ECE2018 Guided Posters Pituitary Clinical (12 abstracts)
Predictors of failure to respond to fluid restriction and furosemide efficacy prediction in patients presenting Syndrome of Inappropriate Antidiuretic while receiving parenteral nutrition. Prospective Multicenter Study
Emilia Gomez-Hoyos 1 , Ana Ortola-Buigues 1 , Alfonso Vidal Casariego 2 , Yaiza Garcia Delgado 3 , Maria Julia Oncon Breton 4 , Angel Luis Abad González 5 , Luis Miguel Luengo Perez 6 , Pilar Matia Martin 7 , Maria Jose Tapia Guerrero 8 & Daniel De Luis Roman 1
1Clinico de Valladolid Hospital-Ien, Valladolid, Spain; 2Leon Hospital, Leon, Spain; 3Insular de Gran Canaria Hospital, Gran Canaria, Spain; 4Lozano Blesa Hospital, Zaragoza, Spain; 5General de Alicante Hospital, Alicante, Spain; 6Badajoz Hospital, Badajoz, Spain; 7Clinico San Carlos Hospital, Madrid, Spain; 8Regional de Malaga Hospital, Malaga, Spain.
Introduction: Syndrome of Inappropriate Antidiuretic (SIAD) is the most frequent cause of hyponatremia in parenteral nutrition (PN) patients. Yet studies concerning SIAD therapy are lacking. Our objective was to describe SIAD treatment and determine pre-treatment predictors of failure to respond to fluid restriction (FR) and furosemide efficacy prediction in a group of patients with SIAD while receiving PN.
Methods: Prospective, non-interventional, multicenter study in 19 Spanish hospitals. Forty-seven patients with SIAD-induced hyponatremia while receiving PN were recruited. Hyponatraemia was defined as a Serum Na level (SNa) <135 mmol/l. A positive response to therapy was defined as reaching SNa >135 mmol/l (eunatremia) following 72 hours of treatment. Urine osmolality-UOsm- >500 mOsm/kg, a Furst formula (ratio Urine Sodium + Urine Potassium/SNa) >1, or a 24-hour urine volume <1500 ml were all considered predictors of a negative response to FR. A UOsm >350 mOsm/kg was considered a predictor of a positive response to furosemide. The therapy used for the treatment of hyponatremia in these patients was also collected.
Results: 59.6% were men. The average age was 66.9 (S.D. 11,5). All patients had diagnostic criteria for the diagnosis of SIAD. 20/47 received treatment: (80% FR, 10% FR and furosemide, 10% tolvaptan). No patient achieved FR to ≤ 1 liter/24 h. 26/47 (55.3%) patients had UOsm >500 mOsm/kg, 16/44 (36.4%) had a Furst formula>1 and 8/36 (22.2%) had a urinary volume <1500 ml/24 h. Thus, 68.1% had at least one criterion predicting a lack of response to FR. 69.6% had UOsm >350 mOsm/kg, and would be candidates for furosemide therapy. The percentage of patients achieving eunatraemia following 72 hours was: 40% with FR, 100% with furosemide, 100% with tolvaptan.
Conclusions: In parenteral nutrition patients with SIAD, fluid restriction is by definition difficult to achieve, and could compromise nutritional treatment. Furthermore, it is ineffective, with more than two-thirds of patients presenting predictors of non-response. Yet fluid restriction was the therapy most frequently used to treat SIAD-induced hyponatremia in this series of patients. Furosemide and tolvaptan should be considered first-line therapy for the treatment of SIAD in patients receiving parenteral nutrition.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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