SYMPTOMATIC HYPONATREMIA, ETIOLOGY AND OUTCOME IN A TERTIARY CARE HOSPITAL

Muzaffar Maqbool 1 , Akhter Amin Raina 2 , Bilal A Mir 3 , Asma Rafi 3 and Parvaiz A Shah 4 . 1. Assistant professor, Department of Medicine, Government Medical College Srinagar, J & K India. 2. Registrar, Department of Medicine, Government Medical College Srinagar, J & K India. 3. Post-graduate, Department of Medicine, Government Medical College Srinagar, J & K India. 4. Professor, Department of Medicine, Government Medical College Srinagar, J & K India. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 4 (12), 1781-1784 1782 vomiting to severe symptoms like seizures, coma and death 4,6,7 . Early recognition of hyponatremia decreases morbidity and mortality. The prognostic implications of hyponatremia are grave and far reaching, unless addressed meticulously 8 . This study was conducted to evaluate the etiological profile of admitted patients with symptomatic hyponatremia and their eventual in-hospital outcome.
Aims and objectives:- To evaluate the clinical and etiological profile of hyponatremia.  To study the in-hospital outcome of hyponatremia.

Materials and Methods:-
This study was conducted in the department of medicine in a tertiary care hospital of Kashmir over a period of one year from October 2015 to September 2016. The study was approved and cleared by the ethical committee of the hospital. Thorough history and clinical examination of each individual patient was performed in the ward. Any patient with symptomatic hyponatremia and serum sodium concentration of <125meq/l was included in this study. A detailed history regarding presenting symptoms, course of symptomatology and history regarding co-morbid illness like hypertension and diabetes mellitus was recorded. In patients with co-morbid illness, detailed drug history was noted from their prescription cards with special emphasis on use of diuretics, selective serotonin reuptake inhibitors, and other important medications.Volume status of each individual patient was assessed. Patients were categorized as hypervolemic, hypovolemic or euvolemic depending on the volume status. In hypervolemic patients clinical features ofperipheral edema(like swelling of lower limbs, sacral edema orperi-orbital puffiness), ascites and pleural effusion was noted. Patients having dry tongue, decreased skin turgor and orthostatic hypotension were classified as hypovolemic. Complete hemogram, liver function tests, kidney function tests, blood glucose, serum electrolytes (Na + , K + , Ca 2+ ,PO 4 2+ , Cland HCO 3 ),routine urine examination, X-ray chest and ultrasonography was performed in all patients. Serum sodium estimation was done in the automated analyzer using ion selective electrode technology. Plasma and urine osmolality was estimated by depression in freezing point method in all patients. Urinary sodium concentration was also checked in each individual patient. MRI brain, CT head, thyroid function and serum cortisol estimation was done as directed by the clinical scenario. Normal serum sodium concentration of 135-145 mmol/l is the reference range in our laboratory. Patients with serum sodium concentration of <125 mmol/l were included in the study. The normal reference range of serum osmolality and urine osmolality in our laboratory is 278-298mmol/l and 300-900mmol/l respectively.Patients with paraproteinemia, hyperlipidemia and those receiving mannitol were excluded from the study.
Statistical analysis:-Data was analyzed using EpiInfo 7.0. Relationship between two categorical variables was analyzed using chi-square test.Two sided p-values were reported and a p-value <0.05 was considered statistically significant.
Management of the patients was individualized depending on the underlying etiology. Increased salt intake, restriction of total fluid intake of less than a litre per day and hypertonic saline intravenously after calculation of 1783 proper dose and rate of infusion(2meq/hr) not more than 10meq/day was instituted. One patient developed central pontine myelinolysis even after slow and proper correction of hyponatremia. 12(12%) patients with very severe hyponatremia <110meq/l expired in our study.

Discussion:-
Hyponatremia is not a disease itself, but many serious and life threatening conditions can manifest with hyponatremia. It has different etiologies with a variation in frequency of different diseases leading to hyponatremia in different populations groups.