulininduced potentiation of vasopressin-induced acquaporin AQP2 water channels expression and the absorption of water from the GI tract due • Diabetes mellitus -associated hyponatremia…”

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confidence: 99%

“…Patients with diabetic nephropathy and chronic renal failure are very prone to the development of hyponatremia due to decreased water excretion. Additionally, diabetic patients with hyporeninemic hypoaldosteronism commonly exhibit exaggerated natriuresis leading to volume depletioninduced increase in ADH secretion, decreased water excretion and mild hyponatremia associated with asymptomatic hyperkalemia, and hyperchloremic metabolic acidosis [19].Interestingly, Liamis et al have recently shown that diabetes mellitus per se is associated with hyponatremia, independently of the presence of hyperglycemia [2]. It has been suggested that the altered vasopressin regulation in diabetes mellitus, the increased insulininduced potentiation of vasopressin-induced acquaporin AQP2 water channels expression and the absorption of water from the GI tract due • Diabetes mellitus -associated hyponatremia…”

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confidence: 99%

“…Hyponatremia is the most common electrolyte abnormality in clinical practice and is associated with increased morbidity and mortality [1,2]. Even small decreases of serum sodium are associated with increased probability for adverse outcomes (cognitive impairment, falls, osteoporosis and fractures) [3].…”

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confidence: 99%

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Decreased serum sodium levels are occasionally observed in patients with diabetes mellitus and can be attributed to numerous underlying pathogenetic mechanisms (Table 1) [4,5].

The direct measurement of serum osmolality (Posm) can differentiate between hypotonic hyponatremia (with decreased Posm) and hyponatremia associated with normal or even increased tonicity.

…”

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confidence: 99%

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Hyponatremia in Diabetes Mellitus: Clues to Diagnosis and Treatment

Vasilios¹

2015

J Diabetes Metab

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Hyponatremia is the most common electrolyte abnormality in clinical practice and is associated with increased morbidity and mortality [1,2]. Even small decreases of serum sodium are associated with increased probability for adverse outcomes (cognitive impairment, falls, osteoporosis and fractures) [3].Decreased serum sodium levels are occasionally observed in patients with diabetes mellitus and can be attributed to numerous underlying pathogenetic mechanisms (Table 1) [4,5].The direct measurement of serum osmolality (Posm) can differentiate between hypotonic hyponatremia (with decreased Posm) and hyponatremia associated with normal or even increased tonicity. In the latter case hyponatremia is usually due to the coexistent hyperglycemia [6]. In fact, glucose is an osmotic active substance. Thus, in cases of marked hyperglycemia Posm is increased leading to movement of water out of cells and subsequently to a reduction of serum sodium levels (dilutional hyponatremia). In such cases the corrected, for the degree of hyperglycemia, serum sodium value should be calculated. Thus, to obtain the "true" sodium level in cases of extreme hyperglycemia, the addition of 2.4 mEq/L to the measured concentration for every 100 mg/dl increment in plasma glucose above normal levels is required [7]. This corrected serum sodium level should be used during treatment of severe hyperglycemic states [8]. In patients with dilutional hyponatremia the treatment of hyperglycemia is usually followed by a normalization of serum sodium levels [4].No hypotonic hyponatremia (with a normal measured Posm) can also be due to pseudohyponatremia associated with hyperglycemiainduced severe hypertriglyceridemia and perhaps hypovolemiainduced hyperproteinemia. It is well known that when the proportion of a serum sample occupied by substances other than water and electrolytes (such as lipids and proteins) exceeds the usual value of 7%, serum sodium levels measured by ion-selective electrodes using the indirect method are falsely lower than true values [9][10][11][12][13]. Thus, in patients with lipemic serum and severe hypertriglyceridemia, sodium levels should be measured by direct potentiometry in blood gas panels. This method does not include a predilution step and is not susceptible to the aforementioned errors [13]. Diagnosis of pseudohyponatremia is necessary to avoid dangerous overtreatment. It should be mentioned that pseudohyponatremia does not produce any of the symptoms classically attributed to hyponatremia. Improvement in glycemic control is associated with a rapid decrease in serum triglycerides resulting in the correction of pseudohyponatremia. Thus, no specific treatment is required [4,6].The most common cause of hypotonic hyponatremia in patients with diabetes is osmotic diuresis-induced hypovolemia [4]. It should be mentioned that in patients with diabetic ketoacidosis the excretion of β-hydroxybutyrate and acetoacetate obligate urine sodium losses resulting in aggravation of hypovolemia [14]. Hypovolemia can also be due to diabetes mel...

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confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

“…

Decreased serum sodium levels are occasionally observed in patients with diabetes mellitus and can be attributed to numerous underlying pathogenetic mechanisms (Table 1) [4,5].

The direct measurement of serum osmolality (Posm) can differentiate between hypotonic hyponatremia (with decreased Posm) and hyponatremia associated with normal or even increased tonicity.

…”

mentioning

confidence: 99%

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Hyponatremia in Diabetes Mellitus: Clues to Diagnosis and Treatment

Vasilios¹

2015

J Diabetes Metab

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“…For example, epidemiologic data have shown that CKD patients have a 2-fold higher prevalence of hyponatremia compared with their non-CKD counterparts [3][4][5]. In CKD patients undergoing maintenance hemodialysis, a consistent association between low serum sodium and higher mortality has been observed across a number of studies [3,[6][7][8][9][10][11].…”

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confidence: 95%

Pre-Dialysis Serum Sodium and Mortality in a National Incident Hemodialysis Cohort

2015

American Journal of Kidney Diseases

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A B S T R AC TBackground. A consistent association between low serum sodium measured at a single-point-in-time (baseline sodium) and higher mortality has been observed in hemodialysis patients. We hypothesized that both low and high time-varying sodium levels (sodium levels updated at quarterly intervals as a proxy of short-term exposure) are independently associated with higher death risk in hemodialysis patients. Methods. We examined the association of baseline and timevarying pre-dialysis serum sodium levels with all-cause mortality among adult incident hemodialysis patients receiving care from a large national dialysis organization during January 2007-December 2011. Hazard ratios were estimated using multivariable Cox models accounting for case-mix+laboratory covariates and incrementally adjusted for inter-dialytic weight gain, blood urea nitrogen and glucose. Results. Among 27 180 patients, a total of 7562 deaths were observed during 46 194 patient-years of follow-up. Median (IQR) at-risk time was 1.4 (0.6, 2.5) years. In baseline analyses adjusted for case-mix+laboratory results, sodium levels <138 mEq/L were associated with incrementally higher mortality risk, while the association of sodium levels ≥140 mEq/L with lower mortality reached statistical significance only for the highest level of pre-dialysis sodium (reference: 138-<140 mEq/L). In time-varying analyses, we observed a U-shaped association between sodium and mortality such that sodium levels <138 and ≥144 mEq/L were associated with higher mortality risk. Similar patterns were observed in models incrementally adjusted for inter-dialytic weight gain, blood urea nitrogen and glucose.

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Sodium and water homeostasis and derangements

Fielding¹

2014

Equine Fluid Therapy

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Electrolyte Disorders in Community Subjects: Prevalence and Risk Factors

Cited by 282 publications

References 44 publications

Hyponatremia in Diabetes Mellitus: Clues to Diagnosis and Treatment

Hyponatremia in Diabetes Mellitus: Clues to Diagnosis and Treatment

Pre-Dialysis Serum Sodium and Mortality in a National Incident Hemodialysis Cohort

Sodium and water homeostasis and derangements

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