ABSTRACT
The aim of this study was to analyze the impact and the clinical and evolutionary characteristics of hypotonic hyponatremia in patients hospitalized in Internal Medicine units. Prospective multicenter observational study of patients with hypotonic hyponatremia (<135 mmol/L) in 5 hospitals in southern Spain. Patients were included according to point prevalence studies carried out every 2 weeks between March 2015 and October 2017, by assessing demographic, clinical, analytical, and management data; each patient was subsequently followed up for 12 months, during which time mortality and readmissions were assessed. A total of 501 patients were included (51.9% women, mean ageâ =â 71.3â ±â 14.24 years), resulting in an overall prevalence of hyponatremia of 8.3%. The mean comorbidities rate was 4.50â ±â 2.41, the most frequent diagnoses being heart failure (115) (23%), respiratory infections (65) (13%), and oncological pathologies (42) (6.4%). Of the total number of hyponatremia cases, 180 (35.9%) were hypervolemic, 164 (32.7%) hypovolemic, and 157 (31.3%) were euvolemic. A total of 87.4% did not receive additional diagnostic tests to establish the origin of the condition and 30% did not receive any treatment. Hospital mortality was 15.6% and the mean length of stay was 14.7 days. Euvolemic and admission hyponatremia versus hyponatremia developed during admission were significantly associated with lower mortality rates (Pâ =â .037). Mortality at 1 year and readmissions were high (31% and 53% of patients, respectively). Hyponatremia was common in Internal Medicine areas, with hypervolemic hyponatremia being the most frequent type. The mortality rate was high during admission and at follow-up; yet there is a margin for improvement in the clinical management of this condition.
Subject(s)
Hospital Mortality , Hyponatremia , Internal Medicine , Humans , Hyponatremia/epidemiology , Hyponatremia/etiology , Hyponatremia/diagnosis , Female , Male , Aged , Prospective Studies , Spain/epidemiology , Middle Aged , Aged, 80 and over , Hospitalization/statistics & numerical data , Prevalence , Patient Readmission/statistics & numerical data , Length of Stay/statistics & numerical data , Comorbidity , Hospital UnitsABSTRACT
La calcifilaxis es una enfermedad poco frecuente, aunque presenta una elevada tasa de mortalidad debido sobre todo a complicaciones como sepsis o gangrena. Generalmente se asocia a insuficiencia renal severa y en otras ocasiones a alteraciones del metabolismo calcio-fósforo o al uso de corticoides para enfermedades autoinmunes. Se presenta como lesiones cutáneas que se pueden ulcerar o infectar, debiendo diferenciarlas de las lesiones de causa vascular mediante el estudio histológico de la biopsia de la lesión. La biopsia cutánea muestra alteraciones histológicas características que facilitan el diagnóstico diferencial de esta patología. Para su tratamiento, se deben identificar y corregir los posibles factores implicados en su aparición. El tiosulfato de sodio es útil para el tratamiento. Presentamos el caso de una paciente con insuficiencia renal leve que padeció dicha entidad con buena evolución tras tratamiento (AU)
Calciphylaxis is a relatively rare disease associated with high mortality rates due to potential complications of sepsis or gangrene. It is observed mainly in patients with severe kidney disease, and in other cases it is associated with altered calcium-phosphorus metabolism or to the use of corticosteroids in the treatment of autoimmune diseases. It is characterized by painful skin lesions that may become ulcerated or infected. We must differentiate them from vascular lesions through a histological study of the lesion biopsy. The skin biopsy shows characteristic histological findings that facilitate differential diagnosis. As a treatment we must identify and correct risk factors involved in its development. Sodium thiosulphate has proved to be an effective treatment. We present the case of a patient with mild kidney disease who suffered calciphylaxis with good outcome after treatment (AU)
Subject(s)
Humans , Female , Aged , Skin , Skin/injuries , Biopsy , Leg Ulcer/drug therapy , Sodium Compounds/therapeutic use , Calciphylaxis/complications , Calciphylaxis/drug therapy , Renal Insufficiency/complications , Skin Diseases/pathology , Leg Ulcer/complications , Skin Diseases/drug therapy , Diagnosis, Differential , Skin/pathology , Wound Healing , Pain Management/methodsABSTRACT
La polimialgia reumática es una enfermedad inflamatoria reumática que se caracteriza por dolor y rigidez bilateral que afecta principalmente a la musculatura proximal. Aparece sobre todo en personas por encima de los 50 años y se asocia a una velocidad de sedimentación globular elevada en la analítica. La enfermedad generalmente responde muy bien a dosis bajas de corticoides. A continuación, presentamos el caso de un varón de 80años que presentó un cuadro compatible con polimialgia reumática asociado a derrame pleuropericárdico que respondió rápidamente a corticoides, con rápida mejoría en la sintomatología y en los hallazgos de laboratorio. La polimialgia reumática es una enfermedad que se presenta con relativa frecuencia pero que raramente se asocia a derrame pleuropericárdico. Es importante tenerla en cuenta en el diagnóstico diferencial del derrame pericárdico en personas mayores de 50años por su buena respuesta a tratamiento (AU)
Polymyalgia rheumatica is an inflammatory rheumatic disease that presents with bilateral pain and stiffness affecting mainly proximal muscles. It affects individuals over 50 years of age and it is usually associated with a raised erythrocyte sedimentation rate. Classically, treatment with low-dose corticosteroids results in a dramatic improvement in both symptoms and laboratory findings. We report the case of an 80 years old patient presenting polymyalgia rheumatica coinciding with pleuropericardial effusion. The patient had a very good response to treatment with rapid improvement in the symptomatology and laboratory findings. Polymyalgia Rheumatica is a common disease but it is rarely associated to pleuropericardial effusion. It should be considered in the differential diagnostic in patients presenting with pericardial effusion over 50 of age years due to the good response to treatment (AU)
Subject(s)
Humans , Male , Aged, 80 and over , Polymyalgia Rheumatica/complications , Polymyalgia Rheumatica/diagnosis , Polymyalgia Rheumatica/drug therapy , Pericardial Effusion/complications , Pericardial Effusion/diagnosis , Pleural Effusion/complications , Pleural Effusion/diagnosis , Adrenal Cortex Hormones/therapeutic use , Polymyalgia Rheumatica/physiopathology , Pleural Effusion/etiology , Diagnosis, Differential , Radiography, Thoracic/methods , Radiography, Thoracic , Tomography, Emission-ComputedABSTRACT
Polymyalgia rheumatica is an inflammatory rheumatic disease that presents with bilateral pain and stiffness affecting mainly proximal muscles. It affects individuals over 50 years of age and it is usually associated with a raised erythrocyte sedimentation rate. Classically, treatment with low-dose corticosteroids results in a dramatic improvement in both symptoms and laboratory findings. We report the case of an 80 years old patient presenting polymyalgia rheumatica coinciding with pleuropericardial effusion. The patient had a very good response to treatment with rapid improvement in the symptomatology and laboratory findings. Polymyalgia Rheumatica is a common disease but it is rarely associated to pleuropericardial effusion. It should be considered in the differential diagnostic in patients presenting with pericardial effusion over 50 of age years due to the good response to treatment.
