Aetiological diagnosis of hyponatraemia in non-critical patients on total parenteral nutrition: A prospective multicentre study.

Autor: Ortolá Buigues A; Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain. Electronic address: anaortola@hotmail.com., Gómez-Hoyos E; Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain., Ballesteros Pomar MD; Endocrinology and Nutrition Department, Complejo Asistencial Universitario de León, León, Spain., Vidal Casariego A; Endocrinology and Nutrition Department, Complejo Asistencial Universitario de León, León, Spain., García Delgado Y; Endocrinology and Nutrition Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain., Ocón Bretón MJ; Endocrinology and Nutrition Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain., Abad González ÁL; Endocrinology and Nutrition Department, Hospital General Universitario de Alicante, Alicante, Spain., Luengo Pérez LM; Endocrinology and Nutrition Department, Hospital Universitario Infanta Cristina, Badajoz, Spain., Matía Martín P; Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria San Carlos (IDISSC), Madrid, Spain., Tapia Guerrero MJ; Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, Málaga, Spain., Del Olmo García MD; Endocrinology and Nutrition Department, Hospital Universitario Severo Ochoa, Leganés, Spain., Herrero Ruiz A; Endocrinology and Nutrition Department, Hospital Clínico Universitario de Salamanca, Salamanca, Spain., Álvarez Hernández J; Endocrinology and Nutrition Department, Hospital Universitario Príncipe de Asturias, Getafe, Spain., Tejera Pérez C; Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain., Herranz Antolín S; Endocrinology and Nutrition Department, Hospital Universitario de Guadalajara, Guadalajara, Spain., Tenorio Jiménez C; Endocrinology and Nutrition Department, Complejo Hospitalario de Jaén, Jaén, Spain., García Zafra MV; Endocrinology and Nutrition Department, Hospital General Universitario Santa Lucía, Cartagena, Spain., Botella Romero F; Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain., Argente Pla M; Endocrinology and Nutrition Department, Hospital Universitario y Politécnico de La Fe, Valencia, Spain., Martínez Olmos MÁ; Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain., Bretón Lemes I; Endocrinology and Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain., Runkle De la Vega I; Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria San Carlos (IDISSC), Madrid, Spain., De Luis Román D; Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain.
Jazyk: angličtina
Zdroj: Endocrinologia, diabetes y nutricion [Endocrinol Diabetes Nutr (Engl Ed)] 2022 Mar; Vol. 69 (3), pp. 160-167.
DOI: 10.1016/j.endien.2022.02.013
Abstrakt: Background: In patients receiving total parenteral nutrition (TPN), the frequency of hyponatraemia is high. However, the causes of hyponatraemia in TPN have not been elucidated, although diagnosis is required for appropriate therapy. The aim of this study is to describe the aetiology of hyponatraemia in non-critical hospitalised patients receiving TPN.
Methods: Prospective multicentre study in 19 Spanish hospitals. Non-critically hyponatraemic patients receiving TPN and presenting hyponatraemia over a 9-month period were studied. Data collected included sex, age, previous comorbidities, and serum sodium levels (SNa) before and following TPN initiation. Parameters for study of hyponatraemia were also included: clinical volaemia, the presence of pain, nausea, gastrointestinal losses, diuretic use, oedema, renal function, plasma and urine osmolality, urinary electrolytes, cortisolaemia, and thyroid stimulating hormone.
Results: 162 patients were included, 53.7% males, age 66.4 (SD13.8) years. Volume status was evaluated in 142 (88%): 21 (14.8%) were hypovolaemic, 96 (67.6%) euvolaemic and 25 (17.6%) hypervolaemic. In 111/142 patients the analytical assessment of hyponatraemia was completed. Hypovolaemic hyponatraemia was secondary to GI losses in 10/111 (9%), and to diuretics in 3/111 (2.7%). Euvolaemic hyponatraemia was due to Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) in 47/111 (42.4%), and to physiological stimuli of Arginine Vasopressin (AVP) secretion in 28/111 (25.2%). Hypervolaemic hyponatraemia was induced by heart failure in 19/111 (17.1%), cirrhosis of the liver in 4/111 (3.6%).
Conclusions: SIADH was the most frequent cause of hyponatraemia in patients receiving TPN. The second most frequent cause was physiological stimuli of AVP secretion induced by pain/nausea.
(Copyright © 2021 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze: MEDLINE
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