OBJECTIVE: Hyponatraemia is common in community-acquired pneumonia (CAP) and is associated with increased mortality. The mechanism of hyponatraemia in CAP is not completely understood and treatment is therefore ill-defined. We aimed to define the causation of hyponatraemia in CAP. DESIGN: Prospective, single-centre, observational study of all patients with CAP and hyponatraemia (≤ 130 mmol/L) during a 9-month period. PATIENTS: The prevalence of each subtype of hyponatraemia, and the associated mortality, was determined in 143 admissions with CAP (Study 1). A sub-cohort of patients with SIAD (n = 10) was prospectively followed, to document the natural history of SIAD associated with CAP (Study 2). MEASUREMENTS: In Study 2, blood and urine were collected on day 1, 3, 5 and 7 following admission for measurement of plasma vasopressin, sodium, osmolality and urine osmolality. RESULTS: In study 1, 143/1723(8.3%) of CAP patients had hyponatraemia (≤130 mmol/L). About 66 had SIAD (46%), 60(42%) had hypovolaemic hyponatraemia (HON), 13(9%) had hypervolaemic hyponatraemia (HEN) and 4(3%) patients had hyponatraemia due to glucocorticoid hormone deficiency. Mortality was higher in the HEN than in the HON, SIAD or normonatraemic groups (P < 0.01). In Study 2, plasma sodium concentration normalized in 8/10 (80%) by day 7. Two patients with persistent hyponatraemia were discovered to have underlying bronchiectasis. CONCLUSIONS: Hyponatraemia in CAP is most commonly secondary to SIAD or hypovolaemia. HEN is less common, but has worse prognosis. Prospective observation demonstrates that in SIAD, plasma AVP and sodium concentrations normalize with antimicrobials; failure of reversal of suggests underlying lung disease, such as bronchiectasis.
OBJECTIVE: Hyponatraemia is common in community-acquired pneumonia (CAP) and is associated with increased mortality. The mechanism of hyponatraemia in CAP is not completely understood and treatment is therefore ill-defined. We aimed to define the causation of hyponatraemia in CAP. DESIGN: Prospective, single-centre, observational study of all patients with CAP and hyponatraemia (≤ 130 mmol/L) during a 9-month period. PATIENTS: The prevalence of each subtype of hyponatraemia, and the associated mortality, was determined in 143 admissions with CAP (Study 1). A sub-cohort of patients with SIAD (n = 10) was prospectively followed, to document the natural history of SIAD associated with CAP (Study 2). MEASUREMENTS: In Study 2, blood and urine were collected on day 1, 3, 5 and 7 following admission for measurement of plasma vasopressin, sodium, osmolality and urine osmolality. RESULTS: In study 1, 143/1723(8.3%) of CAP patients had hyponatraemia (≤130 mmol/L). About 66 had SIAD (46%), 60(42%) had hypovolaemic hyponatraemia (HON), 13(9%) had hypervolaemic hyponatraemia (HEN) and 4(3%) patients had hyponatraemia due to glucocorticoid hormone deficiency. Mortality was higher in the HEN than in the HON, SIAD or normonatraemic groups (P < 0.01). In Study 2, plasma sodium concentration normalized in 8/10 (80%) by day 7. Two patients with persistent hyponatraemia were discovered to have underlying bronchiectasis. CONCLUSIONS: Hyponatraemia in CAP is most commonly secondary to SIAD or hypovolaemia. HEN is less common, but has worse prognosis. Prospective observation demonstrates that in SIAD, plasma AVP and sodium concentrations normalize with antimicrobials; failure of reversal of suggests underlying lung disease, such as bronchiectasis.
Authors: José C de La Flor; Ana Gomez-Berrocal; Alexander Marschall; Francisco Valga; Tania Linares; Cristina Albarracin; Elisa Ruiz; Gioconda Gallegos; Alberto Gómez; Andrea de Los Santos; Miguel Rodeles Journal: Med Clin (Engl Ed) Date: 2022-06-29
Authors: Julie Martin-Grace; Maria Tomkins; Michael W O'Reilly; Chris J Thompson; Mark Sherlock Journal: J Clin Endocrinol Metab Date: 2022-07-14 Impact factor: 6.134
Authors: Jorge Gabriel Ruiz-Sánchez; Ivan J Núñez-Gil; Martin Cuesta; Miguel A Rubio; Charbel Maroun-Eid; Ramón Arroyo-Espliguero; Rodolfo Romero; Victor Manuel Becerra-Muñoz; Aitor Uribarri; Gisela Feltes; Daniela Trabattoni; María Molina; Marcos García Aguado; Martino Pepe; Enrico Cerrato; Emilio Alfonso; Alex Fernando Castro Mejía; Sergio Raposeiras Roubin; Luis Buzón; Elvira Bondia; Francisco Marin; Javier López Pais; Mohammad Abumayyaleh; Fabrizio D'Ascenzo; Elisa Rondano; Jia Huang; Cristina Fernandez-Perez; Carlos Macaya; Paz de Miguel Novoa; Alfonso L Calle-Pascual; Vicente Estrada Perez; Isabelle Runkle Journal: Front Endocrinol (Lausanne) Date: 2020-11-30 Impact factor: 5.555
Authors: Jennifer A Frontera; Eduard Valdes; Joshua Huang; Ariane Lewis; Aaron S Lord; Ting Zhou; D Ethan Kahn; Kara Melmed; Barry M Czeisler; Shadi Yaghi; Erica Scher; Thomas Wisniewski; Laura Balcer; Elizabeth Hammer Journal: Crit Care Med Date: 2020-12 Impact factor: 9.296