Patient and medication-related factors associated with hospital-acquired hyponatremia in patients hospitalized from heart failure

Abstract

Background Hyponatremia has been known as an important predictor of clinical outcomes in patients with heart failure (HF). While information on hyponatremia in patients with HF has been available abundantly, information on factors associated with increased risk of developing hospital-acquired hyponatremia (HAH) is still limited. Objective To identify patients and medication-related factors associated with HAH in patients hospitalized from HF. Setting Fatmawati Hospital in Jakarta, Indonesia. Methods This is a nested case-control study with patients developing HAH served as case group and each patient in case group was matched by age and gender to three patients in control group. Patients included in this study are patients hospitalized from HF, and coded with I.50 according to ICD-10, during 2011-2013 at Fatmawati Hospital in Jakarta, Indonesia. Information retrieved from patients' medical records included demographic profiles, vital signs and symptoms at admission, past medical history, medication during hospitalization and clinical chemistry laboratory records. Multivariable logistic regression analysis was performed to find out patient and treatment-related factors associated with the development of HAH. Main outcome measures Patients and medication related factors having significant association with HAH. Results Four hundreds sixty-four patients were included in this study and 45 of them (9.7 %) met criteria of developing HAH so then, accordingly, 135 patients were selected as controls. 36 patient- and 22 treatment-related factors were analyzed in univariate logistic regression resulted in 20 factors having p value <0.2 and were included in multivariable logistic regression analysis. Final factors showing significant association with HAH are presence of ascites at admission (odds ratio = 4.7; 95 % confidence interval 1.9-11.5) and administration of amiodarone (3.2; 1.3-7.4) and heparin (3.1; 1.2-7.3) during hospital stay. Conclusion Presence of ascites at admission was found as patient-related factors associated with HAH in this study. In addition, administration of amiodarone and heparin during hospital stay were found as medication-related factors associated with HAH in patients hospitalized from HF.

Adverse Events with Amiodarone—Will the List Ever End?

“…Their report details the time course as related to amiodarone use, both with respect to its appearance and its termination. As with the other rare reports of this association (specifically, the 17 cases mentioned in the review by Barham et al and several more I identified 5,6 ), under lying disorders, including heart failure, pulmonary disorders, and the like, have also been present. Nonetheless, with considered deliberation and evaluation, the relationship to amiodarone seems highly likely, though its development in the absence of other underlying patho logies is uncertain.…”

Hiponatremia e hiperpotasemia persistente inducida por enoxaparina y revertida con hidrocortisona en paciente con metástasis lumbares

“…Otra opción descrita es el uso concomitante de HBPM con fludrocortisona 10 . Si bien es menos frecuente, el desarrollo de hiponatremia inducida por heparina también está descrito en la literatura, probablemente también mediado por el bloqueo del eje aldosterónico 2,11 . En general, se trata de hiponatremias leves, no menores de 130.…”

First ripples in a tidal wave?

“…As diuretics excrete sodium and the water goes with the sodium, plus the inhibition of aldosterone release and antagonism of its action, we find one easy explanation for the growing interest in hyponatremia as a frequently missed condition. This "depletional" form of hyponatremia occurs at serum sodium levels much closer to what is regarded as "normal," frequently identified with levels around 130-135 mmol/l, which is very different from the "dilutional" form seen with the syndrome of inappropriate antidiuretic hormone secretion produced by medications such as the selective serotonin reuptake inhibitors where levels of 118-125 mmol/l are common (Saepudin et al, 2015;2016).…”