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Tacrolimus-induced symptomatic hyponatremia after kidney transplantation: A case study
Published in Elida Zairina, Junaidi Khotib, Chrismawan Ardianto, Syed Azhar Syed Sulaiman, Charles D. Sands, Timothy E. Welty, Unity in Diversity and the Standardisation of Clinical Pharmacy Services, 2017
Hypotonic hyponatremia is classified into three types depending on volume depletion, namely hypervolemic, euvolemic, and hypovolemic. Renal salt loss has characteristic of hypovolemic hypotonic hyponatremia and is defined as urine sodium >30 mEq/L. By contrast, for nonrenal sodium loss, the urine sodium level is <10 mEq/L. The first step of treatment of hypovolemic hypotonic hyponatremia is to evaluate severity of symptoms based on biochemical severity. Mild hyponatremia is defined as serum sodium concentration between 130 and 135 mmol/L; moderate hyponatremia is defined as serum sodium concentration between 125 and 129 mmol/L; and severe hyponatremia is defined as serum sodium concentration >125 mmol/L. Treatment of severe hyponatremia is started promptly after IV infusion of 150 ml of 3% hypertonic for over 20 min. The goal of treatment is to gradually increase serum sodium to 10 mmol/L during the first 24 h and an additional 8 mmol/L during every 24 h thereafter until the serum sodium concentration reaches 130 mmol/L for prevention of the risk of osmotic demyelination syndrome (ODS) (Spasovski et al. 2014). Serum sodium should be closely monitored every 6 and 12 h daily (Spasovski et al. 2014).
Endocrinology of aging
Published in Philip E. Harris, Pierre-Marc G. Bouloux, Endocrinology in Clinical Practice, 2014
Prasanth N. Surampudi, Christina Wang, Yanhe Lue, Ronald Swerdloff
Hyponatremia is an electrolyte disturbance with sodium below 135. Hyponatremia can cause significant consequences for the aging individual including decreased cognitive function and increased risk of falls. The ability to retain sodium through reabsorption in the kidney plays an important role in maintaining normal sodium levels. Hypotonic hyponatremia can be categorized as hypovolemic, euvolemic, or hypervolemic.
Asymptomatic hyponatremia precipitated by COVID-19 pneumonia
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Abhinandan R. Chittal, Shiavax J. Rao, Pallavi Lakra, Mary E. Zulty
The patient was admitted to the hospital for further management of severe, but asymptomatic, Hypotonic hyponatremia. She was started on a continuous infusion of normal saline at 100 cc/h and was given a 1-g tablet of sodium chloride. Her home medication of chlorthalidone 25 mg was held. She was also kept on fluid restriction limited to 1200 cc/day. Fluid restriction was then intensified to 800 cc/day, however her sodium increased only to 112 mEq/dL. Nephrology was consulted. Her sodium gradually improved to 113 mEq/dL with the same management for 24 hours, and the frequency of salt tabs was increased to 1 g twice a day. She was then given 15 mg of tolvaptan, which increased the serum sodium to 121 mEq/dL over the next 24 hours. After this correction of sodium, she was managed with only fluid restriction and her sodium gradually corrected to 134 mEq/dL.
Approach to and management of abnormalities in plasma sodium
Published in Acta Clinica Belgica, 2019
Hypotonic hyponatremia always results from an excess of water relative to the exchangeable sodium and potassium pool, as a consequence of a decrease in electrolyte free water excretion [3]. Division of total body solutes by total body water (TBW) allows determination of the osmolality of all body fluids and therefore: osmolality = 2 (Na E + K E)/TBW. Na E and KE represent, respectively, the total exchangeable body sodium and potassium. Any decrease in this ratio implies the presence of hyponatremia. TBW varies with gender and decreases with aging. For example, a male under 40 years has a TBW of about 60% of body weight (BW) and over 60 years about 50% of BW. In females TBW is about 50% (< 40 years) to 40% (> 70 years). Hence, variation in TBW in females calls for greater modification in serum sodium concentration than in males (Figure 2). Because Na+ is restricted to the ECF volume, where it represents the most important solute, the control of sodium balance regulates the ECF volume, while the water balance determines the concentration of solute in all body fluid compartments. In general the decrease in free water excretion in a hyponatremic patient is due to the effect of ADH secretion, which is considered as appropriate if it is secondary to volume stimuli (hypovolemic or hypervolemic patients) or inappropriate (euvolemic patients: SIADH), if it occurs in the absence of osmotic or volume stimuli (see Table 1).
Thiazide-associated hyponatremia in internal medicine patients: analysis of epidemiological and biochemical profiles
Published in Postgraduate Medicine, 2022
Patients admitted to the Internal Medicine Department of the Tomas Bata Hospital in Zlín during the period between 1 Januray 2016 and 31 December 2019 with a diagnosis of hypotonic hyponatremia (defined as serum sodium ≤135 mmol/L and serum osmolality <280 mmol/kg) were enrolled. Serum osmolality was calculated by the formula: serum osmolality = (2x serum Na [mmol/L] + serum urea [mmol/L] + serum glucose [mmol/L]) [24] and/or directly measured. Exclusion criteria were: one of the measured or calculated serum osmolality≥ 280 mmol/kg, need for dialysis, and age under 18 years.