Development of hyponatremia in non-critical patients receiving total parenteral nutrition: A prospective, multicenter study.

BACKGROUND & AIMS: Hyponatremia is frequent in hospitalized patients, especially in those receiving total parenteral nutrition (TPN). Furthermore, the presence of hyponatremia is associated with increased morbimortality in both groups. The goal of this study is to describe the prevalence of hyponatremia developing during TPN in non-critical patients, and identify risk factors for its appearance. METHODS: This prospective multicenter study involved 19 Spanish hospitals. Noncritically-ill patients prescribed TPN over a 9-month period were studied. Variables analyzed demographic characteristics, prior comorbidities, drug therapy, PN composition, additional iv fluids, and serum sodium levels. RESULTS: A total of 543 patients were recruited, 60.2% males. Age: 67 (IR 57-76). Of 466/543 who were eunatremic when starting TPN, 18% developed hyponatremia (serum sodium < 135 mmol/L) during TPN. Independent risk factors identified by logistic regression analysis: female (OR 1.74 [95% CI = 1.04-2.92], p = 0.036); severe malnutrition (OR 2.15 [95% CI = 1.16-4.35], p = 0.033); opiates (OR 1.97 [95% CI = 1.10-3.73], p = 0.036); and nausea/vomiting (OR 1.75 [95% CI = 1.04-2.94], p = 0.036). CONCLUSIONS: Previously eunatremic patients frequently develop hyponatremia while receiving TPN. In this group, severe malnutrition is an independent risk factor for hyponatremia, as well as previously described risk factors: opiates, nausea/vomiting, and female gender.

PREDyCES study: The cost of hospital malnutrition in Spain.

OBJECTIVES: The aim of this study was to analyze the economic effects of hospital malnutrition and the cost of longer hospital stays according to the Prevalence of Hospital Malnutrition and Associated Costs in Spain (PREDyCES) study data. METHODS: This was a nested case-control study in a prospective cohort of patients (n = 114) who were at nutritional risk at admission and controls (n = 354) who were not at risk at admission. The total cost of hospital stay was the cost of the bed plus the cost of drugs administered during the stay. Hospital costs were extrapolated to Spanish National Health System admissions for 2009. RESULTS: The mean hospital length of stay for patients at risk (cases) was significantly longer (11.5 ± 7.5 versus 8.5 ± 5.8 d; P < 0.001) than for the controls. The cost of patients at risk at admission was significantly higher than that of those not at risk (€8590 ± €6127 versus €7085 ± €5625; P = 0.015). The most significant difference in the cost of the hospital stay was observed between controls at nutritional risk at discharge and controls who remained not at risk throughout the hospital stay (€13 013 ± €9086 versus €6665 ± €5091; P < 0.001). Extrapolation of the study findings to Spanish National Health System hospital admissions showed that the potential cost of hospital malnutrition in Spain was at least €1.143 billion per year. CONCLUSION: Hospital malnutrition in Spain is associated with substantial costs, suggesting the need to establish procedures for screening, diagnosing, and treating malnutrition.

La lucha contra la desnutrición. Evidencias de la eficacia de su tratamiento y coste de la desnutrición. Utilización óptima de los recursos disponibles / Fighting against malnutrition. Evidence of the efficiency of treating it and malnutrition costs. Optimal utilization of the available resources

La Desnutrición relacionada con la enfermedad(DRE) constituye un problema socio-sanitario, universal ,altamente prevalente, infradiagnosticado e infratratado. Complica la evolución de los pacientes, alarga su estancia hospitalaria y aumenta el número de reingresos prematuros con el consiguiente aumento en la utilización de recursos sanitarios lo que eleva su coste. Se estima que en Europa hay 33 millones de personas en riesgo de desnutrición lo que supone un coste de 170 billones de euros. La European Nutrition For Health Alliance (ENHEA) se ha constituido como un grupo de presión que trabaja con el objetivo de mejorar la atención nutricional de los pacientes en Europa mediante la promoción activa de la implementación de la detección del riesgo nutricional en Europa; la conciencia pública; las políticas apropiadas de reembolso y la formación a los equipos sanitarios. Con el mismo impulso se han venido desarrollando en los últimos años distintas iniciativas en países europeos de nuestro entorno con la implementación de programas y planes de Lucha Contra la Desnutrición. En el texto el modelo Holandés es revisado con más detalle analizando los factores que han hecho posible cosechar éxitos poco tiempo después de su implantación. El uso adecuado de los recursos nutricionales permite definir fórmulas de ahorro. La suplementación oral es una terapia actica no invasiva enel abordaje de la DRE en todos los niveles asistenciales. Mejora la ganancia de peso y previene su pérdida en pacientes en riesgo de desnutrición. Su utilización está directamente relacionada con reducción de morbimortalidad de pacientes desnutridos

Disease-related malnutrition (DRM) represents a universal, highly prevalent social and health problem, which is underdiagnosed and undertreated. It complicates the clinical course of the patients, prolongs their hospital staying, and increases the number of early re-admissions with the subsequent increase in health resources usage, increasing the costs. It is estimated that in Europe 33 million people are at risk for malnutrition, representing a cost of € 170 billion. The European Nutrition For Health Alliance (ENHEA) has-been created as a lobbying group working with the aim of improving the nutritional care of European patients by actively promoting the implementation of detection of nutritional risk in Europe; public awareness; appropriate reimbursement policies, and heath teams training. In the last years, several initiatives have been developed in neighbor European countries with the implementation of programs and plans to Fight Against Malnutrition. In this manuscript, the Dutch model is reviewed in more detail by analyzing the factors that have made possible its success in a short time after its implementation. Appropriate usage of nutritional resources allows defining ways for saving. Oral supplementation is an active, rather than invasive, therapy in the management of DRM at all health care levels. It improves weight gaining and prevents weight loss in patients at risk for malnutrition. Its usage is directly related with a reduced morbimortality rate in malnourished patients

[Pendred's syndrome: a cause of goiter associated with deafness]. / Síndrome de Pendred: una causa de bocio relacionada con sordera.

Pendred's syndrome is an autosomal recessive disorder leading to congenital sensorineural hearing loss and a variable degree of goiter due to reduced iodine organification. The cause of this disease is dysfunction of an anion transporter protein located on the apical membrane of thyrocytes, called pendrin, which is also found in the kidney and cochlea. Molecular analysis of the gene is useful to identify other affected family members and provide proper genetic advice and early diagnosis in descendants. We present the cases of two siblings with sensorineural deafness who were diagnosed with Pendred's syndrome as adults because one of them consulted for goiter.