Hyponatremia natural history, complications and prognosis: Difference between revisions

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===Complications  ===
===Complications  ===
'''Hyponatremic Encephalopathy :'''Early symptoms of hyponatremia from any cause may include apathy, weakness, muscular cramps, nausea, vomiting, and headache. More advanced clinical manifestations include impaired response to verbal and painful stimuli, hallucinations, urinary incontinence, and pulmonary edema. As edema worsens, clinical manifestations of hyponatremia are related to the degree of increased intracranial pressure and brain herniation. These manifestations may include decorticate posturing, hypothermia and hyperthermia, central diabetes insipidus, seizures, respiratory arrest, coma, permanent brain damage, and death <ref name="MoritzAyus20092">{{cite journal|last2=Ayus|first2=Juan Carlos|year=2009|title=New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children|journal=Pediatric Nephrology|volume=25|issue=7|pages=1225–1238|doi=10.1007/s00467-009-1323-6|issn=0931-041X|last1=Moritz|first1=Michael L.}}</ref>.Pulmonary edema in hyponatremic encephalopathy named Ayus-Arieff syndrome, is a noncardiogenic edema results from increased vasoconstriction and protein permeability of pulmonary vessels. Pulmonary edema by hyponatremic encephalopathy is more common with exercise associated hyponatremia and postoperative. The treatment is to correct the underlying causes of hyponatremia and reversible. Hyponatremic encephalopathy can occur without any evidence of brain edema in CT scan.
'''Hyponatremic Encephalopathy :C'''linical presentation of hyponatremic encephalopathy are associated with the degree of increased intracranial pressure and brain edema. These manifestations are ranged from nausea and vomiting which are the most common symptoms to cardiac arrest, permanent brain damage, and death <ref name="MoritzAyus20092">{{cite journal|last2=Ayus|first2=Juan Carlos|year=2009|title=New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children|journal=Pediatric Nephrology|volume=25|issue=7|pages=1225–1238|doi=10.1007/s00467-009-1323-6|issn=0931-041X|last1=Moritz|first1=Michael L.}}</ref>.Pulmonary edema in hyponatremic encephalopathy named Ayus-Arieff syndrome, is a noncardiogenic edema results from increased vasoconstriction and protein permeability of pulmonary vessels. Pulmonary edema by hyponatremic encephalopathy is more common with exercise associated hyponatremia and postoperative. The treatment is to correct the underlying causes of hyponatremia and reversible. Hyponatremic encephalopathy can occur without any evidence of brain edema in CT scan.
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Revision as of 16:58, 31 May 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Saeedeh Kowsarnia M.D.[2]

Overview

If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

Natural History, Complications, and Prognosis

Natural History

Serum sodium concentration is the main determinant of serum osmolality. Maintaining constant serum sodium and osmolality is essential for keeping cell volume stable. This maintenance is very crucial for brain cells and volume. In acute hyponatremia, an osmotic gradient between brain cells and serum, causing water to enter brain cells and increasing brain volume, edema, intracranial pressure and risk of herniation .In chronic hyponatremia, brain cells have time to lose osmoles (amino acids, polyols) to re-equilibrate the osmolar gradient and cell volume [1].

Complications

Hyponatremic Encephalopathy :Clinical presentation of hyponatremic encephalopathy are associated with the degree of increased intracranial pressure and brain edema. These manifestations are ranged from nausea and vomiting which are the most common symptoms to cardiac arrest, permanent brain damage, and death [2].Pulmonary edema in hyponatremic encephalopathy named Ayus-Arieff syndrome, is a noncardiogenic edema results from increased vasoconstriction and protein permeability of pulmonary vessels. Pulmonary edema by hyponatremic encephalopathy is more common with exercise associated hyponatremia and postoperative. The treatment is to correct the underlying causes of hyponatremia and reversible. Hyponatremic encephalopathy can occur without any evidence of brain edema in CT scan.

Stage Clinical manifestation of hyponatremic encephalopathy
Early Anorexia, headache, nausea, vomiting, muscule cramps, weakness, confusion, altered consciousness, agitation, gait disturbances
Advanced Impaired response to verbal stimuli, impaired response to painful stimuli, bizarre (inappropriate) behavior, hallucinations (auditory or visual), asterixis, obtundation, incontinence (urinary or fecal), respiratory insufficiency
Severe Decorticate and/or decerebrate posturing, bradycardia, hyper- or hypotension, altered temperature regulation (hypo- or hyperthermia), anisocornea, papilledema, dilated pupils, seizure activity (usually grand mal), cardiac arrhythmias, myocardial ischemia, pulmonary edema, respiratory arrest, coma, polyuria (secondary to central diabetes insipidus)

Brain herniation :In acute hyponatremia, if the brain adaptation to hyponatremia is impaired especially solute excretion of brain cells to achieve osmotic equilibrium, it causes brain cells swelling, increased intracranial pressure, cerebral edema, and eventual tentorial herniation [3].

Osmotic Demyelination syndrome (Central Pontine Demyelination) :Hyponatremia, serum sodium < 135 mEq/L, causes brain edema due to shift of water from extracellular in to the brain cells. In the next 24 to 48 hours, brain starts to compensate by excreting solutes and water. If serum sodium is corrected too rapidly, brain cells do not have time to replace the solutes which results in dehydration of the brain cells named osmotic demyelination syndrome [4].

Signs and symptoms of ODS
  • Change in mental status
  • Dysphagia
  • Reduced attention span
  • Loss of memory
  • Rapid development of quadriparesis
  • Dysarthria
  • Reduced speed of processing information
  • Ataxia and Parkinson-like symptoms

Risk of developing Osmotic Demyelination Syndrome is increased with:

  • Serum sodium concentration ≤105 mmol/L
  • Hypokalemia
  • Alcoholism
  • Malnutrition
  • Advanced liver disease

Prognosis

  • Asymptomatic hyponatremia in:
    • Adults is associated with attention and gait deficit, falls and fractures, and increased mortality in patients with pneumonia, heart failure and liver disease [5].
    • Preterm neonates is associated with poor development and growth, cerebral palsy, sensorineural hearing loss, and intracranial hemorrhage, increased perinatal mortality in neonates who suffered perinatal asphyxia and increased sodium intake in later life [6] [7][8] .

References

  1. Guillaumin, Julien; DiBartola, Stephen P. (2017). "Disorders of Sodium and Water Homeostasis". Veterinary Clinics of North America: Small Animal Practice. 47 (2): 293–312. doi:10.1016/j.cvsm.2016.10.015. ISSN 0195-5616.
  2. Moritz, Michael L.; Ayus, Juan Carlos (2009). "New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children". Pediatric Nephrology. 25 (7): 1225–1238. doi:10.1007/s00467-009-1323-6. ISSN 0931-041X.
  3. A. I. Arieff, F. Llach & S. G. Massry (1976). "Neurological manifestations and morbidity of hyponatremia: correlation with brain water and electrolytes". Medicine. 55 (2): 121–129. PMID 1256311. Unknown parameter |month= ignored (help)
  4. King, Joshua D.; Rosner, Mitchell H. (2010). "Osmotic Demyelination Syndrome". The American Journal of the Medical Sciences. 339 (6): 561–567. doi:10.1097/MAJ.0b013e3181d3cd78. ISSN 0002-9629.
  5. Benoit Renneboog, Wim Musch, Xavier Vandemergel, Mario U. Manto & Guy Decaux (2006). "Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits". The American journal of medicine. 119 (1): 71. doi:10.1016/j.amjmed.2005.09.026. PMID 16431193. Unknown parameter |month= ignored (help)
  6. N. A. Mir, A. M. Faquih & M. Legnain (1989). "Perinatal risk factors in birth asphyxia: relationship of obstetric and neonatal complications to neonatal mortality in 16,365 consecutive live births". Asia-Oceania journal of obstetrics and gynaecology. 15 (4): 351–357. PMID 2624578. Unknown parameter |month= ignored (help)
  7. T. Ertl, K. Hadzsiev, O. Vincze, J. Pytel, I. Szabo & E. Sulyok (2001). "Hyponatremia and sensorineural hearing loss in preterm infants". Biology of the neonate. 79 (2): 109–112. doi:10.1159/000047076. PMID 11223652. Unknown parameter |month= ignored (help)
  8. Adi Shirazki, Zalman Weintraub, Dan Reich, Edith Gershon & Micah Leshem (2007). "Lowest neonatal serum sodium predicts sodium intake in low birth weight children". American journal of physiology. Regulatory, integrative and comparative physiology. 292 (4): R1683–R1689. doi:10.1152/ajpregu.00453.2006. PMID 17170236. Unknown parameter |month= ignored (help)

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