Documento práctico del manejo de la hiponatremia en pacientes críticos / Practical document on the management of hyponatremia in critically ill patients

La hiponatremia es el trastorno electrolítico más prevalente en las Unidades de Cuidados Intensivos. Se asocia a un aumento de la morbilidad, mortalidad y estancia hospitalaria. La mayoría de los estudios publicados hasta el momento son observacionales, retrospectivos y no incluyen pacientes críticos, lo que dificulta la extracción de conclusiones sólidas. Además, debido a la escasa evidencia científica de calidad, incluso las recomendaciones realizadas por distintas sociedades científicas recientemente publicadas difieren en aspectos importantes como son el diagnóstico o el tratamiento de la hiponatremia. Los mecanismos etiopatogénicos en los pacientes críticos suelen ser complejos. Sin embargo, hay que profundizar en ellos para llegar al diagnóstico más probable y a la pauta de tratamiento más adecuada. Todo ello, ha motivado la realización de esta revisión práctica sobre aspectos útiles en el abordaje de la hiponatremia en las Unidades de Cuidados intensivos, con el objetivo de homogeneizar el manejo de esta entidad y disponer de un algoritmo diagnóstico a nivel nacional

Hyponatremia is the most prevalent electrolyte disorder in Intensive Care Units. It is associated with an increase in morbidity, mortality and hospital stay. The majority of the published studies are observational, retrospective and do not include critical patients; hence it is difficult to draw definitive conclusions. Moreover, the lack of clinical evidence has led to important dissimilarities in the recommendations coming from different scientific societies. Finally, etiopathogenic mechanisms leading to hyponatremia in the critical care patient are complex and often combined, and an intensive analysis is clearly needed. A study was therefore made to review all clinical aspects about hyponatremia management in the critical care setting. The aim was to develop a Spanish nationwide algorithm to standardize hyponatremia diagnosis and treatment in the critical care patient

Practical document on the management of hyponatremia in critically ill patients. / Documento práctico del manejo de la hiponatremia en pacientes críticos.

Hyponatremia is the most prevalent electrolyte disorder in Intensive Care Units. It is associated with an increase in morbidity, mortality and hospital stay. The majority of the published studies are observational, retrospective and do not include critical patients; hence it is difficult to draw definitive conclusions. Moreover, the lack of clinical evidence has led to important dissimilarities in the recommendations coming from different scientific societies. Finally, etiopathogenic mechanisms leading to hyponatremia in the critical care patient are complex and often combined, and an intensive analysis is clearly needed. A study was therefore made to review all clinical aspects about hyponatremia management in the critical care setting. The aim was to develop a Spanish nationwide algorithm to standardize hyponatremia diagnosis and treatment in the critical care patient.

Pérdidas de nitrógeno y balance nitrogenado en pacientes con infarto maligno de la arteria cerebral media y sometidos a hipotermia moderada (32-33 ºC) / Nitrogen losses and nitrogen balance in patients with malignant infarction of the median cerebral artery submitted to moderate hypothermia (32-33 ºC)

Objetivos: La inducción de hipotermia moderada en pacientes con infarto de la arteria cerebral media (ACM) puede ocasionar alteraciones metabólicas y nutricionales. En la actualidad se desconoce cuál es el mejor método para realizar la valoración nutricional en este grupo de población. El objetivo del presente estudio fue valorar la utilidad del balance nitrogenado en el seguimiento de pacientes con infarto de la ACM y sometidos a hipotermia moderada (32-33 ºC) mediante enfriamiento intravascular, en la Unidad de Cuidados Neurocríticos de un hospital de tercer nivel. Material y métodos: Se diseñó un estudio retrospectivo en el que se incluyeron pacientes con infarto de la ACM de los que se recogieron variables biodemográficas, clínicas, de hipotermia y nutricionales. Del mismo modo se realizó el seguimiento prospectivo de un paciente con infarto de la ACM e hipotermia inducida, recogiendo las mismas variables en distintos tiempos de su evolución clínica. Resultados: En la serie retrospectiva se incluyeron 6 pacientes con infarto de ACM sometidos a hipotermia moderada durante un periodo promedio de 12 días (intervalo 9-15). Se constataron pérdidas de nitrógeno (media 9,9 g) inferiores a las que cabría esperar en pacientes críticos durante la fase aguda. En el seguimiento prospectivo del paciente con infarto maligno de la ACM desde día 1 hasta día 22 tras la aplicación de la hipotermia se observaron, al igual que en la serie de pacientes anteriormente descrita, valores bajos de nitrógeno eliminado durante la fase de hipotermia inducida que se elevaron posteriormente cuando el paciente recuperó la normotermia. El nitrógeno eliminado promedio durante el periodo de hipotermia fue de 10,7 g y presentó una elevación hasta 27,3 g durante el periodo normotérmico (día 17). Conclusiones: Estos resultados sugieren que la supresión metabólica inducida por la hipotermia moderada es clínicamente relevante y que, por lo tanto, la determinación del balance nitrogenado no parece ser una herramienta útil en el seguimiento nutricional de este tipo de pacientes (AU)

Objectives: Induction of moderate hypothermia in patients with median cerebral artery (MCA) infarction may produce metabolic and nutritional impairments. Currently, we do not know which is the best method to carry out nutritional assessment in this population group. The aim of the present study was to assess the usefulness of nitrogen balance in the follow-up of patients with MCA submitted to moderate hypothermia (32-33 ºC) by means of intravascular cooling at the Neurocritical Patients Unit at a tertiary hospital. Material and methods: We designed a retrospective study including patients with MCA infarction of whom we gathered bio-demographical, clinical, hypothermia, and nutritional variables. Similarly, we carried out a prospective follow-up of a patient with MCA infarction and induced hypothermia, gathering the same variables at different time points of his clinical course. Results: Six patients with MCA infarction submitted to moderate hypothermia for a mean duration of 12 days (interval 9-15) were included in the retrospective series. We observed that nitrogen losses (mean 9.9 g) were lower than those previously thought for critical patients during the acute phase. During the prospective follow-up of the patient with malignant infarction of the MCA from day 1 to day 22 after the application of hypothermia, low levels of nitrogen losses were similarly observed during the phase of induced hypothermia, which increased later on when the patient recovered normothermia. The mean nitrogen expenditure during the period of hypothermia was 10.7 g and increased up to 27.3 g during the normothermia period (day 17). Conclusions: These results suggest that moderate hypothermia-induced metabolic suppression is clinically relevant and thus the determination of nitrogen balance does not seem to be a useful tool in the nutritional followup of this type of patients (AU)

[Nitrogen losses and nitrogen balance in patients with malignant infarction of the median cerebral artery submitted to moderate hypothermia (32-33 degrees C)]. / Pérdidas de nitrógeno y balance nitrogenado en pacientes con infarto maligno de la arteria cerebral media y sometidos a hipotermia moderada (32-33 degrees C).

OBJECTIVES: Induction of moderate hypothermia in patients with median cerebral artery (MCA) infarction may produce metabolic and nutritional impairments. Currently, we do not know which is the best method to carry out nutritional assessment in this population group. The aim of the present study was to assess the usefulness of nitrogen balance in the follow-up of patients with MCA submitted to moderate hypothermia (32-33 degrees C) by means of intravascular cooling at the Neurocritical Patients Unit at a tertiary hospital. MATERIAL AND METHODS: We designed a retrospective study including patients with MCA infarction of whom we gathered bio-demographical, clinical, hypothermia, and nutritional variables. Similarly, we carried out a prospective follow-up of a patient with MCA infarction and induced hypothermia, gathering the same variables at different time points of his clinical course. RESULTS: Six patients with MCA infarction submitted to moderate hypothermia for a mean duration of 12 days (interval 9-15) were included in the retrospective series. We observed that nitrogen losses (mean 9.9 g) were lower than those previously thought for critical patients during the acute phase. During the prospective follow-up of the patient with malignant infarction of the MCA from day 1 to day 22 after the application of hypothermia, low levels of nitrogen losses were similarly observed during the phase of induced hypothermia, which increased later on when the patient recovered normothermia. The mean nitrogen expenditure during the period of hypothermia was 10.7 g and increased up to 27.3 g during the normothermia period (day 17). CONCLUSIONS: These results suggest that moderate hypothermia-induced metabolic suppression is clinically relevant and thus the determination of nitrogen balance does not seem to be a useful tool in the nutritional followup of this type of patients.