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      Hyponatremia in Acute-Phase Response Syndrome Patients in General Surgical Wards

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          Abstract

          Background: In surgical patients, hypoalbuminemia may occur as a component of acute-phase response (APR) syndrome, which we hypothesized could decrease serum sodium levels. Aim: To compare the frequency of hyponatremia in adult surgical inpatients with or without APR syndrome. Methods: All the simultaneous plasma sodium and albumin results (n = 168), obtained from adults in surgical wards and corresponding to a 6-month period, were searched in the hospital mainframe. Other relevant laboratory and clinical data were also registered. APR was ascertained by the presence of major physical trauma, surgery or infection, plus hypoalbuminemia (serum albumin <3.5 g/dl) and neutrophil left shift (≥7% of band count) associated with peripheral leukopenia (white blood cells <4,000/mm<sup>3</sup>) or leukocytosis (WBC >9,000/mm<sup>3</sup>). Hyponatremia was defined by serum sodium concentration <135 mEq/l. Results: APR-positive patients (n = 113) had lower blood hemoglobin (10.92 ± 2.18 vs. 13.53 ± 2.30 g/dl), and serum albumin levels (median, range: 2.8, 1.9–3.4 vs. 3.7, 3.5–4.2 g/dl) than APR-negative (n = 55) ones, the same occurring in relation to antibiotics (54.8 vs. 10.9%) and intravenous 5% dextrose in water (55.7 vs. 20.0%) or isotonic saline (46.0 vs. 9.1%) infusion. The hyponatremia frequency was higher among APR-positive patients (31.0 vs. 10.9%). Conclusion: The higher percentage of hyponatremia among APR-positive patients could be attributed to decreased serum albumin levels associated with APR.

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          Most cited references 3

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          Postoperative hyponatremia. A prospective study.

          In the present study, we found that at least 4.4% of 1,088 prospectively studied patients developed postoperative hyponatremia (plasma sodium concentration less than 130 mEq/L). Most patients (42%) were normovolemic. Edematous states (21%), hyperglycemia (21%), volume depletion (8%), and renal failure (8%), however, were also common settings of postoperative hyponatremia. Plasma arginine vasopressin was present in all patients in whom it was measured and 94% of the patients were receiving hypotonic fluid at the time of development of hyponatremia. Hyponatremia was not associated with significant neurologic deterioration in the 48 postoperative patients in the present study. In eight patients, however, the positive water balance that resulted in hyponatremia was associated with development of pulmonary vascular congestion. We conclude that hyponatremia commonly occurs following all types of surgical procedures and is due to hypotonic fluid administration in the presence of nonosmotic secretion of arginine vasopressin.
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            Postoperative cerebral oedema after transcervical endometrial resection and uterine irrigation with 1.5% glycine.

            Absorption of irrigating solution during transcervical resection of endometrium can cause dilutional hyponatraemia, nausea, and cerebral oedema. We studied 6 patients who absorbed more than 1500 mL of 1.5% glycine, and 14 patients who absorbed less. Cerebral oedema was diagnosed by blinded, paired comparison of computed tomography (CT) scans 3-6 hours and 3-6 days after operation. The absorbed volume of irrigating glycine solution was correlated with peroperative decrease in serum sodium. 10 patients who absorbed 500 mL of glycine or more had postoperative nausea, with cerebral oedema suspected in 9. None of the 10 patients who absorbed less than 500 mL had nausea; changes on CT scan suggestive of cerebral odema were found in 1. 8 patients who absorbed 1000 mL or more had a decrease in serum sodium of 10 mmol/L or more, nausea, and cerebral oedema on CT scan. Cerebral oedema may contribute to the development of postoperative nausea in patients undergoing transcervical surgery who absorb more than 500 mL of 1.5% glycine irrigating solution.
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              Hypophosphatemia in Acute-Phase Response Syndrome Patients

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                Author and article information

                Journal
                AJN
                Am J Nephrol
                10.1159/issn.0250-8095
                American Journal of Nephrology
                S. Karger AG
                0250-8095
                1421-9670
                2000
                February 2000
                13 January 2000
                : 20
                : 1
                : 37-41
                Affiliations
                Nutrition Division, Department of Internal Medicine, Medical School of Uberaba, Brazil
                Article
                13553 Am J Nephrol 2000;20:37–41
                10.1159/000013553
                10644866
                © 2000 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 2, Tables: 1, References: 22, Pages: 5
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/13553
                Categories
                Clinical Study

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