Farooqui M A, Ahmed S.
Severe Hyponatremia in hospitalised adults at Sultan Qaboos University Hospital.
J Pak Med Assoc Jan ;53(5):180-2.

Objective: To see the frequency of severe-hyponatremia in hospitalised cases and correlate it with etiology and outcome. Methods: Adult inpatients in 1998 at Sultan Qaboos University Hospital with serum sodium <125 mmol/I were identified through the computerized hospital information system and studied retrospectively. Pseudohyponatremia and where hyponatremia due to laboratory error were excluded. Demographic, clinical, laboratory data and treatment and out come were recorded. Results: There were a total of 11632 adult admissions with 149 deaths (1.28%). A total of 35 patients (age range 18 to 75 years) fulfilled the inclusion criteria. Major comorbid conditions were congestive heart failure (34.2%), diabetes mellitus (31.4%), surgical or obstetrical procedure (22.8%), hypertension (17.1%), malignancy (11.4%), pneumonia (8.5%), cerebrovascular disorder (8.5%), cirrhosis (8.5%) and nephrotic syndrome (2.85%). Volume status was determined as euvolemic (48.5%), overloaded (42.8%) and dehydrated (8.5%). The etiology was iatrogenic in (62.8%) with major iatrogenic factors being diuretics (37.1%), hypotonic fluids (22.8%) and antidiuretic hormone analogs (2.85%). Common symptoms included nausea and vomiting (51.42%), followed by irritability (14.2%). No seizures or long term neurological sequelae were noted. Treatment included isotonic fluids (31.4%) and fluid restriction (11.4%). Six out of 35 patients died (17.1%) compared to 1.28% in general inpatients; a figure thirteen times higher. Conclusion: Severe hyponatremia is observed in hospitalised patients with significant comorbid conditions and is associated with significantly higher mortality when compared to non-hyponatremic patients. Further prospective studies are required to determine the differences noted in presentations and outcome in comparison to previously published reports (JPMA 53:180;2003).

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