Aetiological diagnosis of hyponatraemia in non-critical patients on total parenteral nutrition: A prospective multicentre study.

Fecha de publicación: 01/03/2022

Autores de IIS La Fe

María Argente Pla

Autor

Participantes ajenos a IIS La Fe

Ortolá Buigues A
Gómez-Hoyos E
Ballesteros Pomar MD
Vidal Casariego A
García Delgado Y
Ocón Bretón MJ
Abad González ÁL
Luengo Pérez LM
Matía Martín P
Tapia Guerrero MJ
Del Olmo García MD
Herrero Ruiz A
Álvarez Hernández J
Tejera Pérez C
Herranz Antolín S
Tenorio Jiménez C
García Zafra MV
Botella Romero F
Martínez Olmos MÁ
Bretón Lemes I
Runkle De la Vega I
De Luis Román D

Grupos

Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética clínica

Abstract

BACKGROUND: In patients receiving total parenteral nutrition (TPN), the frequency of hyponatraemia is high. However, the causes of hyponatraemia in TPN have not been elucidated, although diagnosis is required for appropriate therapy. The aim of this study is to describe the aetiology of hyponatraemia in non-critical hospitalised patients receiving TPN. METHODS: Prospective multicentre study in 19 Spanish hospitals. Non-critically hyponatraemic patients receiving TPN and presenting hyponatraemia over a 9-month period were studied. Data collected included sex, age, previous comorbidities, and serum sodium levels (SNa) before and following TPN initiation. Parameters for study of hyponatraemia were also included: clinical volaemia, the presence of pain, nausea, gastrointestinal losses, diuretic use, oedema, renal function, plasma and urine osmolality, urinary electrolytes, cortisolaemia, and thyroid stimulating hormone. RESULTS: 162 patients were included, 53.7% males, age 66.4 (SD13.8) years. Volume status was evaluated in 142 (88%): 21 (14.8%) were hypovolaemic, 96 (67.6%) euvolaemic and 25 (17.6%) hypervolaemic. In 111/142 patients the analytical assessment of hyponatraemia was completed. Hypovolaemic hyponatraemia was secondary to GI losses in 10/111 (9%), and to diuretics in 3/111 (2.7%). Euvolaemic hyponatraemia was due to Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) in 47/111 (42.4%), and to physiological stimuli of Arginine Vasopressin (AVP) secretion in 28/111 (25.2%). Hypervolaemic hyponatraemia was induced by heart failure in 19/111 (17.1%), cirrhosis of the liver in 4/111 (3.6%). CONCLUSIONS: SIADH was the most frequent cause of hyponatraemia in patients receiving TPN. The second most frequent cause was physiological stimuli of AVP secretion induced by pain/nausea.

Datos de la publicación

ISSN/ISSNe:: 2530-0180, 2530-0180
Tipo:: Article
Páginas:: 160-167
DOI:: 10.1016/j.endien.2022.02.013
PubMed:: 35396114

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Filiaciones

Ortolá Buigues A:: Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain
Gómez-Hoyos E:: Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain
Ballesteros Pomar MD:: Endocrinology and Nutrition Department, Complejo Asistencial Universitario de León, León, Spain
Vidal Casariego A:: Endocrinology and Nutrition Department, Complejo Asistencial Universitario de León, León, Spain
García Delgado Y:: Endocrinology and Nutrition Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
Ocón Bretón MJ:: Endocrinology and Nutrition Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
Abad González ÁL:: Endocrinology and Nutrition Department, Hospital General Universitario de Alicante, Alicante, Spain
Luengo Pérez LM:: Endocrinology and Nutrition Department, Hospital Universitario Infanta Cristina, Badajoz, Spain
Matía Martín P:: Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria San Carlos (IDISSC), Madrid, Spain
Tapia Guerrero MJ:: Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, Málaga, Spain
Del Olmo García MD:: Endocrinology and Nutrition Department, Hospital Universitario Severo Ochoa, Leganés, Spain
Herrero Ruiz A:: Endocrinology and Nutrition Department, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
Álvarez Hernández J:: Endocrinology and Nutrition Department, Hospital Universitario Príncipe de Asturias, Getafe, Spain
Tejera Pérez C:: Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
Herranz Antolín S:: Endocrinology and Nutrition Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
Tenorio Jiménez C:: Endocrinology and Nutrition Department, Complejo Hospitalario de Jaén, Jaén, Spain
García Zafra MV:: Endocrinology and Nutrition Department, Hospital General Universitario Santa Lucía, Cartagena, Spain
Botella Romero F:: Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
Argente Pla M:: Endocrinology and Nutrition Department, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
Martínez Olmos MÁ:: Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
Bretón Lemes I:: Endocrinology and Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
Runkle De la Vega I:: Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria San Carlos (IDISSC), Madrid, Spain
De Luis Román D:: Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain

Keywords

Aetiology of hyponatraemia; Estímulo fisiológico de la secreción de AVP; Etiología de la hiponatremia; Nutrición parenteral; Parenteral nutrition; Physiological stimuli of AVP secretion; SIADH

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