Mild Chronic Hyponatremia Is Associated With Falls, Unsteadiness, and Attention Deficits

Renneboog, B.; Musch, Wim; Vandemergel, X.; Manto, Mario; Decaux, Guy

doi:10.1016/j.amjmed.2005.09.026

Cited by 765 publications

(643 citation statements)

References 19 publications

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“…Our experience suggests that for most patients with symptomatic hyponatremia, this aggressive approach may not be necessary, and we are unaware of any data showing that it produces better results than the more conservative approach that we have used. As others have reported (18,19), most patients with hyponatremia have at least subtle symptoms, and in our patients, these symptoms did not worsen or lead to respiratory arrests during treatment despite rates of correction that are considerably slower than what others have reported. We do not dispute the recommendation that patients with active seizures or impending herniation be given 100-ml bolus infusions of hypertonic saline (12); however, we did not encounter any patients with such a presentation in this series.…”

Section: Discussionmentioning

confidence: 42%

Hypertonic Saline for Hyponatremia

Mohmand

Issa

Ahmad

et al. 2007

Clinical Journal of the American Society of Nephrology

159

112

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Background and objectives: Data regarding dosage-response relationships for using hypertonic saline in treatment of hyponatremia are extremely limited. Objectives of this study were to assess adherence to previously published guidelines (limiting correction to <12 mEq/L per d and <18 mEq/L per 48 h) in treating hyponatremia with hypertonic saline and to determine the predictive accuracy of the Adrogué-Madias formula.Design, setting, participants & measurements: A retrospective review was conducted of all 62 adult, hyponatremic patients who were treated with hypertonic saline during 5 yr at a 528-bed, acute care, teaching hospital.Results: Median infusion rate was 0.38 ml/kg per h, increasing serum sodium concentration by 0.47 ؎ 0.05 mEq/L per h, 7.1 ؎ 0.6 mEq/L per 24 h, and 11.3 ؎ 0.7 mEq/L per 48 h. In 11.3% of cases, the increase was >12 mEq/L per 24 h and in 9.7% was >18 mEq/L per 48 h. No patient's rate was corrected by >25 mEq/L per 48 h. Among patients with serum sodium <120 mEq/L, the observed increase in sodium exceeded the rise predicted by the Adrogué-Madias formula in 74.2%; the average correction in overcorrectors was 2.4 times the predicted. Inadvertent overcorrection was due to documented water diuresis in 40% of cases.Conclusions: The Adrogué-Madias formula underestimates increase in sodium concentration after hypertonic saline therapy. Unrecognized hypovolemia and other reversible causes of water retention pose a risk for inadvertent overcorrection. Hypertonic saline should be infused at rates lower than those predicted by formulas with close monitoring of serum sodium and urine output.

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Section: Discussionmentioning

confidence: 42%

Hypertonic Saline for Hyponatremia

Mohmand

Issa

Ahmad

et al. 2007

Clinical Journal of the American Society of Nephrology

159

112

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“…Most studies to date in patients with hyponatremia have only been of relatively short duration. Thus, the most appropriate way to use these agents, their long-term response rates, how important the role of water restriction will remain during chronic use, and whether correction of chronic hyponatremia will result in improved cognitive function as suggested by 30-day studies of tolvaptan, 112 and quality of life, or functional status, as suggested by initial studies of gait stability and falls, 120 are unknown at the present time and will require additional study.…”

Section: Potential Future Indications For Vasopressin Receptor Antagomentioning

confidence: 99%

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Verbalis

Goldsmith

Greenberg

et al. 2007

The American Journal of Medicine

523

498

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Although hyponatremia is a common, usually mild, and relatively asymptomatic disorder of electrolytes, acute severe hyponatremia can cause substantial morbidity and mortality, particularly in patients with concomitant disease. In addition, overly rapid correction of chronic hyponatremia can cause severe neurologic deficits and death, and optimal treatment strategies for such cases are not established. Hyponatremia is the most common disorder of electrolytes encountered in clinical practice, occurring in up to 15% to 30% of both acutely and chronically hospitalized patients. 1 Although most cases are mild and relatively asymptomatic, hyponatremia is important clinically because: (1) acute severe hyponatremia can cause substantial morbidity and mortality; (2) mortality is higher in patients with hyponatremia who have a wide range of underlying diseases; and (3) overly rapid correction of chronic hyponatremia can cause severe neurologic deficits and death.Despite knowledge of hyponatremia since the mid-20th century, this common disorder remains incompletely understood in many basic areas because of its association with a plethora of underlying disease states, and its multiple etiologies with differing pathophysiologic mechanisms. 2 Optimal treatment strategies have not been well defined, both for these reasons and because of marked differences in symptomatology and clinical outcomes based on the acuteness or chronicity of the hyponatremia. 3 Vasopressin receptor antagonists have long been anticipated as a more effective method to treat hyponatremia by virtue of their unique aquaretic effect to selectively increase solute-free water excretion by the kidneys. 4 The recent approval of the first such agent, conivaptan, for clinical use by the US Food and Drug Administration (FDA) heralds the beginning of a new era in the management of hyponatremic disorders. However, effective therapy with these agents will require intelligent guidelines for their use. To this end, a panel of experts in hyponatremia convened to review current therapies for hyponatremia and to evaluate the situations in which aquaretic agents should be considered as alternatives or supplements to accepted current therapies. This review is a summary of the conclusions of this panel.

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“…Symptoms are associated primarily with the severity of the HN, and range from confusion and vomiting in mild HN (< 135 mmol/l sodium) to seizures, coma and death in severe cases (< 125 mmol/l sodium; Figure 1) 4, 12, 13. In addition to symptoms, patients are subject to serious sequelae of HN, including gait abnormalities, falls 14, and an increased fracture risk 15. Such morbidities are clinically significant, as HN is particularly common in elderly people 12.…”

Section: Introductionmentioning

confidence: 99%

Evidence for the use of demeclocycline in the treatment of hyponatraemia secondary to SIADH : a systematic review

2015

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SummaryAimsHyponatraemia (HN) is the most common electrolyte balance disorder in clinical practice. Since the 1970s, demeclocycline has been used in some countries to treat chronic HN secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH). The precise mechanism of action of demeclocycline is unclear, but has been linked to the induction of nephrogenic diabetes insipidus. Furthermore, the safety profile of demeclocycline is variable with an inconsistent time to onset, and a potential for complications. There has been no systematic evaluation of the use of demeclocycline for the treatment of HN secondary to SIADH to date. A systematic literature review was performed to obtain an insight into the clinical safety and efficacy of demeclocycline for this condition.MethodsEmbase™, MEDLINE ®, MEDLINE ® In‐Process, and The Cochrane Library were searched on two occasions using MeSH terms combined with free‐text terms. References were screened by two independent reviewers. Relevant publications were then extracted by two independent reviewers, with a third reviewer collating and finalising extractions.ResultsThe searches returned a total of 705 hits. 632 abstracts were screened after the removal of duplicates. Following screening, 35 full‐length publications were reviewed. Of these, 17 were excluded, resulting in 18 studies deemed relevant for data extraction. Two were randomised controlled trials (RCTs), 16 were non‐RCTs, and 10 were case reports.DiscussionAlthough most reports suggest that demeclocycline can address serum sodium levels in specific patients with HN, efficacy is variable, and may depend upon the underlying aetiology. Demeclocycline dose adjustments can be complex, and as its use in clinical practice is not well defined, it can differ between healthcare professionals.ConclusionThere is a lack of clinical and economic evidence supporting the use of demeclocycline for HN secondary to SIADH. Patients receiving demeclocycline for HN secondary to SIADH must be closely monitored.

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Mild Chronic Hyponatremia Is Associated With Falls, Unsteadiness, and Attention Deficits

Cited by 765 publications

References 19 publications

Hypertonic Saline for Hyponatremia

Hypertonic Saline for Hyponatremia

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Evidence for the use of demeclocycline in the treatment of hyponatraemia secondary to SIADH : a systematic review

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