Système gastro-intestinal et digestif

Abstrait

Digestive Diseases 2020: Retrospective audit on the use of hypertonic saline in the management of acute symptomatic hyponatraemia in hospitalized patients - Devina Sharma - Royal Liverpool and Broadgreen University Hospitals

Devina Sharma

We introduced the hospital policy on the management of severe symptomatic hyponatraemia (SSH), with hypertonic saline (HS) of 1.8% and 5% saline in 2017. This is one of the few UK centres to offer this treatment, therefore the evidence is limited. The policy was based on European and American guidelines (1) (2). Objectives To study the adherence, and effectiveness, of this guideline in managing patients with SSH. Methods Patients were identified using the Biochemistry tracking system between 01/01/18 until 14/05/20. The terms - Hypona, sod, Hypertonic, 5%, 1.8% as were searched. The laboratory result system was used to identify hyponatraemia.

Standard 1: 11 patients had symptoms of hyponatraemia. They were confusion (6), somnolence (5), seizure (4), and vomiting (3). Other symptoms included muscle twitching, fatigue and nausea. SSH was suspected in 2/11 patients, but it was not the primary diagnoses. One patient was asymptomatic- the only patient with chronic hyponatraemia. Standard 2a/b: All patients identified were treated with 1.8% saline. None with 5% saline. Standard 2c: 7/12 patients overcorrected Although there are many approaches to the management of hyponatremia, one of the most common approaches used by nonexpert clinicians begins with an assessment of extracellular fluid (ECF) volume status. Because diabetes mellitus is becoming more prevalent in the adult population, clinicians should be mindful of ruling out hyperosmolar hyponatremia caused by hyperglycaemia as a potential cause of hyponatremia (there should be a 130mmol/L) their serum sodium. In the absence of diuretics or an osmotic diuresis, for example glucosuria, bicarbonaturia, the normal kidney will respond to arterial underfilling by increasing tubular sodium reabsorption with a decrease in fractional excretion of sodium (FENa) to less than 1.0%. A clinical search for the cause of hyponatremia relating to a decrease in CO or arterial vasodilation as a nonosmotic stimulus of AVP is therefore indicated patient self-discharged before this. The mean length of time to achieve this was 6.5 days In addition: 3 patients died. No deaths were attributed to treatment with 1.8% saline. Specifically, Although osmotic regulation of AVP is more sensitive, nonosmotic stimulation the pathogenesis of hyponatremia has been found to occur secondary to the nonosmotic secretion of AVP in over 95% of cases. A new

class of medications, AVP receptor antagonists, is now available, and numerous trials have shown them to be effective at increasing electrolyte-free water excretion and serum sodium concentration is more potent. Thus, in spite of hyponatremia and hypoosmolality, nonosmotic stimulation of AVP overrides the osmotic AVP regulation and leads to water retention and hyponatremia. In general, nonosmotic stimulation of AVP is due to decreased integrity after completing the review; however, clinicians should be aware that patients with diuretic use may not have a low urine sodium level despite being hypovolemic. In addition, these patients may exacerbate their hyponatremia through the ingestion of solute-poor fluids it became clear that to provide the reader with a clinical approach that could be applied in practice, we also needed to review and Urine sodium concentration is usually hyponatremia is usually a result of increased ECF volume such conducted a double-blind, placebo-controlled crossover trial involving nine patients with a chronic psychiatric illness and documented hyponatremia. Demeclocycline was administered for 21 days, and serum sodium levels were obtained. Compared with placebo, sodium levels in the treatment group were not statistically different. We identified no other eligible studies in our search as that seen with congestive heart failure, cirrhosis and nephrotic syndrome greater including malignant disease, intracranial pathology and some medications. SIADH is a diagnosis of exclusion and implies normal renal, thyroid and adrenal function.15 Proposed treatment of SIADH includes the management of the underlying disorder or discontinuation of the offending medication. However, reversal of the initiating disorder is not always possible. In such cases, and while the underlying cause is being evaluated, current therapy is to restrict the patient’s intake of fluid to less than than 30 mmol/L. In disorders of excess water intake, the urine osmolality is usually less than 100 mOsm/kg H20. Beer-drinker pocomania discuss management strategies of the arterial circulation no patients developed central pontine myelinolysis

Conclusions 1. Our audit showed symptomatic improvement in moderate and SSH, following.