Hyponatremia: Clinical Diagnosis and Management

Lien, Yeong‐Hau H.; Shapiro, Joseph I.

doi:10.1016/j.amjmed.2006.09.031

Cited by 110 publications

(92 citation statements)

References 42 publications

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“…Female sex hormones might contribute to the mechanism regulating the neuronal volume regulation in response to hypo-osmolarity and sensitize the brain vasculature to vasopressin. 6) In the present case, blood examination detected no hyperlipidemia, hyperproteinemia, hyperglycemia, signs of blood loss, active infection, or renal or liver dysfunction. She had no clinical symptoms of congestive heart failure or sodium loss from the gastrointestinal tract and kidney.…”

Section: Central Pontine and Extrapontine Myelinolysis In An Infantmentioning

confidence: 88%

“…6) The mechanism of hyponatremia is crucial to identify before selecting the treatment of hyponatremia. Hyperlipidemia, hyperproteinemia, and hyperglycemia can be laboratory artifacts and the cause of apparent hyponatremia.…”

Section: Discussionmentioning

confidence: 99%

“…6) The sex and age of the affected patients are apparently significant prognostic factors of hyponatremia. Female sex hormones might contribute to the mechanism regulating the neuronal volume regulation in response to hypo-osmolarity and sensitize the brain vasculature to vasopressin.…”

Section: Central Pontine and Extrapontine Myelinolysis In An Infantmentioning

confidence: 99%

“…Once symptomatic, the prognosis is likely to be dismal. 6) Osmotic demyelination syndrome is very rare in the pediatric population, with only a few cases associated with chronic renal failure, dehydration, germ cell tumor, and craniopharyngioma. [1][2][3][4][5]12) Here we present a rare case of severe osmotic demyelination syndrome in an infant which oc- curred after endoscopic surgery of a suprasellar craniopharyngioma with resultant dismal outcome.…”

Section: Introductionmentioning

confidence: 99%

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Central Pontine and Extrapontine Myelinolysis in an Infant Associated With the Treatment of Craniopharyngioma -Case Report-

Tsutsumi

Yasumoto

Ito

2008

Neurol. Med. Chir.(Tokyo)

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A 3-year-old girl presented with osmotic demyelination syndrome after undergoing uneventful neuroendoscopic cystostomy for a growing cystic suprasellar craniopharyngioma following microscopic subtotal resection 1 year previously. Endocrinopathy had well been controlled by hormone replacement therapy and administration of 1-amino-8-d-arginine-vasopressin with serum sodium concentration within the normal range. She presented generalized seizure and fever on postoperative day 7, with hyponatremia beginning on postoperative day 4 and deteriorating despite frequent correction. The serum sodium concentration began to fluctuate on the same day, in the range 111-164 mEq/l, which lasted for 2 weeks, refractory for intense management. Her body temperature also fluctuated between hypoand hyperthermia not correlated with serum inflammatory markers. Her conscious disturbance progressively deteriorated with spastic paraparesis. T 2 -weighted magnetic resonance (MR) imaging taken on postoperative day 19 revealed hyperintense areas in the pons, external capsule, bilateral thalami, and basal nuclei, which had not been recognized before, suggesting osmotic demyelination syndrome causing central pontine and extrapontine myelinolysis. MR imaging taken on postoperative days 230 and 360 showed some diminished lesions but others persisted and resulted in a cavity. The patient's depressed conscious level did not improve. Suprasellar craniopharyngioma with long-standing hypothalamic dysfunction may be associated with severe osmotic demyelination syndrome even after less invasive surgery, so serum sodium derangement after surgery should be promptly corrected even if only subtle signs are present.

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Section: Central Pontine and Extrapontine Myelinolysis In An Infantmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Central Pontine and Extrapontine Myelinolysis In An Infantmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Central Pontine and Extrapontine Myelinolysis in an Infant Associated With the Treatment of Craniopharyngioma -Case Report-

Tsutsumi

Yasumoto

Ito

2008

Neurol. Med. Chir.(Tokyo)

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“…5 In addition, to avoid complications of overcorrection, patients with chronic hyponatremia should never be corrected more than 12 mmol in 24 hours and 18 mmol in 48 hours because of the potential risk of neurologic complications including central pontine myelinolysis. 12,13,68,69 The goal in treating hypervolemic hyponatremia seen in cirrhosis is decreased solute-free water consumption or increased excretion. Hence, the total volume of urine output and insensible losses must exceed free water intake, yielding a net negative balance.…”

Section: Clinical Associationsmentioning

confidence: 99%

Hyponatremia: Clinical Associations, Prognosis, and Treatment in Cirrhosis

Sharma²,

Saab³

2012

Exp Clin Transplant

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Hyponatremia has long been associated with worsened clinical outcomes in patients with cirrhosis and those awaiting liver transplant. However, in the last several years, new modalities of therapy, particularly aquaretics known as "vaptans," and comprehensive prognostic models have been increasingly studied in the hopes of bolstering serum sodium levels and altering liver transplant candidate status. To examine the most recent, comprehensive, and pertinent data, a systematic review of both prospective and retrospective studies available on MEDLINE was completed, which provided information detailing clinical associations, treatment, and prognoses seen in those with hyponatremia in cirrhosis. Clinical associations with hyponatremia in cirrhosis including hepatorenal syndrome and hepatic encephalopathy were identified. For hyponatremia in those awaiting liver transplant, tolvaptan is an effective agent in temporarily normalizing serum sodium levels with minimal risk of osmotic demyelination. Prognostic models incorporating serum sodium levels were better able to predict urgency and need for transplant; yet the benefits and posttransplant effects of redefining a liver allocation score have yet to be established. Key words: Hyponatremia, Cirrhosis, Outcomes IntroductionHyponatremia is a common electrolyte disturbance in patients with advanced liver disease. [1][2][3][4] In the setting of cirrhosis, hyponatremia can be classified as either hypovolemic hyponatremia, which occurs in the setting of overtreatment with diuretics or excessive losses from the gastrointestinal tract, or hypervolemic hyponatremia, which results in decreased effective circulating volume from increased arterial from splanchnic vasodilatation leading to excessive secretion of arginine vasopressin. 1,5,6 Hyponatremia can occur both before and after liver transplant. Pretransplant, it is associated with several clinical manifestations of decompensation, 4,7,8 and the degree of hyponatremia may increase the accuracy of the model for end-stage liver disease (MELD) score to predict survival. [8][9][10][11] Treatment of hyponatremia has not been demonstrated to improve survival in patients with advanced liver disease, and rapid correction can lead to life-threatening neurologic complications. 12,13 This systematic review focuses on the prevalence, clinical associations, treatment, and prognosis of hypervolemic hyponatremia in patients with liver disease. An algorithm will be developed to guide management based on best available data. Methods Search strategy and identification of studiesWe searched database MEDLINE for all studies on hyponatremia in the setting of cirrhosis as related to clinical implications, prognosis, and treatment. We used combinations of the key words: "hyponatremia," "sodium," "liver cirrhosis," "prevalence," "incidence," "intensive care units," "hepatorenal syndrome," "ascites," "central pontine myelinolysis," "therapeutics," "prognosis," and "liver Experimental and Clinical Transplantation (2013) 1: 3-11Christine Yu et a...

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