Background
Hyponatremia is one of the most common electrolyte abnormalities. Overcorrection of severe hyponatremia can result in serious neurological complications such as osmotic demyelination ...syndrome, but the incidence and risk factors of overcorrection and osmotic demyelination have not been thoroughly investigated.
Methods
This is a single-center retrospective cohort study of 50 patients admitted through the emergency department with initial serum sodium (serum Na) < 125 mEq/L between January 2015 and December 2017. Incidence and risk factors of overcorrection and osmotic demyelination were examined. Overcorrection was defined as an increase in serum sodium concentration > 10 mEq/L at 24 h and/or > 18 mEq/L at 48 h, respectively.
Results
Six patients (12%) and one patient (2%) had overcorrection at 24 h and 48 h, respectively. A total of 5 (10%) patients had a brain MRI completed after overcorrection, and no patient showed radiologic evidence of osmotic demyelination. Symptomatic hyponatremia at presentation and 3% saline use were associated with the risk of overcorrection in univariable analysis (
p
< 0.001;
p
= 0.006, respectively).
Conclusions
Among patients admitted with severe hyponatremia, overcorrection occurred in 14%. Symptomatic hyponatremia at presentation and 3% saline use were associated with the risk of overcorrection.
Serum tonicity is defined by the serum concentrations of sodium (sNa) and glucose, which can promote free water movement across intra/extracellular compartments. Rapid changes in serum tonicity can ...cause brain damage. We herein report an educational case of a patient with hyponatremia (sNa: 112 mEq/L) concomitant with acute alcoholic pancreatitis. The cause of hyponatremia was considered complex. Pseudo- and trans-locational natremia was secondary to hyperglycemia (721 mg/dL) and hypertriglyceridemia (1,768 mg/dL), respectively, and true hypotonic hyponatremia. Regarding sNa correction, rapid correction was suspected. However, this was safely managed by monitoring tonicity (not sNa or osmolarity), thereby avoiding brain damage.
In patients with chronic kidney disease (CKD), restricting dietary salt is recommended to prevent fluid retention. Rapid weight loss is often observed when CKD patients with a high salt intake are ...hospitalized and started on a low-salt diet. We investigated the effects of 7-day dietary salt restriction on weight loss in hospitalized patients with CKD. During the 7-day hospitalization, a low-salt (6 g/day) and low-protein (0.6-0.8 g/kg/day ideal body weight) diet was served to all patients. Urine samples were collected for the first 24 h after admission, and patients were divided into quartiles (Q1-Q4) by urinary salt excretion. Body weight was measured on days 1 and 7. Weight loss after admission was compared among the groups. Factors associated with weight loss were evaluated by multivariate logistic regression. The mean age of the patients was 70.3 ± 11.7 years, and 73% were male. Mean weight loss was 1.6 ± 1.7 kg on day 7. Weight loss was significantly greater in Q3 and Q4 than in Q1 (P = 0.009 and P <0.001, respectively). In the univariate analysis, weight loss correlated positively with 24-h urinary salt excretion on admission (γ2 = 0.146) and body mass index (γ2 = 0.223). The 24-h urinary salt excretion on admission and BMI were independently associated with weight loss of >2 kg. The adjusted odds ratios (95% confidence interval) were 1.24 (1.13-1.36) and 1.15 (1.07-1.22), respectively. Twenty-four-hour urinary salt excretion on admission is useful for predicting significant weight loss with short-term dietary salt restriction.
Backgrounds
Few studies have reported the prevalence and characteristics of hypouricemia in the emergency department (ED). We investigated the prevalence and characteristics of hypouricemia in the ED ...of a university‐affiliated hospital in Japan.
Methods
This is a retrospective cross‐sectional single‐center study. All adult patients (18 years old or older) who had their serum uric acid (SUA) measured at the ED between 2011 and 2021 were included. Information collected included age, sex, SUA, and serum creatinine. Hypouricemia was defined as an SUA level ≦2.0 mg/dL.
Results
A total of 10,551 patients were included in the study. Fifty‐one percent were male. The median SUA levels were significantly higher in men than in women (6.0 4.8−7.4 vs. 4.7 3.7−6.1, p < 0.001). The prevalence of hypouricemia was higher in women than in men (2.0% vs. 0.9%, p < 0.001). A possible cause of hypouricemia was identified in 88 patients. Malignancy and diabetes were the major possible cause of hypouricemia (p < 0.001).
Conclusion
The distribution of SUA levels and prevalence of hypouricemia differed significantly by sex and age in the ED. Malignancy was the leading cause of hypouricemia in the ED.
Background
Hypernatremia is one of the most commonly encountered electrolyte disorders in the emergency department (ED). Few studies have reported the seasonal fluctuations of the prevalence of ...hypernatremia with conflicting results. We investigated the seasonal prevalence of hypernatremia in an emergency department in Japan.
Methods
A total of 12,598 patients presented to the ED between January 2015 and December 2017 were reviewed. The adult group aged between 18 and 64 years old consisted of 5427 patients and the elderly group aged over 65 years consisted of 7171 patients. Information collected included age, sex, serum sodium, and serum creatinine. Hypernatremia was defined as a serum sodium leve1 > 145 mEq/L, and moderate to severe hypernatremia was defined as a serum sodium level ≥ 150 mEq/L.
Results
The prevalence of hypernatremia was significantly higher in the elderly group than in the adult group (2.6% vs. 0.7%;
p
< 0.001). Similarly, the prevalence of moderate to severe hypernatremia was significantly higher in the elderly group than in the adult group (1.0% vs. 0.1%;
p
< 0.001). The prevalence of hypernatremia and moderate to severe hypernatremia was significantly higher in the elderly group than in the adult group in all seasons. In the elderly group, the seasonal prevalence of moderate to severe hypernatremia was significantly higher during the winter. Also, there was a correlation between weather temperature and the prevalence of moderate to severe hypernatremia in the elderly group (
r
= − 0.34,
p
= 0.04).
Conclusions
Hypernatremia is prevalent in the elderly and the prevalence is highest during the winter. Special attention should be paid in the elderly patients to prevent hypernatremia especially in the winter.
Hyponatremia is one of the most commonly encountered electrolyte disorders in emergency department (ED). Seasonal fluctuations of the prevalence of hyponatremia has been reported. We investigated the ...impact of age on the seasonal prevalence of hyponatremia in the emergency department in Japan.
Total of 8377 patients presented to the ED between January 2015 and December 2016 were reviewed. The adult group aged between 18 and 64 years old consisted of 3656 patients and the elderly group aged over 65 years consisted of 4721 patients. Information collected included age, sex, serum sodium, and serum creatinine. Hyponatremia was defined as a serum sodium leve1 < 135 mEq/L and severe hyponatremia was defined as a serum sodium level < 125 mEq/L.
Prevalence of hyponatremia was significantly higher in the elderly group than in the adult group (17.0% vs. 5.7%, p < 0.001). Similarly, the prevalence of severe hyponatremia was significantly higher in the elderly group than in the adult group (1.9% vs. 0.3%, p < 0.001). Prevalence of hyponatremia and severe hyponatremia was significantly higher in the elderly group than in the adult group in all seasons. In the elderly group, there was a significant correlation between weather high temperature during summer and prevalence of hyponatremia (r = 0.510, p = 0.011).
There was a major impact of age on the seasonal prevalence of hyponatremia and severe hyponatremia. Strategies to prevent hyponatremia and severe hyponatremia should be taken especially in the elderly patients during summer.
Hyperkalemia is an electrolyte disorder frequently encountered in the emergency department. There are few studies on seasonal variation in the prevalence of hyperkalemia. The aim of this study was to ...investigate the seasonal changes in the prevalence of hyperkalemia in the emergency department.
We retrospectively reviewed a total of 24,085 patients presented to the emergency department between January 2012 and December 2020. Age, gender, serum potassium level, and serum creatinine level were recorded. The definition used for hyperkalemia was a serum potassium level of ≥ 5.5 mEq/L. Renal function was divided into two categories: preserved (eGFR ≥ 60 mL/min/1.73 m
) or reduced (eGFR < 60 mL/min/1.73 m
).
The prevalence of hyperkalemia was 2.1% in patients with preserved renal function and was 11.9% in patients with reduced renal function (
< 0.001). The prevalence of hyperkalemia was highest in winter, followed by spring, autumn, and summer in patients with preserved renal function (
< 0.001) and those with reduced renal function (
< 0.001). There was a linear correlation between monthly weather temperature and the prevalence of hyperkalemia in patients with preserved renal function (r = -0.392;
< 0.001) and those with reduced renal function (r = -0.487;
< 0.001).
: we found that the prevalence of hyperkalemia was significantly higher in winter for both patients with preserved renal function and those with reduced renal function.
Various stresses including ischemia are known to up-regulate renal L-FABP gene expression and increase the urinary excretion of L-FABP. In diabetic patients with anemia, the urinary excretion of ...L-FABP is significantly increased. We studied the clinical significance of urinary L-FABP and its relationship with anemia in non-diabetic patients.
A total of 156 patients were studied in this retrospective cross-sectional analysis. The associations between anemia and urinary L-FABP levels, and the predictors of urinary L-FABP levels in non-diabetic patients were evaluated.
Urinary L-FABP levels were significantly higher in patients with anemia compared to those in patients without anemia. Similarly, the urinary L-FABP levels were significantly higher in patients with albuminuria compared to those in patients without albuminuria. Urinary L-FABP levels correlated with urinary albumin-to-creatinine ratios, estimated glomerular filtration rates, body mass index, and hemoglobin levels. Multivariate linear regression analysis determined that hemoglobin levels (β = -0.249, P = 0.001) and urinary albumin-to-creatinine ratios (β = 0.349, P < 0.001) were significant predictors of urinary L-FABP levels.
Urinary L-FABP is strongly associated with anemia in non-diabetic patients.
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