ECE2015 Eposter Presentations Pituitary: basic and neuroendocrinology (62 abstracts)
The use of an oral salt load followed by furosemide in the treatment of euvolemic SIADH-induced hyponatremia
Ana Ortolá 1 , Irene Crespo 1 , Teresa Ruiz-Gracia 1 , Emilia Gomez-Hoyos 2 , Martin Cuesta 3 , Rona Penso 1 , Angela Amengual 1 , Paz de Miguel 1 , Alfonso Calle-Pascual 1 & Isabelle Runkle 1
1Hospital Clinico San Carlos, Madrid, Spain; 2Hospital Clinico de Valladoilid, Valladolid, Spain; 3Beaumont Hospital, Dublin, Ireland.
Introduction: Furosemide can be used in the treatment of SIADH. However, to be effective, renal medulla osmolality (OsmRM) as reflected in urinary osmolality (UOSM) must be high. Sodium is the most important contributor to OsmRM, which increases following the administration of oral salt. We analyze the use of an oral salt load followed by furosemide for the acute/short-term treatment of euvolemic SIADH hyponatremia.
Methods: Retrospective analysis of nine patients with SIADH-induced hyponatremia and moderate hyponatremic encephalopathy receiving 4–5 g of oral salt, followed 3 h later by 20 mg furosemide i.v. or 40 mg furosemide po (salt-plus-furosemide). Serum sodium levels (SNa), serum potassium (SK), and urinary sodium (UNa) were measured at baseline, and 12–16 h following salt administration. In six out of nine patients, a SNa level was available from 24 h or less previously (PSNa). Electrolytes in mmol/l. Plasma (POSM) and UOSM in mOsm/kg. Wilcoxon and Mann–Whitney U tests. SPSS15.
Results: Baseline: 4/9 (44.4%) were women. Median age: 69.3 (S.D.: 20.7). Prior to salt-plus-furosemide, SNa levels were descending in five out of six patients with a median change of −1.5 (IQR −2.3 to −0.25). PSNa: 121 (S.D.: 4.5). Initial SNa: 119 (S.D.: 4.8), SK: 4.4 (S.D.: 0.6), UNa 54 (IQR: 42.5–86), POSM 249 (S.D.: 7.9), and UOSM 449 (S.D.: 251.2). Following salt-plus-furosemide, SNa rose from 3 to 7 mmol/l, with a median increment of 5 (IQR: 4–7), reaching a SNa of 124 (IQR: 121–127), SK: 4.1 (S.D.: 0.4), UNa 66.4 (S.D.: 24.6), POSM: 259 (S.D.: 7.4), and UOSM: 370 (S.D.: 151.4). The SNa change post salt-plus-furosemide vs the change prior to salt-plus-furosemide was statistically significant (P=0.027). SK descent was also significant (P=0.017). All blood pressure levels were below 130/85 mmHg before and after salt administration.
Conclusions: The oral administration of 4–5 g of salt followed by furosemide was useful for the acute/short-term treatment of euvolemic SIADH-hyponatremia in our patients. However, this therapy should not be attempted in severe hyponatremia, since a minimum 4 mmol/l SNa rise was not assured.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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