DOI: http://dx.doi.org/10.18203/2349-3933.ijam20163739

Profile of hyponatremia in a tertiary care centre in North India

Mahim Mittal, . Deepshikha, Hunny Khurana

Abstract


Background: Hyponatremia is the commonest electrolyte imbalance. Hyponatremia is a heterogenous disorder and classified into hypovolemic, euvolemic and hypervolemic types depending on the volume status of the patient. Approach is based on etiology and type of hyponatremia. The aim of the present study was to determine the profile of hyponatremia in adult patients including underlying etiology, type, clinical features and outcome

Methods: The study was conducted at BRD medical college Gorakhpur, India between July 2014 to August 2015 after approval by the ethical committee. Consenting patients >18 years of age with hyponatremia (<130meq/l) were included and investigated as per protocol. Based on volume status and urinary sodium patients were classified as euvolemic, hypervolemic and hypovolemic.

Results: N = 250, mean age 53.9 years. 56% males, 154(61.6%) patients had euvolemic, 53 (21.2%) hypervolemic and 43(17.2%) hypovolemic hyponatremia.  The most common causes for euvolemic, hypervolemic, hypovolemic hyponatremia were CNS infections, CLD and acute gastroenteritis respectively. Neurologic symptoms were more common in severe as compared to mild hyponatremia (69.7% versus 8.1%). Seizures attributable to hyponatremia were seen in 44 patients (17.6%), all with severe hyponatremia. Overall mortality was 14%. Deaths were more frequently seen in patients with severe hyponatremia as compared to patients with mild hyponatremia (25.5% vs. 4.7% P = 0.035).

Conclusions: Euvolemic hyponatremia is the most common type seen in hospitalized patients and is associated mainly with intracranial pathologies. Severe hyponatremia is significantly associated with neurological manifestations and higher mortality.


Keywords


Hyponatremia, Serum osmolality, Urine osmolality, Urinary excretion of sodium

Full Text:

PDF

References


Man S. Management of hyponatremia and clinical Use of vasopressin antagonists. Am J Med Sci. 2007;333(2):101-5.

Montain SJ, Sawka MN, Wenger CB. Hyponatremia associated with exercise: risk factors and pathogenesis. Exer Sports Sci Rev. 2001;29(3):113-7.

Gonc NE, Kandemir N, Sen Y, Yordam N, Hyponatremia can be a presenting finding of multiple pituitary hormone deficiency in children: report of a case and review of literature. Clin Pediatr. 2005;44:623-8.

Bhananker SM, Paek R, Vavilala MS. Water intoxication and symptomatic hyponatremia after outpatient surgery. Anesth Analg. 2004;98:1294-6.

Coenraad MJ, Meinders AE, Vandenbroucke JP, Frolich M, Taal JCW, Bolk JH. Causes of hyponatremia in the departments of internal medicine and neurosurgery. Eur J Inter Med. 2003;14:302-9.

Douglas I. Hyponatremia: Why it matters, how it presents, how we can manage it. Cleveland Clin J Med. 2006;73:4-12.

Fegan G, Begley J. Hyponatremia in the elderly. CME Geriatr Med. 2005;7:76-85.

Kugler JP, Hustead T. Hyponatremia and hypernatremia in the elderly. Am Fam Physician. 2000;61:3623-30.

Schrier RW. Body fluid volume regulation in health and disease: a unifying hypothesis. Ann Intern Med. 1990;113:155-9.

Rahul L. Hyponatremia in neurological diseases in ICU. Indian J Crit Care Med. 2005;9:47-51.

Goh KP. Management of Hyponatremia. Am Fam Physician. 2004;69:2387-94.

Hochman I, Cabili S, Peer G. Hyponatremia in internal medicine ward patients: cause, treatment and prognosis. Isr J Med Sci. 1989;25:73-6.

Vurgese TA, Radhakrishan SB, Mapkar OAW. Frequency and etiology of hyponatremia in adult hospitalized patients in medical wards of a general hospital in Kuwait. Kuwait Med J. 2006;3(3):211-3.

Anderson RJ, Chung HM, Kluge R, Schrier RW. Hyponatremia: a prospective analysis of its epidemiology and the pathogenetic role of vasopressin. Ann Intern Med. 1985;102:164-8.

Young A. Ageing and physiological function. Philos Trans R Soc Lond B Biol Sci. 1997;352:1837-43.

Beck LH. The aging kidney: Defending a delicate balance of fluid and electrolyte. Geriatrics. 2000;55(4):26-8, 31-2.

Allison SP, Lobo DN. Fluid and electrolytes in the elderly. Curr Opin Clin Nutr Metab Care. 2004;7:27–33.

M Gheorghiade, JS Rossi, W Cotts. Characteriz-ation and prognostic value of persistent hyponatremia in patients with severe heart failure in the Escape Trial. Arch Intern Med. 2007;167(18): 1998-2005.