Sodium-based osmotherapy for hyponatremia in acute decompensated heart failure

Mohiuddin, Naushaba; Frinak, Stanley; Yee, Jerry

doi:10.1007/s10741-021-10124-7

Cited by 3 publications

(3 citation statements)

References 74 publications

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“…These values are controversial (Nguyen et al, 2016; Nguyen & Kurtz, 2004a), so until better measurements are made, it may be prudent to just denote them as

m

and

b

, as in

\left[\mathrm{Na}\right]=m\cdotp \frac{\mathrm{Na}+\mathrm{K}}{\mathrm{TBW}}+b

. Most sodium equations assume

m=1

and

b=0

(Chen, 2019; Chen et al, 2021; Chen & Shey, 2018; Mohiuddin et al, 2022); these values are used throughout, except where noted. Note:

m

is a scalar (unitless), and

b

has units of mEq/L.…”

Section: Methodsmentioning

confidence: 99%

“…The dilution should be determined scientifically, based upon the principles of sodium kinetics. This field uses sophisticated modeling to predict how the serum sodium will evolve under various perturbations, including RRT (Mohiuddin et al, 2022 ; Yee et al, 2020 ; Yessayan et al, 2016 ; Yessayan et al, 2021 ). Its quantitative underpinnings allow us to calculate ways to gradually increase the serum sodium throughout an RRT session.…”

Section: Introductionmentioning

confidence: 99%

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Safely correct hyponatremia with continuous renal replacement therapy: A flexible, all‐purpose method based on the mixing paradigm

Chen

Yee

Chiaramonte

2023

Physiological Reports

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Treating chronic hyponatremia by continuous renal replacement therapy (CRRT) is challenging because the gradient between a replacement fluid's [sodium] and a patient's serum sodium can be steep, risking too rapid of a correction rate with possible consequences. Besides CRRT, other gains and losses of sodium‐ and potassium‐containing solutions, like intravenous fluid and urine output, affect the correction of serum sodium over time, known as osmotherapy. The way these fluids interact and contribute to the sodium/potassium/water balance can be parsed as a mixing problem. As Na/K/H 2 O are added, mixed in the body, and drained via CRRT, the net balance of solutes must be related to the change in serum sodium, expressible as a differential equation. Its solution has many variables, one of which is the sodium correction rate, but all variables can be evaluated by a root‐finding technique. The mixing paradigm is proved to replicate the established equations of osmotherapy, as in the special case of a steady volume. The flexibility to solve for any variable broadens our treatment options. If the pre‐filter replacement fluid cannot be diluted, then we can compensate by calculating the CRRT blood flow rate needed. Or we can deduce the infusion rate of dextrose 5% water, post‐filter, to appropriately slow the rise in serum sodium. In conclusion, the mixing model is a generalizable and practical tool to analyze patient scenarios of greater complexity than before, to help doctors customize a CRRT prescription to safely and effectively reach the serum sodium target.

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“…These values are controversial (Nguyen et al, 2016; Nguyen & Kurtz, 2004a), so until better measurements are made, it may be prudent to just denote them as

m

and

b

, as in

\left[\mathrm{Na}\right]=m\cdotp \frac{\mathrm{Na}+\mathrm{K}}{\mathrm{TBW}}+b

. Most sodium equations assume

m=1

and

b=0

(Chen, 2019; Chen et al, 2021; Chen & Shey, 2018; Mohiuddin et al, 2022); these values are used throughout, except where noted. Note:

m

is a scalar (unitless), and

b

has units of mEq/L.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safely correct hyponatremia with continuous renal replacement therapy: A flexible, all‐purpose method based on the mixing paradigm

Chen

Yee

Chiaramonte

2023

Physiological Reports

Self Cite

View full text Add to dashboard Cite

show abstract

“…The osmolality is adjusted by varying the glucose content, ionic composition, in particular sodium content, or by diluting the isosmotic solution with distilled water. Selecting solutions with different sodium osmolality is associated with the most common electrolyte imbalance in patients, which leads to varying symptoms depending on severity, and is also associated with higher mortality from CVD [48,49]. Differences in osmotic and oncotic pressure locally in the myocardium can occur not only due to sodium, for example, but due to lactate during ischemia; hence, modeling of the ionic imbalance between the interstitium and the intracellular space is even more complicated.…”

Section: Cellular Models Of Myocardial Edemamentioning

confidence: 99%

Mechanisms of Myocardial Edema Development in CVD Pathophysiology

Kiseleva,

Kirichenko,

Markina

et al. 2024

Biomedicines

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Myocardial edema is the excess accumulation of fluid in the myocardial interstitium or cardiac cells that develops due to changes in capillary permeability, loss of glycocalyx charge, imbalance in lymphatic drainage, or a combination of these factors. Today it is believed that this condition is not only a complication of cardiovascular diseases, but in itself causes aggravation of the disease and increases the risks of adverse outcomes. The study of molecular, genetic, and mechanical changes in the myocardium during edema may contribute to the development of new approaches to the diagnosis and treatment of this condition. This review was conducted to describe the main mechanisms of myocardial edema development at the molecular and cellular levels and to identify promising targets for the regulation of this condition based on articles cited in Pubmed up to January 2024.

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Arrhythmogenic Potential of Myocardial Edema: The Interstitial Osmolality Induces Spiral Waves and Multiple Excitation Wavelets

Kiseleva,

Dzhabrailov,

Aitova

et al. 2024

Biomedicines

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Myocardial edema is a common symptom of pathological processes in the heart, causing aggravation of cardiovascular diseases and leading to irreversible myocardial remodeling. Patient-based studies show that myocardial edema is associated with arrhythmias. Currently, there are no studies that have examined how edema may influence changes in calcium dynamics in the functional syncytium. We performed optical mapping of calcium dynamics on a monolayer of neonatal rat cardiomyocytes with Fluo-4. The osmolality of the solutions was adjusted using the NaCl content. The initial Tyrode solution contained 140 mM NaCl (1T) and the hypoosmotic solutions contained 105 (0.75T) and 70 mM NaCl (0.5T). This study demonstrated a sharp decrease in the calcium wave propagation speed with a decrease in the solution osmolality. The successive decrease in osmolality also showed a transition from a normal wavefront to spiral wave and multiple wavelets of excitation with wave break. Our study demonstrated that, in a cellular model, hypoosmolality and, as a consequence, myocardial edema, could potentially lead to fatal ventricular arrhythmias, which to our knowledge has not been studied before. At 0.75T spiral waves appeared, whereas multiple wavelets of excitation occurred in 0.5T, which had not been recorded previously in a two-dimensional monolayer under conditions of cell edema without changes in the pacing protocol.

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Sodium-based osmotherapy for hyponatremia in acute decompensated heart failure

Cited by 3 publications

References 74 publications

Safely correct hyponatremia with continuous renal replacement therapy: A flexible, all‐purpose method based on the mixing paradigm

Safely correct hyponatremia with continuous renal replacement therapy: A flexible, all‐purpose method based on the mixing paradigm

Mechanisms of Myocardial Edema Development in CVD Pathophysiology

Arrhythmogenic Potential of Myocardial Edema: The Interstitial Osmolality Induces Spiral Waves and Multiple Excitation Wavelets

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