ECE2014 Poster Presentations Neuroendocrinology (27 abstracts)
Hyponatremia in the emergency room of a general teaching hospital: room for improvement
Ana Ortolá Buigues 1 , Martin Cuesta Hernández 1 , Teresa Ruiz Gracia 1 , Emlia Gomez Hoyos 1, , Irene Crespo Hernandez 1 , Francisco Elias Fernandez Capel 1 , Paz de Miguel Novoa 1 , Jose Angel Diaz Perez 1 , Alfonso Calle Pascual 1 & Isabelle Runkle de la Vega 1
1Hospital Clinico San Carlos, Madrid, Spain; 2Hospital Clinico de Valladolid, Valladolid, Spain.
Introduction: Hyponatremia(HN) is frequent in the emergency room(ER), yet often ignored, or poorly studied/managed. Our objective was to determine the characteristics of patients presenting HN at the ER of a general hospital.
Methods: Retrospective analysis of all 347 patients(AllP) presenting/developing non-translocational HN (serum sodium (SNa)<135 mmol/l) the first 48 h at the Hospital Clinico San Carlos ER in August 2012. Volemia was determined by physical exam, hemodilution vs hemoconcentration (urea/creatinine/hematocrit). SNa expressed in mmol/l. SPSS15. Student’s t test, χ2.
Results: A 5.4% of patients with SNa determined presented HN. Of these 33.7% had SNa<130, 0.1%<120. Average age: 60 (S.D. 19); 55.9% (194) were women.19.3% (67) were on SSRI, 10.5% (37) thiazides, 6.9% (24) opiates, 6.9% (24). 13.5% (47) were hypovolemic, 4% (14) hypervolemic, 62% (215) euvolémica (EU), 20.2% (70) undetermined. Physiologic stimuli of AVP were present in most EU, 56.9% presenting pain(EUPAIN). 36.7% (79) of EU had neither pain nor nausea (EUNPH), 16/79 were polydypsic. Plasma/Urine Osmolality were determined in only 7.2% (25), urine electrolytes in 10.1% (35), TSH in 27.3% (92), cortisol in 1.4% (5). AllP Admittance SNa(A-SNa): 131.7 mmol/l (S.D.:3.8), nadir SNa(N-SNa):130.87 (S.D.:3.6). SNa improved in only 124 (35.7%) within 24 h. 41% remained hyponatremic post-discharge (PD). 5% (18) developed overcorrection of SNa (>10 mmol/l at 24 or >18 mmol/l at 48 h). Patients with prior HN (42.1%) had lower A-SNa:129 (S.D.:3.7) vs 131.9 (S.D.:2.9) (P<0.001), N-SNa(129 (S.D.:3.7) vs 131.9 (S.D.:2.9) (P<0.001), PD SNa:126.1 (S.D.:4.6) vs 131.2 (S.D.:3.3) (P<0.001). EUVNPH had lower SNas than the remaining patients AllP-EUNPH) with A-SNa:131.1 (S.D.:3.7) vs 132.1 (S.D. 3.8) (P=0.016), N-SNa:130.2 (S.D.:4.15) vs 131.2 (S.D.:3.28) (P=0.014). Principal diagnoses: urinary tract infection:11.8% (41), neoplasia:10.1% (35), HN:4% (14). 6-month ER readmissions rate was higher in EUNPH than in the remaining patients: 45.5 vs 27% P<0.001).
Conclusions: Most ER hyponatremic patients were euvolemic. Of these a majority were in pain. Euvolemic patients without pain/nausea (many of whom will have undiagnosed SIADH), had more marked HN, and a higher readmissions rate. HN was often persistent and unresolved. Study, diagnosis and treatment of HN were clearly inadequate.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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