Hyponatremia could identify patients with intrabdominal sepsis and anastomotic leak after colorectal surgery: a systematic review of the literature

Alsaleh, Ahmad; Pellino, Gianluca; Christodoulides, Natasha; Malietzis, George; Kontovounisios, Christos

doi:10.1007/s13304-019-00627-2

Cited by 8 publications

(5 citation statements)

References 12 publications

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“…The circulating cytokines cross the blood-brain barrier and act on the neurons of the supraoptic and the paraventricular nucleus. Subsequently, there is activation of the Janus tyrosine kinases-signal transducer and activator of transcription (JAK-STAT) pathway, thus leading to the release of ADH [ 52 , 53 , 54 , 55 , 56 ]. This non-osmotic release of ADH leads to excess free water reabsorption in the kidneys and causes dilutional hyponatremia.…”

Section: Discussionmentioning

confidence: 99%

Hyponatremia—A New Diagnostic Marker for Complicated Acute Appendicitis in Children: A Systematic Review and Meta-Analysis

et al. 2022

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Background: Acute appendicitis in the pediatric population remains a diagnostic challenge for clinicians. Despite many biochemical markers, imaging modalities and scoring systems, initial misdiagnosis and complication rates are high in children. This suggests the need for investigations directed towards new diagnostic tools to aid in the diagnosis. Recent studies have shown a correlation between serum sodium levels and complicated appendicitis. Although the exact reasons for hyponatremia in patients with complicated appendicitis are not known, there is persuasive data to support the role of pro-inflammatory cytokines such as IL-6 in the non-osmotic release of antidiuretic hormone. This meta-analysis aims to investigate all available data on hyponatremia as a diagnostic marker of complicated appendicitis in the pediatric population. Methods: The literature search was conducted by two independent investigators according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The scientific databases (PubMed, EMBASE, Web of Science, and Scopus) were systematically searched for relevant studies using the keywords (hyponatremia) AND (appendicitis) AND (children). The methodological quality was assessed using a validated scale, and RevMan 5.4 software was utilized for pooled analysis. Results: Seven studies were included in the final meta-analysis, five of which were retrospective. A total of 1615 and 2808 cases were distributed into two groups: group A with complicated appendicitis and group B with uncomplicated acute appendicitis, respectively. The studies compared serum sodium levels of patients among the groups. Pooling the data demonstrated significantly lower serum sodium levels in children with complicated appendicitis vs. the non-complicated appendicitis (WMD: −3.29, 95% CI = −4.52 to −2.07, p < 0.00001). The estimated heterogeneity among the included studies was substantial and statistically significant (I2 = 98%, p < 0.00001). Conclusion: The results of the present meta-analysis indicate that hyponatremia has potential to be utilized as a biochemical marker in the diagnosis of complicated appendicitis in the pediatric population. However, well designed prospective diagnostic efficiency studies are essential to consolidate the association between hyponatremia and complicated acute appendicitis.

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Section: Discussionmentioning

confidence: 99%

Hyponatremia—A New Diagnostic Marker for Complicated Acute Appendicitis in Children: A Systematic Review and Meta-Analysis

et al. 2022

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“…According to his laboratory test results, we found high leukocyte levels, which could have indicated an infectious or inflammatory process. Some studies have mentioned that sepsis may cause hypernatremia with unknown mechanisms [16]. In this patient, sepsis could have been the cause of leukocytosis, but other findings did not match this condition, including normal CRP levels and negative blood and urine cultures, but it seems we could not rely on the laboratory results due to starting antibiotic therapy before sending culture samples.…”

Section: Time From Admission 0 H 4 H 8 H 12 H 18 H 24 H 30 H 36 H 42 Hmentioning

confidence: 70%

“…As the patient was dehydrated, we considered hypovolemic hyponatremia. The normal findings for kidney function and normal urine sodium levels guided us toward extrarenal sodium losses in this patient, especially skin losses [16]. We attempted to correct his sodium level, but due to the increasing endogenous osmoles such as glucose (hyperglycemia) or exogenous sources such as mannitol, that shifted water out of cells and expanded the extracellular volume, this correction was not completed.…”

Section: Time From Admission 0 H 4 H 8 H 12 H 18 H 24 H 30 H 36 H 42 Hmentioning

confidence: 99%

Severe hyponatremia in an infant with epidermolysis bullosa: a case report

2022

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Background Epidermolysis bullosa is a rare inherited connective tissue disorder compromising cellular junctions. Blister formation is the first manifestation of epidermolysis bullosa. As cellular adhesion is affected, it can affect many organs. Due to compromised skin integrity, water loss and electrolyte imbalances are prevalent in these patients. However, hypernatremia is the usual observed sodium imbalance rather than hyponatremia. Case presentation The patient was a 48-day-old Iranian male infant born near term. He was diagnosed with epidermolysis bullosa at 1 month of age. The patient was brought to the pediatrics center with apnea and respiratory distress, and was intubated and admitted to the pediatric intensive care unit. His symptoms started 4 days before the admission with vomiting and poor feeding, and the patient later developed loss of consciousness. Vital signs revealed a pulse rate of 154 beats per minute, respiratory rate of 70 per minute, a temporal temperature of 36.5 °C, nondetectable blood pressure, and oxygen saturation of 96%. The patient was anuric at presentation and was rehydrated. Physical examination showed bolus eruptions all over the body but not in mucosal membranes. Important laboratory findings were white blood cell count of 41,000/mm3 with 68% neutrophils, hemoglobin of 10.8 g/dL, platelet count of 856,000/mm2, negative C-reactive protein (CRP), blood sugar of 514 mg/dL, urea of 129 mg/dL, sodium of 98 mg/dL, corrected sodium of 105 mg/dL, potassium of 5.5 mg/dL, serum creatinine of 1.7 mg/dL, and serum procalcitonin of more than 75 ng/mL. Urine analysis revealed many red blood cells. Brain computed tomography demonstrated loss of differentiation between gray and white matter and effacement of cortical sulci suggesting severe cytotoxic edema. We administered 3% hypertonic saline and corrected the plasma sodium levels, and provided the patient with multiple doses of mannitol as well as antibiotics due to the leukocytosis. Subsequently, after 3 days in pediatric intensive care unit, the symptoms of brain edema resolved, and after 4 days, he was weaned from the ventilator and extubated. Later he was discharged from the pediatric intensive care unit. Conclusion This study illustrates the possibility of severe hyponatremia in patients with epidermolysis bullosa to clinicians. Although uncommon, knowledge on such possibilities is vital due to the possible detrimental outcomes for patients.

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“…Of note, hyponatremia (sodium <136 mmol/L) is not only associated with a PA but also with an increased morbidity and mortality [27][28][29]. In this context, hyponatremia has been hypothesized to have predictive value in detection of perforation in sigmoid diverticulitis in older patients undergoing emergency surgery [29] and anastomotic leakage in patients following colorectal surgery [30]. Compared to the results of a prospective study by Pogorelić et al [13], the discriminatory accuracy of our data on sodium was lower regarding differentiation of a PA from AA.…”

Section: Discussionmentioning

confidence: 99%

Levels of C‐Reactive Protein and Sodium May Differentiate a Perforated Appendix from a Nonperforated Appendix in Children

Nissen

Tröbs

2021

BioMed Research International

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Background. Acute appendicitis (AA) might be amenable to conservative antibiotic treatment, whereas a perforated appendix (PA) necessitates surgery. We investigated the value of clinical–laboratory markers in distinguishing AA from a PA. Methods. Retrospectively obtained preoperative parameters for 306 consecutive patients (<18 years) with histologically confirmed appendicitis (AA ( n = 237 ) vs. PA ( n = 69 )), treated at our institution between January 2014 and December 2017. Results. A PA was associated with male preponderance, younger age, decreased sodium level and increased white blood cell count, Tzanakis score, C-reactive protein (CRP) level, and CRP-to-lymphocyte ratio (CLR). Upon discrimination analysis, CLR and CRP displayed the highest accuracy in differentiating a PA from AA. Regression analysis identified levels of CRP, sodium, and the Tzanakis score as independent predictors for a PA. Conclusion. Levels of CLR, CRP, sodium, and Tzanakis score might support decision-making regarding treatment options for pediatric appendicitis.

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Hyponatremia could identify patients with intrabdominal sepsis and anastomotic leak after colorectal surgery: a systematic review of the literature

Cited by 8 publications

References 12 publications

Hyponatremia—A New Diagnostic Marker for Complicated Acute Appendicitis in Children: A Systematic Review and Meta-Analysis

Hyponatremia—A New Diagnostic Marker for Complicated Acute Appendicitis in Children: A Systematic Review and Meta-Analysis

Severe hyponatremia in an infant with epidermolysis bullosa: a case report

Levels of C‐Reactive Protein and Sodium May Differentiate a Perforated Appendix from a Nonperforated Appendix in Children

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