Hyponatremia in patients with infectious diseases

Liamis, Georgé; Milionis, Haralampos; Elisaf, Moses

doi:10.1016/j.jinf.2011.07.013

Cited by 66 publications

(83 citation statements)

References 92 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, a growing list of drugs implicated in the development of hyponatremia has been published [15], including NSAIDs, angiotensin converting enzyme inhibitors, rosiglitazone or even amlodipine [15]. Patients with central nervous system disorders, pulmonary disorders including lung infections, and malignancies may exhibit hyponatremia due to the syndrome of inappropriate antidiuresis [4,6,[16][17][18]. Patients with diabetic nephropathy and chronic renal failure are very prone to the development of hyponatremia due to decreased water excretion.…”

mentioning

confidence: 99%

Hyponatremia in Diabetes Mellitus: Clues to Diagnosis and Treatment

Vasilios¹

2015

J Diabetes Metab

View full text Add to dashboard Cite

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...

show abstract

mentioning

confidence: 99%

Hyponatremia in Diabetes Mellitus: Clues to Diagnosis and Treatment

Vasilios¹

2015

J Diabetes Metab

View full text Add to dashboard Cite

show abstract

“…sedatives or antidepressants), which are all well-established causes of hyponatremia (32,40). It is also possible that myxedema and hyponatremia may have a common underlying cause (e.g.…”

Section: Discussionmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Hypothyroidism-associated hyponatremia: mechanisms, implications and treatment

Liamis

Filippatos

Liontos

et al. 2017

European Journal of Endocrinology

View full text Add to dashboard Cite

Background: Patients with moderate to severe hypothyroidism and mainly patients with myxedema may exhibit reduced sodium levels (<135 mmol/L). Summary: The aim of this short review is the presentation of the mechanisms of hyponatremia and of the available data regarding its implications and treatment in patients with hypothyroidism. Hypothyroidism is one of the causes of hyponatremia, thus thyroid-stimulating hormone determination is mandatory during the evaluation of patients with reduced serum sodium levels. The main mechanism for the development of hyponatremia in patients with chronic hypothyroidism is the decreased capacity of free water excretion due to elevated antidiuretic hormone levels, which are mainly attributed to the hypothyroidism-induced decrease in cardiac output. However, recent data suggest that the hypothyroidism-induced hyponatremia is rather rare and probably occurs only in severe hypothyroidism and myxedema. Other possible causes and superimposed factors of hyponatremia (e.g. drugs, infections, adrenal insufficiency) should be considered in patients with mild/moderate hypothyroidism. Treatment of hypothyroidism and fluid restriction are usually adequate for the management of mild hyponatremia in patients with hypothyroidism. Patients with possible hyponatremic encephalopathy should be urgently treated according to current guidelines. Conclusions: Severe hypothyroidism may be the cause of hyponatremia. All hypothyroid patients with low serum sodium levels should be evaluated for other causes and superimposed factors of hyponatremia and treated accordingly.

show abstract

“…CNS infections that cause SIADH may do so via a ‘reset osmostat’. This is when the brain resets its osmostat to maintain serum sodium at a lower concentration than normal, and is facilitated by increased release of ADH [11]. Reset osmostat has been reported in diseases like tuberculosis and malaria [12,13].…”

Section: Discussionmentioning

confidence: 99%

Ticks and salt: an atypical case of neuroborreliosis

Siddiqui

Peter

Marur

2017

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

It is well documented that central nervous system (CNS) infections may lead to syndrome of inappropriate anti-diuretic hormone secretion (SIADH), but diagnosing these can prove difficult in patients with atypical presentations. We present a case of SIADH and muscle weakness in a patient without typical signs of CNS infection who was tested and diagnosed with neuroborreliosis based largely on her likelihood of exposure. This case indicates the need for Lyme testing in patients with unexplained SIADH who live in endemic areas. The patient was an 83-year-old female with a history of type 2 diabetes and hypertension, who presented from her primary care physician’s office when her sodium was found to be 123 mEq/L. Her sole symptom was proximal muscle weakness. The diagnosis of SIADH was reached based on laboratory data. A trial of fluid restriction was initiated, but neither her sodium nor her muscle weakness improved. Lyme testing was performed as the patient lived in an endemic area and was positive. Lumbar puncture showed evidence of neurologic involvement. After realizing the appropriate treatment for hyponatremia in this case, intravenous ceftriaxone was started, and patient’s sodium levels improved and muscle weakness resolved. Studies show that SIADH is associated with CNS infections, likely related to the inflammatory cascade. However, the atypical presentation of neuroborreliosis for our patient delayed the appropriate diagnosis and treatment. Our case demonstrates the need to screen for Lyme disease in endemic areas in patients presenting with neurologic symptoms and SIADH.

show abstract

Hyponatremia in patients with infectious diseases

Cited by 66 publications

References 92 publications

Hyponatremia in Diabetes Mellitus: Clues to Diagnosis and Treatment

Hyponatremia in Diabetes Mellitus: Clues to Diagnosis and Treatment

MANAGEMENT OF ENDOCRINE DISEASE: Hypothyroidism-associated hyponatremia: mechanisms, implications and treatment

Ticks and salt: an atypical case of neuroborreliosis

Contact Info

Product

Resources

About