Treating hyponatremia: what is all the controversy about?

Article Abstract:

The treatment of hyponatremia poses a significant dilemma, since the treatment may be as harmful as the condition. The solution to the dilemma comes from careful analysis of each case. Hyponatremia, or low levels of sodium in the blood, is often called water intoxication. The major burden of water intoxication is carried by the brain and estimates of the mortality rate from acute hyponatremia run as high as 50 percent. While the true figure is probably less than 50 percent, this illustrates that the seizures, coma, and respiratory arrest, which may follow acute hyponatremia are serious health concerns. During acute hyponatremia, water rushes into the brain under the impetus of osmotic pressure; patients who die shortly after the onset of hyponatremia have edema. Often the brainstem is herniated as the tremendous force of the swelling brain pushes downward on the brainstem. Hyponatremia may be a postoperative complication of surgery and can occur as a side effect of treatment with thiazides. Severe hyponatremia from these causes is more common among women than men, which has not yet been adequately explained. However, chronic hyponatremia follows a different pattern with adaptive mechanisms coming into play, and an associated mortality of less than 10 percent. In such patients, attempts to normalize the level of sodium in the blood can result in brain damage. Chronic hyponatremia can cause the destruction of myelin in the brainstem. However, it is important that the treatment not be rushed. Therefore, the problem facing the physician is what to do when faced with a patient with hyponatremia. Acute hyponatremia demands immediate attention, but this same attention can harm the patient with chronic hyponatremia. If the duration of the condition cannot be determined, but is thought to be subacute, the best procedure is to raise the blood sodium by 10 percent, which should not damage the brain. Slow correction of the sodium may follow, in combination with restriction of water intake. A prudent balance is the best approach to treating hyponatremia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Water-electrolyte imbalances, Fluid-electrolyte imbalance, editorial

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Plasmapheresis does not increase the risk for infection in immunosuppressed patients with severe lupus nephritis

Article Abstract:

Plasmapheresis is a technique in which the liquid components of blood are filtered through specialized equipment to remove certain immunologically active proteins. This procedure is frequently used for diseases that affect the immune system and cause the production of antibodies that are harmful to the patient. Because the process of plasmapheresis removes immunologically active proteins from the blood, it theoretically could weaken the body's ability to fight infection. A previous study has suggested that plasmapheresis patients have a greater incidence of infection than other patients. Systemic lupus erythematosus is a disease in which the body produces antibodies against some of its own tissues, causing a variety of abnormalities, including an often severe form of kidney disease. A group of 86 patients were assigned to receive standard therapy to suppress their overactive immune systems, or standard therapy plus plasmapheresis. The types and severity of the infections the members of the two subgroups developed were compared. No statistically significant differences in the types of infections (bacterial, viral or fungal) or the severity were found between patients who underwent plasmapheresis and those who did not. The number of deaths from infectious causes was similar within the two groups also. Thus, plasmapheresis does not appear to increase the risk of infection, despite its function of removing some of the immunologically important blood proteins that fight infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Risk factors, Systemic lupus erythematosus, Immunodeficiency, Plasmapheresis

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Myelinolysis after correction of hyponatremia

Article Abstract:

It may be advisable to slowly correct sodium imbalances to avoid a form of brain damage called myelinolysis. Characteristic features of myelinolysis include seizures, abnormal motor function, or paralysis that may occur following rapid sodium correction. Brain scans of these patients typically show lesions in an area of the brain called the pons. Untreated sodium imbalances may cause more generalized brain damage or death. Increasing sodium levels by less than 10 millimoles per liter each day may be advisable. It is unclear how sodium imbalances cause this type of brain damage.

Health aspects, Causes of, Central nervous system diseases, Physiologic salines, Saline solution, Pons

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