Inspection of the internal jugular vein pulse appears to be superior to impedance analysis for determination of volemia in a Hyponatremia outpatient clinic

Lopez, Nevado Celia; Vadillo, Sandra; Villareal, Adriana; Ruiz, J J Novo; Cuesta, Martín; Perez, Candel Xavier; Barrio, Elvira; Larrad, A.; Calle, Pascual Alfonso; Runkle, Isabel

doi:10.1530/endoabs.70.ep281

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“…Although Cumming et al suggested its superiority to clinical examination in elderly patients [ 33 ], several limitations regarding the volemic evaluation have been encountered in their study. In contrast, our group found that physical inspection of the maximum HIJP is a clearly better tool for clinical decision-making than impedance [ 34 ]. These last findings are in accordance with the study by Vasko et al [ 35 ], where clinical judgment was found as the best element for overhydration assessment.…”

Section: Discussionmentioning

confidence: 99%

Changes in Serum Creatinine Levels Can Help Distinguish Hypovolemic from Euvolemic Hyponatremia

et al. 2022

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Background and Objectives: Differentiating between hypovolemic (HH) and euvolemic hyponatremia (EH) is crucial for correct diagnosis and therapy, but can be a challenge. We aim to ascertain whether changes in serum creatinine (SC) can be helpful in distinguishing HH from EH. Materials and Methods: Retrospective analysis of patients followed in a monographic hyponatremia outpatient clinic of a tertiary hospital during 1 January 2014–30 November 2019. SC changes during HH and EH from eunatremia were studied. The diagnostic accuracy of the SC change from eunatremia to hyponatremia (∆SC) was analyzed. Results: A total of 122 hyponatremic patients, median age 79 years (70–85), 46.7% women. In total, 70/122 patients had EH, 52/122 HH. During hyponatremia, median SC levels increased in the HH group: +0.18 mg/dL [0.09–0.39, p < 0.001], but decreased in the EH group: −0.07 mg/dL (−0.15–0.02, p < 0.001), as compared to SC in eunatremia. HH subjects presented a higher rate of a positive ∆SC than EH (90.4% vs. 25.7%, p < 0.001). EH subjects presented a higher rate of a negative/null ∆SC than HH (74.3% vs. 9.6%, p < 0.001). ROC curve analysis found an AUC of 0.908 (95%CI: 0.853 to 0.962, p < 0.001) for ∆SC%. A ∆SC% ≥ 10% had an OR of 29.0 (95%CI: 10.3 to 81.7, p < 0.001) for HH. A ∆SC% ≤ 3% had an OR of 68.3 (95%CI: 13.0 to 262.2, p < 0.001) for EH. Conclusions: The assessment of SC changes from eunatremia to hyponatremia can be useful in distinguishing between HH and EH.

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Section: Discussionmentioning

confidence: 99%