Hyponatraemia and severity and outcome of myocardial infarction.

Abstract

contributing factor to the poorer results, although we do not deny that other factors may have played a part.With these reservations the three principal conclusions may be restated in relation to extradural haematoma. (a) Delay in surgical evacuation of extradural haematomas leads to increased morbidity and mortality. Specifically it appears that delays exceeding two hours are unacceptable. (b) Direct admission of patients to neurosurgical beds from the accident and emergency unit decreased the delay time. The major delay time in the earlier period occurred in hospital and not before admission. (c) Direct admission of patients to neurosurgical beds in the later period was associated with a decline in morbidity and major mortality. That this decline was due to shorter delays is suggested by (b) but may have been contributed to by other factors.It therefore seems reasonable to conclude that direct admission of head-injured patients immediately to the primary care of the neurosurgical team is a good policy. It is, of course, possible only in cities where a neurosurgical department is immediately available and staffed to deal with head injuries in this way. Nevertheless, evacuating an extradural haematoma is not difficult, nor is diagnosing its presence and site if a history of the trend of events from injury, especially conscious level, is always obtained. A telephone consultation service round the clock must be available to district hospitals from the nearest neurosurgical department and backed up with a flying-squad service" to deal with the more complicated problems of surgical technique. Training district hospital and accident and emergency surgeons for three to six months in a head and spinal injuries service as part of a neurosurgical department at the senior house officer/ registrar level has been part of the organisation in Edinburgh for 10 years. Its value is in no doubt.The Kvarnes, T L, and Trumpy, J H, Acta Neurochirurgica, 1978, 41, 223. 7Jamieson, K G, and Yelland, J D N,3Journal of Neurosurgery, 1968, 29, 13. 8 Hooper, R, British Journal of Surgery, 1960, 47, 71. 9 Lewin, W, Proceedings of the Royal Society of Medicine, 1954, 47, 865. 10 Gallagher, J P, and Browder, E J, Journal of Neurosurgery, 1968, 29 Hyponatraemia and severity and outcome of myocardial infarction C T G FLEAR, P HILTON British MedicalJournal, 1979, 1, 1242-1246 Summary and conclusions A total of 235 consecutive patients admitted to a coronary care unit were investigated for serum electrolyte and urea concentrations; activities of aspartate aminotransferase, lactate dehydrogenase, and lactate dehydrogenase isoenzymes; electrocardiographic changes; clinical state; and outcome. Hyponatraemia, hypochloraemia, and uraemia were common in patients with confirmed myocardial infarctions, the degree of infarction correlating well with all the above indices of

Increased Mortality Associated with Higher Pre-Dialysis Serum Sodium Variability: Results of the International MONitoring Dialysis Outcome Initiative

“…Additionally, we tested for the interaction between pre-HD SNa levels and SNa variability in the prediction of death, by using bivariate spline analysis. Our data suggested that next to the well-known prognostic effect of hyponatremia (SNa < 136 or ≤135 mEq/L) [3][4][5][6][7]22], SNa variability has an independent adverse effect on mortality. However, of all tested variability indicators we studied, DR was the strongest predictor, robust against adjustment of the models by various relevant parameters, rendering it a suitable marker for clinical assessment.…”

“…Also, what needs to be considered is the so-called sick cell syndrome, a pathophysiological dynamic, involving the escape of intracellular osmolytes and subsequent shifts of intracellular fluid volumes to the extracellular space and subsequent dilute and lower circulating sodium, which has been described following acute events such as myocardial infarction amongst others [22,[34][35][36][37]. All these, however, remain speculative and at this point cannot be investigated with enough certainty.…”

A Prospective Study of in Hospital Outco Me of Acute Phase of Ste Mi With Hyponatremia

“…Rahman et al found that 9% of patients with MI had arrhythmia. 3,1 This contradiction is probably due to routine use of beta-blocker in that study and improvement in the monitoring of our study population. 3 patients (6%) developed arrhythmia in group II and 15 patients (30%) developed arrhythmia in group-I.…”

“…They got significant ventricular fibrillation in patients with Na level 132 mmol/L and got no arrhythmia in patients with normal sodium level. 1 Previously several studies have focused on the prognostic implications of hyponatremia in patients with chronic heart failure. 4,5 In the presence of heart failure, several mechanisms promote the development of hyponatremia.…”

Relationship between Hyponatremia and In-hospital Outcomes in Chinese Patients with ST-Elevation Myocardial Infarction

“…Flear and Hilton thought this hyponatremia could be caused by a redistribution of body water and solutes, due to a widespread increase in cell membrane permeability (the "sick-cell syndrome") or to a net gain of water caused by a stress-related sustained secretion of arginine vasopressin (AVP) (13). But Evans et al were unable to find the evidence for the sick-cell syndrome in hyponatremic patients with acute myocardial infarction by measurement of the osmolal gap in plasma and urine (14).…”