‘Normal’ serum sodium concentration among inpatients over 65 admitted to hospital: an observational study

Exall, Sarah; Stuckler, David; Wolff, Anthony

doi:10.1136/postgradmedj-2015-133482

Cited by 12 publications

(10 citation statements)

References 12 publications

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“…Our findings, therefore, challenge the rationale for keeping otherwise well patients in hospital solely to monitor Na. It has been suggested that the standard reference range for Na utilised by most laboratories may not be universally applicable to inpatients (McKee et al, 2016 ). Our data would support this concept and the notion that milder degrees of hyponatraemia are common and probably do not require extensive investigation or treatment.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, risk factors, and complications associated with hyponatraemia following elective primary hip and knee arthroplasty

Cunningham¹,

Gallagher²,

Hamilton

et al. 2021

Perioper Med

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Background Hyponatraemia, defined as a serum sodium [Na] concentration below 135 mmol/L, is common following surgery. As inpatient peri-operative stays shorten, there is a need to recognise pre-operative risk factors for post-operative hyponatraemia and complications associated with a peri-operative drop in Na. This audit aimed to investigate the prevalence of, risk factors for, and complications associated with hyponatraemia following elective primary hip and knee arthroplasty. Methods Data were collected within a retrospective audit of inpatient complications and unplanned reattendance or readmission at hospital in consecutive elective primary hip and knee arthroplasty patients in a single high throughput elective primary joint unit. The hospital’s electronic database identified 1000 patients who were admitted electively between February 2012 and June 2013 under the care of a single consultant orthopaedic surgeon for either total hip arthroplasty, total knee arthroplasty, or uni-compartmental knee arthroplasty. Groups were compared using appropriate tests, including chi-square analysis (or Fisher’s exact test), Mann-Whitney U test, Kruskal-Wallis test, and Wilcoxin signed-rank test. Logistic regression analysis was used to determine factors associated with hyponatraemia. Results Of the total 1000 patients, 217 (21.7%) developed post-operative hyponatraemia. Of these, 177 (81.6%) had mild (Na 130–134 mmol/L), 37 (17.1%) had moderate (Na 125–129 mmol/L), and 3 (1.4%) had severe (Na < 125 mmol/L) hyponatraemia. In multivariate analysis, age, pre-operative Na, and fasting glucose on day 1 remained significantly associated with having hyponatraemia post-operatively. There were no significant differences in reattendance at emergency departments and/or readmission within 90 days between those who had post-operative hyponatraemia whilst in hospital (39/217 = 18.0%) and those who did not (103/783 = 13.2%), or between those who were discharged with hyponatraemia (18/108 = 16.7%) and those discharged with normal Na (124/880 = 14.1%). Conclusion Approximately one fifth of elective joint arthroplasty patients had post-operative hyponatraemia. In these patients, older age, lower pre-operative Na and higher fasting glucose predicted post-operative hyponatraemia. We found no evidence that those discharged with hyponatraemia had more reattendance at emergency departments or readmission to hospital. We suggest that otherwise well patients with mild hyponatraemia can safely be discharged and followed up in the community.

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Section: Discussionmentioning

confidence: 99%

Prevalence, risk factors, and complications associated with hyponatraemia following elective primary hip and knee arthroplasty

Cunningham¹,

Gallagher²,

Hamilton

et al. 2021

Perioper Med

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“…Na + is omnipresent in the human host with Na + concentrations above 50 mM within human liquids [e.g. in urine and blood serum (Plough and Baker, 1959; Wang et al ., 2013; McKee et al ., 2016)]. Therefore, Na + cycling is discussed to be crucial for bacteria during infection of the human host (Dibrov et al ., 2004).…”

Section: Discussionmentioning

confidence: 99%

“…This work aimed to highlight the role of sodium ions in the physiology of A. baumannii. Sodium ions are one of the most abundant ions in the human host reaching concentrations of 145 mM in human serum (McKee et al, 2016) and Na + concentrations up to a physiological maximum of 290 mM in human urine (Plough and Baker, 1959;Wang et al, 2013). High intracellular sodium ion concentrations are toxic for bacteria and therefore, the internal Na + concentrations need to be strictly regulated (Padan et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Na⁺ homeostasis in Acinetobacter baumannii is facilitated via the activity of the Mrp antiporter

Hubloher

Sande

Müller

2022

Environmental Microbiology

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Summary The human opportunistic pathogen Acinetobacter baumannii is a global threat to healthcare institutions worldwide, since it developed very efficient strategies to evade host defence and to adapt to the different environmental conditions of the host. This work focused on the importance of Na+ homeostasis in A. baumannii with regards to pathobiological aspects. In silico studies revealed a homologue of a multicomponent Na+/H+ antiporter system. Inactivation of the Mrp antiporter through deletion of the first gene (mrpA′) resulted in a mutant that was sensitive to increasing pH values. Furthermore, the strain was highly sensitive to increasing Na+ and Li+ concentrations. Increasing Na+ sensitivity is thought to be responsible for growth impairment in human fluids. Furthermore, deletion of mrpA′ is associated with energetic defects, inhibition of motility and survival under anoxic and dry conditions.

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“…Given the reported high incidence of hyponatremia in older subjects, we scrutinized whether the commonly used reference limits for serum sodium which are derived from healthy young adults also apply to our geriatric population. Overseeing data from more than 110,000 patients, McKee and co-workers calculated that the mean [Na + ] was lower and the range wider in hospitalized patients >65 years 22 . We applied an indirect method which allows the determination of reference levels from data of a mixed population of healthy and diseased individuals 23 .…”

Section: Discussionmentioning

confidence: 99%

Impact of Resolution of Hyponatremia on Neurocognitive and Motor Performance in Geriatric Patients

Brinkkoetter

Grundmann

Ghassabeh

et al. 2019

Sci Rep

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This observational study investigated the impact of hyponatremia resolution on the results of a comprehensive geriatric assessment (CGA) in 150 patients with age ≥70 years and serum sodium <130 mEq/L. The test battery including Barthel index of Activities of Daily Living (ADL) and various tests of neurocognitive function, motor performance and mood stability was applied on admission and at discharge. Changes of individual test results (Δ) were analyzed and normonatremic patients matched for age, gender, and ADL served as reference group. Most CGA test results improved. The improvement was more pronounced in the hyponatremia group with respect to ADL (ΔADL: 14.3 ± 17.1 vs. 9.8 ± 14.7; p = 0.002) and MMSE (ΔMMSE: 1.8 ± 3.0 vs. 0.7 ± 1.9; p = 0.002). Effect sizes were small (i.e., >0.2) in the overall analysis for ΔADL and ΔMMSE and moderate (i.e., >0.5) for ΔMMSE in the euvolemic subgroup. Beneficial effects on ΔADL and ΔMMSE were only observed in the subgroup of patients in which [Na + ] was raised by >5 mEq/L and multivariable linear regression analysis confirmed [Na + ] increase to be an independent predictor of MMSE improvement. Resolution of hyponatremia has a beneficial impact on the geriatric patients’ overall functional status, in particular in euvolemic cases.

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‘Normal’ serum sodium concentration among inpatients over 65 admitted to hospital: an observational study

Abstract: The range for serum sodium concentration on admission in inpatients is broader and lower than the commonly accepted reference range. The risk of mortality increases at sodium concentration >139 mmol/L, well within reference range currently considered normal.

Cited by 12 publications

References 12 publications

Prevalence, risk factors, and complications associated with hyponatraemia following elective primary hip and knee arthroplasty

Prevalence, risk factors, and complications associated with hyponatraemia following elective primary hip and knee arthroplasty

Na⁺ homeostasis in Acinetobacter baumannii is facilitated via the activity of the Mrp antiporter

Impact of Resolution of Hyponatremia on Neurocognitive and Motor Performance in Geriatric Patients

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‘Normal’ serum sodium concentration among inpatients over 65 admitted to hospital: an observational study

Abstract: The range for serum sodium concentration on admission in inpatients is broader and lower than the commonly accepted reference range. The risk of mortality increases at sodium concentration >139 mmol/L, well within reference range currently considered normal.

Cited by 12 publications

References 12 publications

Prevalence, risk factors, and complications associated with hyponatraemia following elective primary hip and knee arthroplasty

Prevalence, risk factors, and complications associated with hyponatraemia following elective primary hip and knee arthroplasty

Na+ homeostasis in Acinetobacter baumannii is facilitated via the activity of the Mrp antiporter

Impact of Resolution of Hyponatremia on Neurocognitive and Motor Performance in Geriatric Patients

Contact Info

Product

Resources

About

Na⁺ homeostasis in Acinetobacter baumannii is facilitated via the activity of the Mrp antiporter