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2.
Medicine (Baltimore) ; 99(33): e20746, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871970

RESUMO

RATIONALE: Hyponatremia occurs frequently in the hospital setting and may be attributable to a host of etiologies. Drugs are frequently implicated. Trimethoprim-sulfamethoxazole (TMP/SMX) represents a well-recognized pharmacologic precipitant of drug-induced hyponatremia, with several reports extant in the retrievable literature. Nephrologists thus debate the mechanisms giving rise to TMP/SMX-induced hyponatremia and the precise mechanism by which treatment with TMP/SMX generates reductions of serum sodium concentration remain controversial. The agent has a well-known effect of antagonizing the effects of aldosterone upon the distal nephron. Renal salt wasting and the syndrome of inappropriate antidiuretic hormone secretion represent implicated mechanistic intermediaries in TMP/SMX-induced hyponatremia. PATIENT CONCERNS: The patient endorsed no explicit concerns. DIAGNOSES: We describe the case of an 83-year-old female clinically diagnosed with pneumonia found to have an initial serum sodium in the range of 130 to 134 mEq/L consistent with mild hyponatremia upon admission. Sputum cultures grew Achromobacter xylosoxidans susceptible to TMP/SMX. The patient's serum sodium concentration precipitously decline following institution of treatment with TMP/SMX to 112 to 114 mEq/L during the course of 5 days. INTERVENTIONS: Severe hyponatremia proved recalcitrant to initial therapy with supplemental salt tabs and standard doses of the vasopressin receptor antagonist tolvaptan. OUTCOMES: Escalating doses of tolvaptan increased the patient's sodium to 120 to 124 mEq/L. The patient was transferred to another hospital for further management. During her stay, the patient did not exhibit frank or obvious clinical features consistent with hyponatremia nor readily appreciable evidence of volume depletion. LESSONS: TMP/SMX represents a frequent, though underreported cause of hyponatremia in the hospital setting several authors believe natriuresis may represent the most common mechanism underlying TMP/SMX-induced hyponatremia. Evidence implicating natriuresis to be mechanistic in TMP/SMX-induced hyponatremia include clinically appreciable hypovolemia and resolution of hyponatremia with oral or intravenous salt repletion. Salt repletion failed to monotherapeutically enhance our patient's hyponatremiadisfavoring renal salt wasting as originately mechanistic. Contemporaneous refractoriness of serum sodium to fluid restriction nor standard doses of tolvaptan confounded our initial attempts to mechanistically attribute the patient's hyponatremia to a specific cause. Clinical euvolemia and rapid response of hyponatremia to exceptionally high doses of tolvaptan strongly favors syndrome of inappropriate antidiuretic hormone to represent the chief mechanism by which TMP/SMX exacerbates hyponatremia.


Assuntos
Achromobacter denitrificans , Antibacterianos/efeitos adversos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Hiponatremia/induzido quimicamente , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Feminino , Infecções por Bactérias Gram-Negativas/sangue , Infecções por Bactérias Gram-Negativas/complicações , Humanos , Hiponatremia/complicações , Hiponatremia/fisiopatologia , Hiponatremia/terapia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
3.
J Neurovirol ; 26(5): 797-799, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32720233

RESUMO

There is concern that the global burden of coronavirus disease of 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection might yield an increased occurrence of Guillain-Barré syndrome (GBS). It is currently unknown whether concomitant SARS-CoV-2 infection and GBS are pathophysiologically related, what biomarkers are useful for diagnosis, and what is the optimal treatment given the medical comorbidities, complications, and simultaneous infection. We report a patient who developed severe GBS following SARS-CoV-2 infection at the peak of the initial COVID-19 surge (April 2020) in New York City and discuss diagnostic and management issues and complications that may warrant special consideration in similar patients.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Síndrome de Guillain-Barré/complicações , Hiponatremia/complicações , Pneumonia Viral/complicações , Doença Aguda , Idoso , Anticoagulantes/uso terapêutico , Infecções por Coronavirus/patologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Progressão da Doença , Enoxaparina/uso terapêutico , Feminino , Síndrome de Guillain-Barré/patologia , Síndrome de Guillain-Barré/terapia , Síndrome de Guillain-Barré/virologia , Humanos , Hiponatremia/patologia , Hiponatremia/terapia , Hiponatremia/virologia , Cidade de Nova Iorque , Pandemias , Plasmaferese , Pneumonia Viral/patologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-32718076

RESUMO

Hyponatremia is one of the most common water-electrolyte imbalances in the human organism. A serum sodium concentration threshold of less than 135 mmol/L is diagnostic for hyponatremia. The disorder is usually secondary to various diseases, including infections. Our review aims to summarize the diagnostic value and impact of hyponatremia on the prognosis, length of the hospitalization, and mortality among patients with active infection. The scientific literature regarding hyponatremia was reviewed using PubMed, ClinicalKey, and Web of Science databases. Studies published between 2011 and 2020 were screened and eligible studies were selected according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and specific inclusion criteria. The most common infections that were associated with hyponatremia were viral and bacterial infections, including COVID-19 (coronavirus disease 2019). The etiology varied according to the infection site, setting and patient cohort it concerned. In several studies, hyponatremia was associated with prolonged hospitalization, worse outcomes, and higher mortality rates. Hyponatremia can also play a diagnostic role in differentiating pathogens that cause a certain infection type, as it was observed in community-acquired pneumonia. Although many mechanisms leading to hyponatremia have already been described, it is impossible with any certainty to ascribe the etiology of hyponatremia to any of them.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Hiponatremia/complicações , Pneumonia Viral/complicações , Estudos de Coortes , Infecções por Coronavirus/virologia , Hospitalização , Humanos , Masculino , Pandemias , Pneumonia Viral/virologia , Sódio/sangue
5.
J Clin Neurosci ; 78: 353-359, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32622650

RESUMO

To assess the association between hyponatraemia and long-term functional outcome and other relevant outcomes in patients with aneurysmal subarachnoid haemorrhage (aSAH) we conducted a prospective cohort study in a Neurosciences Intensive Care Unit (ICU) in Sydney, Australia. The primary exposure variable was hyponatraemia (Na+ <135 mmol/L). The primary outcome was favourable outcome, a score of 5-8 on the extended Glasgow Outcome Score (GOSe) at 12 months. We also measured mortality, the incidence of delayed cerebral ischaemia (DCI) and cerebral arterial vasospasm and duration of ICU and hospital admission. There were 200 participants, 111 (56%) developed hyponatraemia. Hyponatraemia was not associated with favourable outcome at 12 months (unadjusted odds ratio [OR] OR 1.31, 95% confidence interval [CI] 0.65-2.65, p = 0.56). The result was similar after adjustment for baseline covariates (adjusted OR 0.60, 95% CI 0.16-1.99, p = 0.43). There was no association between hyponatraemia and the incidence of DCI (OR 0.95, 95% CI 0.46 to 2.0, p > 0.99) nor cerebral arterial vasospasm (OR 1.4, 95% CI 0.8 to 2.5, p = 0.27). Those who developed hyponatraemia had a longer median duration of ICU admission (17 days, interquartile range [IQR] 12 to 20, compared to 13 days, IQR 8-21, p = 0.02) and longer median duration of hospital admission (24 days, IQR 21-30, compared to 22 days IQR 14-31, p = 0.05). While hyponatraemia is common following aSAH, it is not associated with worse long-term functional outcome, increased rate of DCI, nor cerebral arterial vasospasm. Hyponatraemia in patients with aSAH was associated with longer duration of ICU and hospital admission.


Assuntos
Hospitalização , Hiponatremia/complicações , Hemorragia Subaracnóidea/complicações , Adulto , Idoso , Austrália/epidemiologia , Isquemia Encefálica , Infarto Cerebral , Estudos de Coortes , Feminino , Humanos , Hiponatremia/epidemiologia , Hiponatremia/mortalidade , Incidência , Unidades de Terapia Intensiva , Aneurisma Intracraniano/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Hemorragia Subaracnóidea/epidemiologia , Hemorragia Subaracnóidea/etiologia , Fatores de Tempo , Vasoespasmo Intracraniano/etiologia
6.
Medicine (Baltimore) ; 99(24): e20283, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541452

RESUMO

RATIONALE: There is an increasing and compelling need for early recognition of features of osmotic demyelination syndrome (ODS), and a further attempt at correcting this even where presentation is late. PATIENT CONCERNS: A 49-year-old male admitted into the emergency department with a complaint of lethargy and severe hyponatremia, with subsequent ODS supervening on initial attempts at correction. DIAGNOSIS: Rapid rise in serum sodium concentration (121 mmol/L in 8 hours from a nadir of 101 mmol/L), concomitant deterioration in patient's conscious level support the diagnosis of ODS. INTERVENTION: Concomitant administration of 5% dextrose water with desmopressin with a therapeutic objective of gradual relowering of serum sodium concentration. OUTCOMES: Significant improvement in patients' conscious level and motor function with the commencement of sodium relowering therapy. The patient was eventually discharged home. LESSONS: Regardless of the temporal profile of neurologic sequelae following ODS due to hyponatremia, its worthwhile attempting initial sodium relowering with dextrose 5% and desmopressin and then monitoring of biochemical and neurologic markers.


Assuntos
Doenças Desmielinizantes/induzido quimicamente , Doenças Desmielinizantes/terapia , Hiponatremia/complicações , Antidiuréticos/administração & dosagem , Antidiuréticos/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Desamino Arginina Vasopressina/administração & dosagem , Desamino Arginina Vasopressina/uso terapêutico , Doenças Desmielinizantes/sangue , Doenças Desmielinizantes/diagnóstico , Quimioterapia Combinada/métodos , Glucose/administração & dosagem , Glucose/uso terapêutico , Humanos , Hiponatremia/terapia , Doença Iatrogênica , Letargia/etiologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , Solução Salina Hipertônica/efeitos adversos , Sódio/sangue , Edulcorantes/administração & dosagem , Edulcorantes/uso terapêutico , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
7.
World Neurosurg ; 141: e864-e872, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32553754

RESUMO

OBJECTIVE: Preoperative patient optimization is increasingly recognized as key to good surgical outcomes. Preoperative hyponatremia is a modifiable risk factor linked to poorer postoperative outcomes in other surgical fields. We provide the first investigation of the association of preoperative hyponatremia with morbidity and mortality in patients undergoing cervical spine surgery. METHODS: We queried the National Surgical Quality Improvement Program registry for patients who underwent cervical spine fusion. Preoperative serum sodium levels were classified as normal (135-145 mEq/L) or hyponatremic (<135 mEq/L); hypernatremic patients were excluded from the analysis. Multivariable logistic analyses using a multiple imputations methodology were performed to determine significant predictors of major morbidity and mortality (MMM). RESULTS: We included 20,817 patients, of whom 5.2% were hyponatremic at presentation. Preoperative hyponatremia was a significant predictor of MMM (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.09-1.39), mortality (OR, 1.36; 95% CI, 1.03-1.77), major morbidity (OR, 1.24; 95% CI, 1.10-1.40), and odds of prolonged hospitalization (OR, 1.13; 95% CI, 1.04-1.23). Other significant predictors of MMM included age, undergoing an emergent versus nonemergent operation, having chronic obstructive pulmonary disease, having disseminated malignancy, being functionally dependent, presenting with sepsis or septic shock, and having an American Society of Anesthesiologists status of 3, 4, or 5. Similar results were seen in analyses using only complete cases and in sensitivity analyses. CONCLUSIONS: Using the National Surgical Quality Improvement Program database, hyponatremia is observed in approximately 1 in every 20 patients undergoing cervical spine fusion. More importantly, it is a predictor of mortality, major morbidity, and prolonged hospitalization. From a systems-level perspective, preoperative hyponatremia may therefore represent a point of intervention for preoperative patient optimization.


Assuntos
Vértebras Cervicais/cirurgia , Hiponatremia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Doenças da Coluna Vertebral/epidemiologia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hiponatremia/complicações , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Retrospectivos
8.
Transplant Proc ; 52(6): 1798-1801, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32448660

RESUMO

OBJECTIVE: The objective of this study is to evaluate the changes in serum sodium levels in adult recipients with and without hyponatremia undergoing living donor liver transplantation (LDLT) without using hypertonic solution. METHODS: Patients were divided into 2 groups according to serum sodium level higher (GI) or lower (GII) than 130 mEq/L. The changes of serum sodium levels during an LDLT procedure and total sodium loads were compared between groups by using the Mann-Whitney U test, while the changes in the same group were paired by using the Student t test. A P value <.005 was considered significant. RESULTS: The total sodium load for GI (n = 438) and GII (n = 28) were 2737 ± 2159 mEq and 4017 ± 2830 mEq, respectively. Although GI received a significantly lower sodium load than GII, the serum sodium levels during the procedure were always within a normal range and higher than GII at all the measured time points; however, the changes of serum sodium level in GI from one point to the next measured point in the same group were unremarkable, while that of GII increased significantly between the 2 measured time points during the procedure. The mean total increase of serum sodium in GII was 5.57 ± 4.9 mEq/L in 14 hours of the LDLT procedure. None of the patients developed central pontine myelinosis (CPM) postoperatively. CONCLUSION: Patients with hyponatremia can be managed safely without using a hypertonic solution during liver transplantation. The mean increase of serum sodium of GII was of 5.57 ± 4.9 mEq/L, which was still within the acceptable and safe level. No postoperative CPM was observed in our GII patients.


Assuntos
Anestesia/métodos , Hidratação/métodos , Hiponatremia/terapia , Hepatopatias/cirurgia , Transplante de Fígado/métodos , Adulto , Feminino , Humanos , Hiponatremia/sangue , Hiponatremia/complicações , Hepatopatias/sangue , Hepatopatias/complicações , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sódio/sangue , Estatísticas não Paramétricas
11.
Am J Med ; 133(9): e465-e482, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32199810

RESUMO

BACKGROUND: Low plasma sodium concentration has been recognized as a prognostic factor in several disorders but never evaluated in sickle cell disease. The present study evaluates its value at admission to predict a complication in adult patients with sickle cell disease hospitalized for an initially uncomplicated acute painful episode. METHODS: The primary outcome of this retrospective study, performed between 2010 and 2015 in a French referral center for sickle cell disease, was a composite criterion including acute chest syndrome, intensive care unit transfer, red blood cell transfusion or inpatient death. Analyses were adjusted for age, sex, hemoglobin genotype and concentration, lactate dehydrogenase (LDH) concentration, and white blood cell count. RESULTS: We included 1218 stays (406 patients). No inpatient death occurred during the study period. Hyponatremia (plasma sodium ≤135 mmol/L) at admission in the center was associated with the primary outcome (adjusted odds ratio [OR] 1.95, 95% confidence interval [CI] 1.3-2.91, P = 0.001), with acute chest syndrome (OR 1.95 [95% CI 1.2-3.17, P = 0.008]), and red blood cell transfusion (OR 2.71 [95% CI 1.58-4.65, P <0.001]) but not significantly with intensive care unit transfer (OR 1.83 [95% CI 0.94-3.79, P = 0.074]). Adjusted mean length of stay was longer by 1.1 days (95% CI 0.5-1.6, P <0.001) in patients with hyponatremia at admission. CONCLUSIONS: Hyponatremia at admission in the medical department for an acute painful episode is a strong and independent prognostic factor of unfavorable outcome and, notably, acute chest syndrome. It could help targeting patients who may benefit from closer monitoring.


Assuntos
Anemia Falciforme/complicações , Hiponatremia/complicações , Adulto , Transfusão de Eritrócitos , Feminino , França , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Sódio/sangue , Adulto Jovem
12.
Neuropsychiatr ; 34(2): 85-87, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32048183

RESUMO

In the literature, several cases of an association between hyponatremia and psychotic symptoms have been reported. We present the case of a young Caucasian male presenting with rapid, incoherent speech, religious and megalomanic delusions, and emotional lability. The patient was described by his relatives as being healthy until a few days before admission. He had no significant medical or psychiatric history, except a short drug-induced psychotic episode a few years earlier. Somatic workup showed moderate hyponatremia, but no other abnormalities. Tests for narcotics, in particular, were also negative. Antipsychotic treatment with risperidone was initiated. After normalization of sodium levels using intravenous saline, the patient remitted within a few days and risperidone was discontinued on day 3. He was discharged by day 13 without further pharmacological treatment.Dysfunction of voltage-gated ion channels, particularly sodium and calcium channels, has been implicated in the pathogenesis of bipolar disorder. We therefore assume a causal relationship between hyponatremia and manic-psychotic symptoms in our patient. Hyponatremia was most likely induced by excessive water intake during a period of fasting in the context of a wellness practice.


Assuntos
Antipsicóticos , Transtorno Bipolar , Hiponatremia , Transtornos Psicóticos , Adulto , Transtorno Bipolar/etiologia , Delusões , Humanos , Hiponatremia/complicações , Masculino , Transtornos Psicóticos/etiologia
14.
BMJ Case Rep ; 13(1)2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31911412

RESUMO

Hyponatremia is the most commonly observed electrolyte disturbance in clinical medicine. Occasionally the initial presentation of a patient with a symptomatic hyponatremia is a seizure or coma. This life-threatening complication needs early diagnosis and immediate treatment. Here, we report a case of a 27-year-old man who presented with an epileptic seizure, lactate acidosis and sulcal effacement on CT in which a transient sodium increase masked a clinically relevant hyponatremia thereby delaying diagnosis. This phenomenon is caused by an extracellular water shift and can occur when blood analysis is performed shortly after vigorous exercise or a seizure. This case provides awareness for a less well-known cause of plasma sodium increase and offers recommendations to prevent misinterpretation and help clinicians in decision making.


Assuntos
Hiponatremia/diagnóstico , Convulsões/etiologia , Sódio/sangue , Sódio/urina , Adulto , Diagnóstico Diferencial , Humanos , Hiponatremia/complicações , Masculino
15.
J Vet Emerg Crit Care (San Antonio) ; 30(1): 66-73, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31845521

RESUMO

OBJECTIVE: Hyponatremia and rapid correction of hyponatremia can lead to neurological abnormalities. The objective of the study was to determine whether plasma sodium concentrations (Na+ ) and speed of correction of hyponatremia are significantly associated with neurological abnormalities in foals. DESIGN: Retrospective cohort study 2012 to 2016. SETTING: Equine hospital. ANIMALS: One hundred and nine foals <6 months old with hyponatremia (Na+ concentration ≤125 mmol/L). INTERVENTIONS: Case records were reviewed for any foal with hyponatremia. Clinicopathological findings, presence or absence of neurological signs on the day of the lowest Na+ concentration measured and the following 5 days, diagnosis and outcome were recorded, and changes in Na+ concentration per hour were calculated for up to 5 subsequent days. Logistic regression was used to assess the association between presence or absence of neurological signs, Na+ concentration, other known risk factors for neurological dysfunction in foals, and possible confounders. MEASUREMENTS AND MAIN RESULTS: In the final multivariable model, only Na+ (odds ratio [OR]: 0.86; 95% CI 0.79-0.95; P = 0.002) and BUN concentrations (OR: 1.04; 95% CI: 1.02-1.06; P = 0.001) were significantly associated with neurological signs. Changes in Na+ concentrations per hour were not associated with neurological signs on any day after the lowest Na+ concentration had been measured (P = 0.18-0.82), and development of new neurological signs following correction of hyponatremia was not reported in any foal. CONCLUSIONS: Na+ concentrations were associated with the development of neurological signs in hyponatremic foals. Increased BUN concentrations might contribute to neurological dysfunction, but further studies are necessary to confirm or refute these findings.


Assuntos
Doenças dos Cavalos/sangue , Hiponatremia/veterinária , Convulsões/veterinária , Sódio/sangue , Animais , Animais Recém-Nascidos/sangue , Nitrogênio da Ureia Sanguínea , Estudos de Coortes , Feminino , Cavalos , Hiponatremia/sangue , Hiponatremia/complicações , Masculino , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Convulsões/sangue , Convulsões/etiologia
17.
Nephrol Dial Transplant ; 35(6): 987-994, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30346587

RESUMO

BACKGROUND: Serum chloride (Cl) levels confer better prognostic value than serum sodium (Na) levels among patients with heart failure. Little is known about the relationship between serum Cl levels and clinical outcomes among patients with chronic kidney disease (CKD). METHODS: This was a retrospective cohort study enrolling patients with Stages G3-G5 CKD who visited the nephrology outpatient department of Osaka University Hospital from April 2005 to December 2014. The main exposure was time-varying serum Cl levels categorized as quartiles. The study outcome was a composite of all-cause death and cardiovascular events. RESULTS: A total of 2661 patients with CKD were included in the analysis. During a median follow-up of 4.0 years, 284 deaths and 416 cardiovascular events occurred. Compared with patients in the third Cl quartile, those in the first Cl quartile showed a significantly higher risk of the outcome after adjustment for demographics and clinical factors including time-varying serum Na, serum albumin and bicarbonate levels, and use of diuretics and sodium bicarbonate [hazard ratio (HR) 2.13; 95% confidence interval (CI) 1.20-3.81; P = 0.01] and, additionally, anion gap (HR 2.13; 95% CI 1.26-3.57; P = 0.004). Adding serum Cl levels, but not serum Na levels, to the multivariable model significantly improved net reclassification index (0.335; P < 0.001) and integrated discrimination improvement (0.0113; P = 0.01). CONCLUSIONS: Lower serum Cl levels are an independent predictor of death and cardiovascular events. The incremental prognostic value of Cl was superior to that of Na in patients with CKD.


Assuntos
Biomarcadores/sangue , Doenças Cardiovasculares/etiologia , Cloretos/sangue , Hiponatremia/sangue , Insuficiência Renal Crônica/diagnóstico , Sódio/sangue , Desequilíbrio Ácido-Base , Idoso , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/mortalidade , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Hiponatremia/complicações , Masculino , Pessoa de Meia-Idade , Prognóstico , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
18.
Heart Lung Circ ; 29(2): 233-241, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30745014

RESUMO

BACKGROUND: Diuretic requirements in patients with acute decompensated heart failure (ADHF) and hyponatraemia versus normonatraemia on admission has not been previously explored. METHODS: The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial dataset was utilised to examine the characteristics and diuretic requirements of patients with ADHF with hyponatraemia or normonatraemia on admission. RESULTS: Patients with ADHF and admission hyponatraemia (n = 103, average Na 130.2 meq/L) had a higher degree of congestion evident in higher frequency of jugular venous distension (JVD) >12 cmH2O (p = 0.007), 2+ lower extremity oedema (p = 0.001), and higher right atrial pressure (p = 0.007), compared with normonatraemic patients (n = 327, average Na 138.6 meq/L). Despite a similar baseline furosemide dose in both groups (median 200 mg), the hyponatraemia group received higher in-hospital furosemide (280 vs. 200 mg, in both groups, respectively, p < 0.001) which represented a higher percentage of furosemide utilisation relative to baseline, compared with the normonatraemia group (33% vs 0%, in both groups respectively, p = 0.007). With in-hospital diuresis, the Na level of hyponatraemic subjects started significantly increasing at discharge and up to 6 months after randomisation-all relative to baseline. Hyponatraemic patients had significantly lower systolic blood pressure (SBP) longitudinally at multiple time points compared with normonataremic patients, but it did not further decrease despite the higher furosemide dose in the former group. CONCLUSION: Patients with ADHF and hyponatraemia on admission had a higher degree of congestion and required higher doses of furosemide, compared with normonatraemic subjects. The lower Na and SBP in this instance should not lead to withholding or minimising diuretic dosage which should rather be dictated by volume status.


Assuntos
Diuréticos/administração & dosagem , Furosemida/administração & dosagem , Insuficiência Cardíaca , Hiponatremia , Sódio/sangue , Doença Aguda , Adulto , Idoso , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Humanos , Hiponatremia/sangue , Hiponatremia/complicações , Hiponatremia/tratamento farmacológico , Hiponatremia/fisiopatologia , Masculino , Pessoa de Meia-Idade
19.
Dig Liver Dis ; 52(1): 91-97, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31542220

RESUMO

BACKGROUND: Few studies have evaluated whether combination and sequential evaluation of ACLF (acute-on-chronic liver failure) and hyponatremia aids prognosis. AIMS: Describe clinical course and determine prognostic capability of assessing ACLF and hyponatremia at specific time-points. METHODS: Prospective study with inclusion of 376 patients. ACLF and hyponatremia were evaluated at days 1 and 7 and classified as persistent, transient, de novo or absent. Follow-up was 90 days. RESULTS: At inclusion, ACLF was diagnosed in 99 patients. Reversal was observed in 57 patients and was associated with lower creatinine and ACLF grade. De novo ACLF developed in 19 patients, and MELD (model of end-stage liver disease) score and lower albumin were predictive factors. Hyponatremia was present in 76 patients (persistent, transient and de novo in 27, 24 and 25 respectively). ACLF at D7 had the lowest survival compared to transient or no ACLF (21, 57 and 80%, p < 0.0001). Hyponatremia at admission was associated with low survival (35%) whereas survival was higher for de novo or absent cases (70%), p < 0.001. In multivariate analysis ACLF at D7 and hyponatremia at D1 were predictors of survival. CONCLUSION: ACLF and hyponatremia are dynamic and evaluation of both conditions at different time-points identifies patients at higher risk of short-term mortality.


Assuntos
Insuficiência Hepática Crônica Agudizada/diagnóstico , Doença Hepática Terminal/mortalidade , Hiponatremia/mortalidade , Cirrose Hepática/mortalidade , Insuficiência Hepática Crônica Agudizada/mortalidade , Adulto , Idoso , Brasil/epidemiologia , Doença Hepática Terminal/etiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Hiponatremia/complicações , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Análise de Sobrevida , Fatores de Tempo
20.
J. bras. nefrol ; 41(4): 501-508, Out.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1056603

RESUMO

Abstract Objective: To evaluate the association between dysnatremias or dyschloremias and mortality during hospitalization in patients with acute kidney injury (AKI) or chronic kidney disease (CKD) undergoing acute hemodialysis. Methods: We carried out a retrospective cohort study on adult patients undergoing acute hemodialysis with AKI or CKD diagnosis at a public hospital in Lima, Peru. Dysnatremias were categorized as hyponatremia (Na < 135mmol/L) or hypernatremia (Na > 145mmol/L), and dyschloremias were defined as hypochloremia (Cl < 98 mmol/L) or hyperchloremia (Cl > 109mmol/L). The outcome of interest was mortality during hospitalization. We performed generalized lineal Poisson family models with bias-corrected and accelerated non-parametric bootstrap to estimate the risk ratios at crude (RR) and adjusted analysis (aRR) by gender, age, HCO3 (for all patients) and Liaño score (only for AKI) with CI95%. Results: We included 263 patients (mean age: 54.3 years, females: 43%): 191 with CKD and 72 with AKI. Mortality was higher in patients with AKI (59.7%) than in patients with CKD (14.1%). In overall, patients with hypernatremia had a higher mortality during hospitalization compared to those who had normal sodium values (aRR: 1.82, 95% CI: 1.17-2.83); patients with hyponatremia did not have different mortality (aRR: 0.19, 95% CI: 0.69-2.04). We also found that hyperchloremia (aRR: 1.35, 95% CI: 0.83-2.18) or hypochloremia (aRR: 0.66, 95% CI: 0.30-14.78) did not increase mortality in comparison to normal chloride values. No association between dysnatremias or dyschloremias and mortality during hospitalization was found in CKD and AKI subgroups. Conclusions: In our exploratory analysis, only hypernatremia was associated with mortality during hospitalization among patients with AKI or CKD undergoing acute hemodialysis.


Resumo Objetivo: Avaliar a associação entre distúrbios do sódio ou do cloro e mortalidade hospitalar de pacientes com insuficiência renal aguda (IRA) ou doença renal crônica (DRC) submetidos a hemodiálise aguda. Métodos: O presente estudo de coorte retrospectiva incluiu pacientes adultos submetidos a hemodiálise aguda com diagnóstico de IRA ou DRC em um hospital público de Lima, Peru. Os distúrbios do sódio foram classificados como hiponatremia (Na < 135mmol/L) ou hipernatremia (Na > 145mmol/L), enquanto os distúrbios do cloro foram classificados como hipocloremia (Cl < 98 mmol/L) ou hipercloremia (Cl > 109mmol/L). O desfecho de interesse foi mortalidade hospitalar. Utilizamos modelos de Poisson da família de modelos lineares generalizados com bootstrap não-paramétrico e correção de viés acelerado para estimar os riscos relativos na análise bruta (RR) e ajustada (RRa) para sexo, idade, HCO3 (para todos os pacientes) e escore de Liaño (apenas para IRA) com IC 95%. Resultados: Foram incluídos 263 pacientes (idade média 54,3 anos; 43% do sexo feminino), 191 com DRC e 72 com IRA. A mortalidade foi mais elevada nos pacientes com IRA (59,7%) do que nos indivíduos com DRC (14,1%). No geral, os pacientes com hipernatremia tiveram mortalidade hospitalar mais elevada do que os indivíduos com valores normais de sódio (RRa: 1,82; IC 95%: 1,17-2,83). Os pacientes com hiponatremia não apresentaram mortalidade diferente (RRa: 0,19; IC 95%: 0,69-2,04). Também identificamos que hipercloremia (RRa: 1,35; IC 95%: 0,83-2,18) e hipocloremia (RRa: 0,66; IC 95%: 0,30-14,78) não elevaram a mortalidade em comparação a indivíduos com níveis normais de cloro. Não foi encontrada associação entre distúrbios do sódio ou do cloro e mortalidade hospitalar nos subgrupos com DRC e IRA. Conclusões: Em nossa análise exploratória, apenas hipernatremia apresentou associação com mortalidade hospitalar em pacientes com IRA ou DRC submetidos a hemodiálise aguda.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Sódio/sangue , Cloretos/sangue , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/mortalidade , Lesão Renal Aguda/mortalidade , Peru/epidemiologia , Bicarbonatos/sangue , Insuficiência Renal Crônica/sangue , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/sangue , Lesão Renal Aguda/terapia , Hospitalização/estatística & dados numéricos , Hipernatremia/complicações , Hipernatremia/mortalidade , Hiponatremia/complicações , Hiponatremia/mortalidade
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