DOI: http://dx.doi.org/10.18203/2349-3933.ijam20201082

Syndrome of inappropriate antidiuretic hormone secretion and cerebral salt wasting as the common causes of hyponatremia in tertiary care hospital

Yogesh Pralhad Bade, Harishchandra Rameshchandra Chaudhari

Abstract


Background: Hyponatremia is a typical condition of electrolyte disturbance that may be euvolemic, hypovolemic or hypervolemic. Proper interpretation through laboratory tests helps to differentiate the types and causes of hyponatremia. This study was conducted to evaluate the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt wasting (CSW) as the common causes of hyponatremia in tertiary care hospital.

Methods: A prospective interventional study was conducted, including hyponatremia cases, admitted in NTU/ICU/CCU and other medical wards at Ruby Hall Clinic from August 2011 to December 2013.

Results: Of 150 patients enrolled in this study, 33.33% patients were euvolemic, 34% patients were hypervolemic and 32.66% patients were hypovolemic. For the euvolemic patients, SIADH (68%) was the most common cause; whereas, CSW (34.39%) was the common cause for hypovolemic type of hyponatremia. Stroke was found to be the most common cause of SIADH (55.88%), Intra-cerebral bleeding was observed to be the most common causative factor between SIADH and CSW associated hyponatremia.

Conclusions: Hyponatremia in central nervous system disorder patients frequently occurred due to SIADH and CSW. Most common cause of SIADH was stroke and for CSW it was intra cerebral bleed.


Keywords


Euvolemic, Hyponatremia, Hypervolemic, Hypovolemic, Intra-cerebral bleeding, Stroke

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References


Douglas I. Hyponatremia: Why it matters, how it presents, how we can manage it. Cleveland Clin J Med. 2006;73(Suppl 3):4-12.

Upadhyay A, Jaber BL, Madias NE. Incidence and prevalence of hyponatremia. Am J Med. 2006;119(Suppl 1):S30-5.

Mohan S, Gu S, Parikh A, Radhakrishnan J. Prevalence of hyponatremia and association with mortality: Results from NHANES. Am J Med. 2013;126(12):1127-37.

Jain AK, Nandy P. Clinico-etiological profile of hyponatremia among elderly age group patients in a tertiary care hospital in Sikkim. J Family Med Prim Care. 2019;8(3):988-94.

Skorecki K, Ausiello D. Disorders of sodium and water homeostasis. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia: Chap 118, Elsevier Saunders; 2011.

Mittal M, Deepshikha, Khurana H. Profile of hyponatremia in a tertiary care centre in North India. Int J Adv Med. 2016;3(4):1011-5.

Sahay M, Sahay R. Hyponatremia: A practical approach. Indian J Endocrinol Metab. 2014;18(6):760-71.

Yee AH, Burns JD, Wijdicks EF. Cerebral salt wasting: pathophysiology, diagnosis, and treatment. Neurosurg Clin N Am. 2010;21(2):339-52.

Petzold A. Disorders of plasma sodium. N Engl J Med. 2015;372(13):1267-9.

Maesaka JK, Imbriano LJ, Miyawaki N. High prevalence of renal salt wasting without cerebral disease as cause of hyponatremia in general medical wards. Am J Med Sci. 2018;356(1):15-22.

Moritz ML. Syndrome of inappropriate antidiuresis. Pediatr Clin North Am. 2019;66(1):209-26.

Siragy H. Hyponatremia, fluid-electrolyte disorders, and the syndrome of inappropriate antidiuretic hormone secretion: diagnosis and treatment options. Endocr Pract. 2006;12(4):446-57.

Verbalis JG, Goldsmith SR, Greenberg A, Schrier RW, Sterns RH. Hyponatremia treatment guidelines 2007: expert panel recommendations. Am J Med. 2007;120(11 Suppl 1):S1-21.

Chaudhari HR, Bade Y. Study of incidence of Medical neurological causes of hyponatremia. Indian J Basic Applied Med Res. 2018;7(2):194-200.

Vurgese TA, Radhakrishan SB, Mapkar OAW. Frequency and etiology of hyponatremia in adult hospitalized patients in medical wards of a general hospital in Kuwait. Kuwait Med J. 2006;3(3):211-3.

Babaliche P, Madnani S, Kamat S. Clinical profile of patients admitted with hyponatremia in the medical intensive care unit. Indian J Crit Care Med. 2017;21(12):819-24.

Anderson RJ, Chung HM, Kluge R, Schrier RW. Hyponatremia: a prospective analysis of its epidemiology and the pathogenetic role of vasopressin. Ann Intern Med. 1985;102(2):164-8.

Huda MSB, Boyd A, Skagen K, Wile D, van Heyningen C, Watson I, et al. Investigation and management of severe hyponatremia in a hospital setting. Postgrad Med J. 2006;82(965):216-9.

Chow KM, Szeto CC, Wong TY, Leung CB, Li PK. Risk factors for thiazide-induced hyponatremia. QJM. 2003;96(12):911-7.

Hawkins RC. Age and gender as risk factors for hyponatremia and hypernatremia. Clin Chim Acta. 2003; 337(1-2):169-72.

Hoorn E, Lindemans J, Zietse R. Development of severe hyponatremia in hospitalized patients: treatment-related risk factors and inadequate management. Nephrol Dial Transpl. 2006;21(1):70-6.

Padhi R, Panda BN, Jagati S, Patra SC. Hyponatremia in critically ill patients. Indian J Crit Care Med. 2014;18(2):83-7.

Rao MY, Sudhir U, Anil Kumar T, Saravanan S, Mahesh E, Punith K. Hospital-based descriptive study of symptomatic hyponatremia in elderly patients. J Assoc Physicians India. 2010;58:667-9.

Saleem S, Yousuf I, Gul A, Gupta S, Verma S. Hyponatremia in stroke. Ann Indian Acad Neurol. 2014;17(1):55-7.

Baylis PH. The syndrome of inappropriate antidiuretic hormone secretion. Int J Biochem Cell Biol. 2003;35(11):1495-9.

Boone M, Deen PM. Physiology and pathophysiology of the vasopressin-regulated renal water reabsorption. Pflugers Arch. 2008;456(6):1005-24.

Momi J, Tang CM, Abcar AC, Kujubu DA, Sim JJ. Hyponatremia-What is cerebral salt wasting? Perm J. 2010;14(2):62-5.

Dholke H, Campos A, Reddy CNK, Panigrahi MK. Cerebral salt wasting syndrome. J Neuroanaesthesiol Crit Care. 2016;3(5):205-10.