Background
Methods
Aims
Setting
Study patients
Treatment protocol for Hyponatremia
Statistical analysis
Results
Parameters | Missing | Total (n = 56) | No-Overcorrection (n = 45) | Overcorrection (n = 11) |
p-value |
---|---|---|---|---|---|
Age, years old | 0 | 78 (60–83) | 79 (63–84) | 60 (48–82) | 0.129 |
Male | 0 | 27 (48.2) | 22 (48.9) | 5 (45.5) | 0.838 |
Body weight, kg | 0 | 52 (42–60) | 50 (40–58) | 56 (51–69) | 0.049 |
Symptoms | |||||
Severe symptoms | |||||
Seizures | 0 | 3 (5.4) | 0 (0.0) | 3 (27.3) | <0.001 |
Coma | 0 | 0 (0.0) | 0 (0.0) | 0 (0.0) | – |
Cardiorespiratory distress | 0 | 0 (0.0) | 0 (0.0) | 0 (0.0) | – |
Other symptoms | |||||
Vomit | 0 | 13 (23.2) | 9 (20.0) | 4 (36.4) | 0.249 |
Nausea | 0 | 9 (16.1) | 7 (15.6) | 2 (18.2) | 0.832 |
Loss of appetite | 0 | 10 (17.9) | 10 (22.2) | 0 (0.0) | 0.085 |
Disorientation | 0 | 34 (60.7) | 28 (62.2) | 6 (54.5) | 0.640 |
Impairment of gait or fall | 0 | 10 (17.9) | 9 (20.0) | 1 (9.1) | 0.397 |
General fatigue | 0 | 3 (5.4) | 3 (6.7) | 0 (0.0) | 0.379 |
Asymptomatic | 0 | 3 (5.4) | 2 (4.4) | 1 (9.1) | 0.540 |
Cause of hyponatremia | |||||
Primary polydipsia | 0 | 6 (10.7) | 2 (4.4) | 4 (36.4) | 0.002 |
Poor solute intake | 0 | 21 (37.5) | 17 (37.8) | 4 (36.4) | 0.931 |
Hypovolemic hyponatremia | 0 | 36 (64.3) | 30 (66.7) | 6 (54.5) | 0.452 |
SIADH | 0 | 4 (7.1) | 4 (8.9) | 0 (0.0) | 0.305 |
Physiological stimulation of ADH | 0 | 11 (19.6) | 9 (20.0) | 2 (18.2) | 0.892 |
CSW | 0 | 2 (3.6) | 2 (4.4) | 0 (0.0) | 0.476 |
Drug intoxication | 0 | 10 (17.9) | 8 (17.8) | 2 (18.2) | 0.975 |
Unidentified | 0 | 1 (1.8) | 1 (2.2) | 0 (0.0) | 0.618 |
Underlying disease | |||||
Psychiatric disease | 0 | 6 (10.7) | 3 (6.7) | 3 (27.3) | 0.048 |
Schizophrenia | 0 | 1 (1.8) | 0 (0.0) | 1 (9.1) | 0.041 |
Anorexia nervosa | 0 | 1 (1.8) | 1 (2.2) | 0 (0.0) | 0.618 |
Depression | 0 | 3 (5.4) | 2 (4.4) | 1 (9.1) | 0.540 |
Development disorder | 0 | 1 (1.8) | 0 (0.0) | 1 (9.1) | 0.041 |
Infectious disease | 0 | 14 (25.0) | 13 (28.9) | 1 (9.1) | 0.174 |
Urinary tract infection | 0 | 5 (8.9) | 4 (8.9) | 1(9.1) | 0.983 |
Pneumonia | 0 | 3 (5.4) | 3 (6.7) | 0 (0.0) | 0.379 |
Thoracic empyema | 0 | 1 (1.8) | 1 (2.2) | 0 (0.0) | 0.618 |
Meningitis | 0 | 2 (3.6) | 2 (4.4) | 0 (0.0) | 0.476 |
Influenza | 0 | 2 (3.6) | 2 (4.4) | 0 (0.0) | 0.476 |
Cellulitis | 0 | 2 (3.6) | 2 (4.4) | 0 (0.0) | 0.476 |
HIV | 0 | 1 (1.8) | 1 (2.2) | 0 (0.0) | 0.618 |
Malignant disease | 0 | 6 (10.7) | 5 (11.1) | 1 (9.1) | 0.846 |
Stomach | 0 | 1 (1.8) | 1 (2.2) | 0 (0.0) | 0.618 |
Pancreatic | 0 | 2 (3.6) | 2 (4.4) | 0 (0.0) | 0.476 |
Renal | 0 | 1 (1.8) | 1 (2.2) | 0 (0.0) | 0.618 |
Prostatic | 2 (3.6) | 1 (2.2) | 1 (9.1) | 0.271 | |
Alcohol abuse | 0 | 4 (7.1) | 3 (6.7) | 1 (9.1) | 0.780 |
Unidentified | 0 | 28 (50.0) | 23 (51.1) | 5 (45.5) | 0.737 |
Medication on admission | |||||
Thiazide | 0 | 7 (12.5) | 5 (11.1) | 2 (18.2) | 0.525 |
Antipsychotic drug | 0 | 2 (3.6) | 2 (4.4) | 0 (0.0) | 0.476 |
DDAVP | 0 | 2 (3.6) | 2 (4.4) | 0 (0.0) | 0.476 |
Parameters | Missing | Total (n = 56) | No-Overcorrection (n = 45) | Overcorrection (n = 11) |
p-value |
---|---|---|---|---|---|
Blood pressure, mmHg | |||||
Systolic | 0 | 130 (112–152) | 127 (111–148) | 142 (140–162) | 0.034 |
Diastolic | 0 | 70 (62–83) | 70 (60–82) | 78 (72–89) | 0.137 |
Laboratory data | |||||
Blood analysis | |||||
Serum Na, mEq/L | 0 | 115 (111–119) | 116 (111–119) | 107 (104–113) | 0.012 |
Serum K, mEq/L | 0 | 4.0 (3.4–4.5) | 4.0 (3.7–4.7) | 3.6 (3.3–4.1) | 0.112 |
Serum BUN, mg/dL | 0 | 12.5 (9.7–18.2) | 14.2 (10.1–22.9) | 10.1 (7.7–10.8) | 0.023 |
Serum Cr, mg/dL | 0 | 0.65 (0.44–0.94) | 0.66 (0.46–1.12) | 0.47 (0.42–0.73) | 0.270 |
Serum TP, mg/dL | 6 | 6.4 (6.0–7.3) | 6.4 (6.0–7.3) | 7.3 (6.3–7.8) | 0.260 |
Serum Glu, mg/dL | 8 | 123 (98–144) | 124 (94–144) | 120 (115–138) | 0.741 |
Urinary analysis | 0 | ||||
Urine Na, mEq/L | 0 | 41 (20–65) | 41 (24–66) | 33 (17–46) | 0.343 |
Urine K, mEq/L | 0 | 28 (14–44) | 33 (17–44) | 13 (10–31) | 0.058 |
Urine Na + K, mEq/L | 0 | 74 (49–114) | 75 (52–115) | 57 (28–97) | 0.101 |
Urine Osm, mOsm/kg H2O | 1 | 332 (245–493) | 336 (265–502) | 217 (137–359) | 0.029 |
Parameters | Missing | Total (n = 56) | No-overcorrection (n = 45) | Overcorrection (n = 11) |
p-value |
---|---|---|---|---|---|
Treatment of hyponatremia | |||||
Hydration (0.9% saline) | 0 | 36 (64.3) | 30 (66.7) | 6 (54.5) | 0.452 |
Maintenance infusion (0.9% saline) | 0 | 32 (57.1) | 26 (57.8) | 6 (54.5) | 0.846 |
3% hypertonic saline | |||||
Bolus infusion | 0 | 1 (1.8) | 0 (0) | 1 (9.1) | 0.041 |
Continuous infusion | 0 | 16 (28.6) | 15 (33.3) | 1 (9.1) | 0.111 |
Diuretics | |||||
Loop diuretic (i.v.) | 0 | 4 (7.1) | 4 (8.9) | 0 (0.0) | 0.305 |
Tolvaptan (p.o.) | 0 | 4 (7.1) | 3 (6.7) | 1 (9.1) | 0.780 |
Intervention for overcorrection | |||||
D5W | 0 | 18 (32.1) | 12 (26.7) | 6 (54.5) | 0.076 |
Instructed to free water intake | 0 | 2 (3.6) | 1 (2.2) | 1 (9.1) | 0.271 |
DDAVP | 0 | 11 (19.6) | 5 (11.1) | 6 (54.5) | 0.001 |
Time from admission, hours | 0 | 8 (7–12) | 9 (8–9) | 8 (7–13) | 0.853 |
Outcomes | |||||
Osmotic demyelination | 0 | 0 (0.0) | 0 (0.0) | 0 (0.0) | NA |
Increase of serum Na, mEq/L | |||||
At 4 h | 5 | 2.0 (1.0–4.0) | 2.0 (0.0–3.0) | 6.5 (3.3–8.5) | 0.001 |
At 24 h | 0 | 8 (6–10) | 7 (5–9) | 12 (11–15) | <0.001 |
At 48 h | 5 | 14 (12–17) | 13 (11–15) | 19 (17–23) | <0.001 |
Early urine output, mL/h | 0 | 205 (114–386) | 183 (85–303) | 436 (196–998) | 0.005 |
Urine output at 24 h, mL | 0 | 2008 (1115–3101) | 1640 (855–3005) | 3725 (2229–4686) | 0.001 |
Urine output at 48 h, mL | 0 | 1930 (1416–3006) | 1875 (1315–2655) | 2695 (1723–3750) | 0.073 |
Univariable | Multivariable model 1 | Multivariable model 2 | ||||
---|---|---|---|---|---|---|
Parameters | OR (95% CI) |
p-value | adjusted OR (95% CI) |
p-value | adjusted OR (95% CI) |
p-value |
Age | 0.97 (0.93–1.01) | 0.108 | 0.98 (0.92–1.05) | 0.537 | – | – |
Male | 0.87 (0.22–3.30) | 0.838 | 0.63 (1.00–3.56) | 0.603 | – | – |
Primary Polydipsia | 12.3 (2.02–102.00) | 0.009 | 2.41 (0.09–60.20) | 0.576 | 3.25 (0.16–73.04) | 0.432 |
Serum Na | 0.83 (0.71–0.94) | 0.006 | 0.84 (0.70–0.98) | 0.036 | 0.86 (0.73–0.99) | 0.041 |
Serum Cr | 1.12 (0.51–2.04) | 0.722 | 1.61 (0.72–4.01) | 0.218 | – | – |
Early urine outputa
| 1.41 (1.13–1.87) | 0.006 | 1.30 (0.94–1.94) | 0.149 | 1.26 (0.93–1.79) | 0.163 |
3% hypertonic continuous infusion | 0.20 (0.01–1.19) | 0.142 | 0.54 (0.02–5.50) | 0.629 | – | – |