• hyponatraemia
• intensive care
• osmotic demyelination syndrome
• overcorrection

• Humans
• Hyponatremia/therapy
• Male
• Female
• Aged
• Retrospective Studies
• Middle Aged
• Critical Care/methods
• Critical Care/statistics & numerical data
• Intensive Care Units/statistics & numerical data
• Risk Factors
• Cohort Studies
• Sodium/blood
• Aged, 80 and over

• acute hyponatremia
• altered mental state
• aspiration pneumonia
• intractable hiccups
• primary polydipsia

• ARL13B
• axon initial segment
• neuron
• osmotic demyelination syndrome
• primary cilium
• thalamus

• Animals
• Mice
• Hyponatremia
• Axon Initial Segment
• ADP-Ribosylation Factors/metabolism
• Cilia/metabolism
• Neurons/metabolism
• Demyelinating Diseases/metabolism

• Apoptosis
• Chloride
• Kidney
• Oxidative stress
• Potassium
• Sodium

• Ephapsis
• Mouse
• Neurons
• ODS
• Thalamus

• Thalamus/ultrastructure
• Animals
• Mice
• Demyelinating Diseases/pathology
• Disease Models, Animal
• Neurons/chemistry
• Neurons/ultrastructure
• Neurilemma/chemistry
• Neurilemma/ultrastructure
• Connexins/analysis
• Male
• Mice, Inbred C57BL
• Blotting, Western

• continuous renal replacement therapy
• hyponatremia
• transurethral resection of prostate syndrome
• volume overload

• Advanced clinical practice
• Critical care
• Electrolyte imbalance
• Hyponatraemia

• Critical Care
• Electrolytes
• Humans
• Hyponatremia/diagnosis
• Hyponatremia/therapy
• Inpatients

• Early prognostication
• Favourable neurological outcome
• Out-of-hospital cardiac arrest
• Sodium

• alcoholism
• anticonvulsants
• antidepressants
• brain edema
• diuretics
• hyponatremia
• sodium

Hyperosmolar agents frequently are used to decrease intracranial pressure but their effects on electrolyte and acid‐base variables have not been prospectively investigated.

Compare duration and magnitude of changes in electrolyte and acid‐base variables after hyperosmolar treatment.

Twenty‐eight client‐owned dogs with intracranial hypertension caused by various pathologies.

Prospective, randomized, nonblinded, experimental cohort study. Fifteen dogs received a single dose (4 mL/kg) of 7.2% hypertonic saline (HTS), 13 dogs received 20% mannitol (MAN) 1 g/kg IV. Electrolyte and acid‐base variables were measured before (T₀), and 5 (T₅), 60 (T₆₀), and 120 (T₁₂₀) minutes after administration. Variables were compared between treatments and among time points within treatment groups.

Mean plasma sodium and chloride concentrations were higher after HTS than MAN at T₅ (158 vs 141 mEq/L; 126 vs 109 mEq/L) and significant differences were maintained at all time points. After HTS, plasma sodium and chloride concentrations remained increased from T₀ at all time points. After MAN, plasma sodium and chloride concentrations decreased at T₅, but these changes were not maintained at T₆₀ and T₁₂₀. Plasma potassium concentration was lower at T₅ after HTS compared with T₀ (3.6 vs 3.9 mEq/L) and compared to MAN (3.6 vs 4.1 mEq/L). At T₆₀ and T₁₂₀, plasma ionized calcium concentration was lower after HTS than MAN (1.2 vs 1.3 mmol/L). No significant differences were found in acid‐base variables between treatments.

At the administered dose, dogs receiving HTS showed sustained increases in plasma sodium and chloride concentrations, whereas dogs receiving MAN showed transient decreases. Future studies should assess the effects of multiple doses of hyperosmolar agents on electrolyte and acid‐base variables.

• canine
• hyperosmolar treatment
• metabolic
• traumatic brain injury

• Aldosterone
• Hyponatremia
• Renin
• Sodium

• Central pontine myelinolysis
• Hyponatremia
• Inappropriate ADH syndrome
• Osmolar concentration
• Tolvaptan

• Cushing’s syndrome
• adrenal insufficiency
• calcium
• diabetic ketoacidosis
• thyroid

• cirrhosis
• clinical research/practice
• liver disease
• liver transplantation/hepatology
• neurology

• bronchiolitis
• cystic fibrosis
• hyponatremia
• pneumonia

• conivaptan
• critical care
• hyponatremia
• neurointensive care unit
• syndrome of inappropriate antidiuretic hormone secretion
• tolvaptan
• vasopressin receptor antagonist

Hyponatraemia is frequent in post-operative patients and may be corrected with hypertonic saline (HTS). Oral tolvaptan is used to treat hypervolaemic or euvolaemic hyponatraemia. This study was performed to assess the efficacy of oral tolvaptan in correcting postoperative hyponatraemia compared to HTS.

This prospective, randomised study was conducted in 40 symptomatic patients with serum sodium level ≤130 mEq/L. In Group H (n = 20), 3% HTS was infused at 20–30 mL/h aiming for correction of 6 mEq/L/day. Group T received oral tolvaptan 15 mg on the 1^st day. If daily correction was <4 mEq/L, the dose was increased by 15 mg/day to a maximum of 45 mg. The primary outcome was serum sodium concentration 48 hours after starting treatment. Paired t-test was used to compare changes in sodium levels.

Baseline sodium and values at 12, 24 and 48 h were comparable in both groups. At 72 h, Group T had significantly higher sodium levels as compared to Group H (133.4 ± 1.9 vs. 131.3 ± 2.4 mEq/L). Intragroup analysis had shown a significant increase in sodium levels from baseline values in both groups at 12, 24, 48 and 72 h. Group H had a significantly lower potassium level and lower negative fluid balance on day 3.

Oral tolvaptan and 3% HTS were equally effective in correcting hyponatraemia at 48 hours, but serum sodium levels were higher at 72 hours after oral tolvaptan.

• Hyponatraemia
• Inappropriate ADH Syndrome
• tolvaptan
• water–electrolyte balance

• clearance
• hyponatremia
• intensive care
• nutrition
• vasopressin

Hyponatremia is a common electrolyte derangement in the setting of the intensive care unit. Life-threatening neurological complications may arise not only in case of a severe (<120 mmol/L) and acute fall of plasma sodium levels, but may also stem from overly rapid correction of hyponatremia. Additionally, even mild hyponatremia carries a poor short-term and long-term prognosis across a wide range of conditions. Its multifaceted and intricate physiopathology may seem deterring at first glance, yet a careful multi-step diagnostic approach may easily unravel the underlying mechanisms and enable physicians to adopt the adequate measures at the patient’s bedside. Unless hyponatremia is associated with obvious extracellular fluid volume increase such as in heart failure or cirrhosis, hypertonic saline therapy is the cornerstone of the therapeutic of profound or severely symptomatic hyponatremia. When overcorrection of hyponatremia occurs, recent data indicate that re-lowering of plasma sodium levels through the infusion of hypotonic fluids and the cautious use of desmopressin acetate represent a reasonable strategy. New therapeutic options have recently emerged, foremost among these being vaptans, but their use in the setting of the intensive care unit remains to be clarified.

• Arginine vasopressin
• Central pontine myelinolysis
• Extracellular fluid volume
• Hyponatremia
• Hyponatremic encephalopathy
• Osmotic demyelination

• Critically ill
• Euvolemic
• Hypervolemic
• Hyponatremia
• ICU
• Serum sodium correction

• CI = confidence interval
• ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification
• IQR = interquartile range
• OR = odds ratio
• PCPC = Pediatric Cerebral Performance Category
• VIF = variance inflation factor
• cognitive function
• hyponatremia
• intracranial neoplasm
• oncology
• serum sodium

For more than 50 years, hypotonic fluids (crystalloids) have been the standard for maintenance fluid used in children. In the last decade, several studies have evaluated the risk of hyponatremia associated with the use of hypotonic vs isotonic fluids, which has lead to an intense debate. Children undergoing surgery have several stimuli for release of antidiuretic hormone, which controls renal water handling, including pain, nausea, vomiting, narcotic use and blood loss. The body’s primary defense against the development of hyponatremia is the ability of the kidneys to excrete free water and dilute urine. Increased levels of antidiuretic hormone can result in hyponatremia, defined as a plasma sodium level < 136 mmol/L, which causes cells to draw in excess water and swell. This manifests as central nervous system symptoms such as lethargy, irritability and seizures. The risk for symptomatic hyponatremia is higher in children than in adults. It represents an emergency condition, and early diagnosis, prompt treatment and close monitoring are essential to reduce morbidity and mortality. The widespread use of hypotonic fluids in children undergoing surgery is a matter of concern and more focus on this topic is urgently needed. In this paper, we review the literature and describe the impact of perioperative hyponatremia in children.

• Children
• Fluid
• Hyponatremia
• Pediatric
• Perioperative