Clinico-etiological profile and outcome of hyponatremia in hospitalised adult patients
Background: Hyponatremia is a common electrolyte abnormality in hospitalised patients. Incidence varies from 1% to 40%. It is common in the elderly, mainly owing to impaired water and electrolyte balance in response to diet, drugs and environmental changes. This study is to evaluate clinical features, aetiologies and outcome in patients with hyponatremia (Sr. Na <120 mmol/L at the time of admission).
Methods: An observational study was conducted in 76 patients admitted in Kamalnayan Bajaj Hospital, Aurangabad from August 2013 to August 2014. All patients having their serum sodium concentration less than 120 mmol/L were included in the study. History, examination and relevant details were taken. Outcome was noted. Student’s t-test, chi square test and Fisher’s exact test were applied for statistical analysis.
Results: In the present study, mean age of the patients was 59.4% years. 43% patients were euvolemic, 38% hypervolemic and 19% hypovolemic. Nausea (54%) was most common gastrointestinal while drowsiness (42%) was the most common neurological symptom. Etiology of hyponatremia was multifactorial in 76% cases. Use of diuretics (53%) was the most common etiological factor. SIADH was suspected in nine patients. Mortality was 21%. Most common comorbid conditions were hypertension (51%) and diabetes mellitus (42%).
Conclusions: Hyponatremia is a common electrolyte abnormality in hospitalised patients. There is an increasing tendency for it to occur with increasing age, hypertension, diabetes mellitus and use of drugs (diuretics). Nausea, vomiting and drowsiness are the commonest symptoms. Mortality is high, though not directly related to serum sodium levels. Hyponatremia acts as a poor prognostic marker of primary disease.
Upadhyay A, Jaber BL, Madias NE. Incidence and prevalence of hyponatremia. Am J Med. 2006;119:S30-5.
Reddy P, Mooradian AD. Diagnosis and management of hyponatraemia in hospitalised patients. Int J Clin Pract 2009;63:494-508.
Juhi C, Neelamsuri, Management of sodium imbalance in Neurosurgical patients. Oman Medical Journal. 2000;12-4.
Scott MG, LeGrys VA, klutts JS. Electrolytes and blood gases. In: clinical chemistry and molecular diagnostics Tietz S. 3rd Ed. Saunders WB, Philadelphia. 2007;983-1018.
Verbalis JG, Goldsmith SR, Greenberg A, Schrier RW, Sterns RH. Hyponatremia treatment guidelines 2007: Expert Panel Recommendations. Am J Med 2007;120 (11A),S1-21.
Saeed BO, Beaumont D, Handley G H , Weaver J U. Severe hyponatraemia: investigation and management in a district general hospital. J Clin Pathol. 2002;55:893-896.
Heinrich S, Wagner A, Gross P. Hyponatremia. Med KlinIntensiv Med Notfmed. 2013; 108(1):53-8.
Shannon G. Severe hyponatraemia – recognition and management. Australian Prescriber 2011;34(2).
Clayton J.A. Severe hyponatraemia in medical in-patients: etiology, assessment and assessment. QJ Med. 2006;99:505–511.
Laczi F. Etiology. Diagnostics and therapy of hyponatremias. Orv Hetil. 2008;149(29):1347-54.
Sirota JC, Berl T. Physiology of water balance and Pathophysiology of hyponatremia. In: Simson’s hyponatremia: evaluation and treatment Springer Science business media, New York. 2013; 23-4.
Scott MG, LeGrys VA, klutts JS. Electrolytes and blood gases. In: clinical chemistry and molecular diagnostics Tietz S, 3rd Ed. Saunders WB, Philadelphia. 2007;468-83.
Laczi F. Etiology, diagnostics and therapy of hyponatremias. Orv Hetil 2008 Jul 20; 149(29):1347-54.
Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000; 342:1581.
Correia L. Severe hyponatremia in older patients at admission in an internal medicine department. Arch Gerontol Geriatr. 2014;59(3):642-7.
Waikar S, Mount D, Curhan G. Mortality after Hospitalization with Mild, Moderate, and Severe Hyponatremia. Am J Med. 2009; 122(9): 857–65.
Hoorn EJ, Lindemans J, Zietse R. Development of severe hyponatraemia in hospitalized patients: treatment-related risk factors and inadequate management. Nephrol Dial Transplant. 2006; 21(1):70-6.
Farooqui M, Ahmed S. Severe Hyponatremia in hospitalised adults at Sultan Qaboos University Hospital. JPMA. 2003.
Rao MY, Sudhir U, Anil Kumar T, Saravanan S, Mahesh E, Punith K. Hospital based descriptive study of symptomatic hyponatremia in elderly patients. J Assoc Physicians India (JAPI). 2010:667-9.
Agrawal SM, Agrawal A. A comparative study of the clinico etiological profile of hyponatremia at presentation with that developing in hospital. Student IJMR 134. 2011;118-22.
Nandkumar, Gane B, Hiremath PB. Clinico-aetiological profile of hyponatremia in adults. Int J Biol Med Res. 2013;4(1):2802-6.
Chatterjee N, Sengupta N, Chanchal D, Roy A, Basu AK, Pal S. A descriptive study of hyponatremia in a tertiary care hospital of Eastern India. Indian J Endocrinol Metab. 2012;16(2):288-91.
Reheem A, Barqawi AL. A study of Hyponatremia in Hospitalized Patients. QMJ. 2007:23-4.
Anderson RJ, Chung HM, Kluge R, Schrier RW. Hyponatremia: a prospective analysis of its epidemiology and the pathogenetic role of vasopressin. Ann Intern Med. 1985;102:164-8.
Erasmus RT, Matsha TE. The frequency, aetiology and outcome of severe hyponatraemia in adult hospitalised patients. Cent Afr J Med. 1998;44(6):154-8.
Gill G, Huda B, Boyd A, Skagen K, Wile D, Watson I, van Heyningen C. Characteristics and mortality of severe hyponatraemia- a hospital-based study.ClinEndocrinol (Oxf). 2006; 65(2):246-9.
Hochman I, Cabili S, Peer G. Hyponatremia in internal medicine ward patients: causes, treatment and prognosis. Isr J Med Sci.1989;25(2):73-6.
Vurgese TA, Radhakrishan SB, Mapkar OA. Frequency and etiology of hyponatremia in adult hospitalized patients in medical wards of a general hospital in Kuwait. Kuwait Medical Journal. 2006;38(3):211-3.
Hiller TA, Abott RD, Barrett EJ. Hyponatremia: Evaluating the correction factor for hyperglycemia. Am J Med. 1999;106:399-403.
Clayton JA, Rodgers S, Blakey J, Avery A, Hall IP.Thiazide diuretic prescription and electrolyte abnormalities in primary care. Br J Clin Pharmacol. 2006;61(1):87-95.
Liamis G, Milionis H, Elisaf M. A review of drug-induced hyponatremia. Am J Kidney Dis. 2008 Jul; 52(1):144-53.
Simson E. hyponatremia- evalution and treatment. New york. springer science business media; 2014.
Gross PA, Pehrisch H, Rascher W, Schömig A, Hackenthal E, Ritz E. Pathogenesis of clinical hyponatremia: observations of vasopressin and fluid intake in 100 hyponatremic medical patients. Eur J Clin Invest. 1987 Apr; 17(2):123-9.