Сlinical cases of symptomatic hyponatremia

Authors

DOI:

https://doi.org/10.22141/2224-0586.4.99.2019.173946

Keywords:

hyponatremia, cerebral pathology, hypochloremia

Abstract

The case series of four symptomatic hyponatremia in patients with cerebral diseases are analyzed. In all cases hyponatremia was severe (serum sodium level < 125 mmol/L) with the signs of cerebral edema, and poorly corrected. For the correction of hyponatremia, we used the intravenous infusion of 7.5% NaCl, and the average rate of correction was 9 mmol/L per day. The clinical signs of hyponatremia mimic as ischemic stroke and epilepsy. The moderate level of hyponatremia (125–129 mmol/L) did not correspond to the symptoms of cerebral edema. The most possible causes of hyponatremia were: traumatic brain injury, administration of X-ray contrast and furosemide, and infusion of 5% dextrose. Except the main suspected causing factor, all patients had several other factors that could predispose the development of hyponatremia. All patients presented with hypochloremia.

Downloads

Download data is not yet available.

References

Adrogué H.J., Madias N.E. The challenge of hyponatremia. J. Am. Soc. Nephrol. 2012. 23(7). 1140-1148. doi: 10.1681/ASN.2012020128. PMID:22626822

McCarthy K., Conway R., Byrne D., Cournane S., O'Riordan D., Silke B. Hyponatraemia during an emergency me­dical admission as a marker of illness severity & case complexity. Eur. J. Intern. Med. 2019. 59. 60-64. https://doi.org/10.1016/j.ejim.2018.08.002

Turgutalp K., Ozhan O., GokOguz E., Horoz M., Camsari A., Yilmaz A., Kiykim A., Arici M. Clinical features, outcome and cost of hyponatremia-associated admission and hospitalization in elderly and very elderly patients: a single-center experience in Turkey. Int. Urol. Nephrol. 2013. 45. 265. https://doi.org/10.1007/s11255-012-0307-9

Cohen D.M., Ellison D.H. Evaluatin ghyponatremia. JAMA. 2015. 313(12). 1260-1261. doi: 10.1001/jama.2014.13967 PMID: 25803349 PMCID: PMC4620993

Maesaka J.K., Imbriano L.J, Miyawaki N. Application of established pathophysiologic processes brings greater clarity to diag­nosis and treatment of hyponatremia. World J. Nephrol. 2017. 6(2). 59-71. doi: 10.5527/wjn.v6.i2.59

Sterns R.H. Disorders of plasma sodium-causes, consequences, and correction. N. Engl. J. Med. 2015. 372(1). 55-65. doi: 10.1056/NEJMra1404489.

Hoorn E.J., Zietse R. Diagnosis and Treatment of Hyponatremia: Compilation of the Guidelines. J. Am. Soc. Nephrol. 2017. 28(5). 1340-1349. doi: 10.1681/ASN.2016101139 PMID: 28174217 PMCID: PMC5407738

Sahay M., Sahay R. Hyponatremia: A practical approach. Indian. J. Endocrinol. Metab. 2014. 18(6). 760-771. doi: 10.4103/ 2230-8210.141320 PMCID: PMC4192979 PMID: 25364669

Imbriano L.J., Mattana J., Drakakis J., Maesaka J.K. Identifying Different Causes of Hyponatremia with Fractional Excretion of Uric Acid. Am. J. Med. Sci. 2016. 352. 385-390. PMID: 27776720. doi: 10.1016/j.amjms.2016.05.035

Verbalis J.G., Goldsmith S.R., Greenberg A., Korzelius C., Schrier R.W., Sterns R.H., Thompson C.J. Diagnosis, evaluation, and treatment of hyponatremia: Expert panel recommendations. Am. J. Med. 2013. 126 (10 Suppl 1). S1–42. doi: 10.1016/j.amjmed.2013.07.006. PMID: 24074529

Spasovski G., Vanholder R., Allolio B., Annane D., Ball S., Bichet D., Decaux G., Fenske W., Hoorn E.J., Ichai C., Joannidis M., Soupart A., Zietse R., Haller M., vander Veer S., van Biesen W., Nagler E., Gonzalez-Espinoza L., Ortiz A., Hyponatraemia Guideline Development Group. Hyponatraemia diagnosis and treatment clinical practice guidelines. Nefrologia. 2017. 37(4). 370-380. PMID: 28619670. doi: 10.1016/j.nefro.2017.03.021

Blair H.A., Keating G.M. Tolvaptan: A Review in Autosomal Dominant Polycystic Kidney Disease. Drugs. 2015. 75(15). 1797-1806. PMID: 26407729. doi: 10.1007/s40265-015-0475-x

Sterns R.H., Silver S.M., Hix J.K. Urea for hyponatremia? Kidney Int. 2015. 87(2). 268-270. PMID: 25635717. doi: 10.1038/ki.2014.320

Gankam Kengne F., Couturier B.S., Soupart A., Decaux G. Urea minimizes brain complications following rapid correction of chronic hyponatremia compared with vasopressin antagonist or hypertonic saline. Kidney Int. 2015. 87(2). 323-331. PMID: 25100046. doi: 10.1038/ki.2014.273

Published

2019-06-29

How to Cite

Fesenko, U., Stepanyuk, O., & Zhovnir, T. (2019). Сlinical cases of symptomatic hyponatremia. EMERGENCY MEDICINE, (4.99), 134–139. https://doi.org/10.22141/2224-0586.4.99.2019.173946

Issue

Section

Notes from Practice

Most read articles by the same author(s)