ECE2016 Eposter Presentations Neuroendocrinology (43 abstracts)
How frequently can we predict failure of fluid restriction in SIAD? Results of a multicenter prospective audit
Martín Cuesta 1 , Ana Ortolá 2 , 2David Slattery , Aoife Garrahy 1 , Alfonso Luis Calle Pascual 2 , William Tormey 3 , Isabelle Runkle de la Vega 2 & Christopher J. Thompson 1
1Academic Department of Endocrinology. Beaumont Hospital/RCSI Medical School, Dublin, Ireland; 2Servicio de Endocrinología y Nutrición del Hospital Clínico San Carlos/Universidad Complutense de Madrid, Madrid, Spain; 3Department of Chemical Pathology Beaumont
Hospital/RCSI Medical School, Dublin, Ireland.
Context: Fluid restriction (FR) is recommended as first line therapy for SIAD by both the European1 and the American guidelines2 for management of SIAD. Not all patients respond to FR however, and the American guidelines have identified clinical predictors of failure to respond to FR. These include 1.Urine osmolality (UOsm) >500 mOsm/Kg 2. Furst formula (ratio UNa+UK/pNa) > 1, and 3. 24 hour-urine volume<1500 ml
Objective: To ascertain the frequency with which patients with SIAD display at least one criterion for prediction of no response to FR.
Design: Prospective, non-interventional, multicenter study in Hospital Clínico San Carlos (Madrid) and Beaumont Hospital (Dublin).
Patients: Hundred and eighty three patients with SIAD were prospectively and consecutively recruited, 51 from Madrid and 132 from Dublin. The investigators did not interfere in the management of hyponatraemia unless specifically requested.
Methods: Collection of data for predictors of response to FR. Results are expressed as median with interquartile range (IQR).
Results: There was 100% ascertainment of the full diagnostic criteria for diagnosis of SIAD. Median plasma sodium was 128 mmol/l (IQR:125,130 mmol/l). 4 patients (2.2%) died during hospitalization. 75/183 (41%) patients had UOsm >500 mOsm/kg, 48/183 (26%) a Furst formula>1, 49/103 (47%) urinary volume <1500 ml/24 h. 109/183 (59%) had at least one criterion predicting no response to FR.
Conclusion: More than half of SIAD patients had at least one criterion which has been recommended to predict failure to respond to FR, the first line therapy for SIAD. If the predictors of non-response to FR are correct, our data challenges the conventional wisdom that FR is first-line treatment for SIAD. Further studies are needed to test the validity of the predictors of non-response in the US guidelines.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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