Abstract | OBJECTIVES: METHODS: A retrospective study included 499 hospitalized AHF patients treated with intravenous loop diuretics for ≥48 h. Patients were grouped by nadir sodium concentrations (normonatremic, NN) ≥135 mEq/l, (mild hyponatremia, MHN) 130-134 mEq/l, and (moderate to severe hyponatremia, MSHN) <130 mEq/l. Association to diuretic response and clinical outcome was assessed. RESULTS: The incidence of hyponatremia was 54% (36% MHN, 18% MSHN). Maximum diuretic dose ( furosemide equivalents: NN 84 ± 132 mg/day vs. MHN 114 ± 165 mg/day vs. MSHN 249 ± 450 mg/day, p < 0.001) and incidence of diuretic regimen escalation (NN 11% vs. MHN 16% vs. MSHN 44%, p < 0.001) were significantly higher in patients experiencing hyponatremia. Hyponatremia was also associated with a higher incidence of acute increases in serum creatinine (NN 27% vs. MHN 45% vs. MSHN 63%, p < 0.001), greater increases in blood urea nitrogen, longer hospital stay, and higher mortality. Outcome disparities to NN patients were similar whether hyponatremia was acute or present upon admission. CONCLUSIONS: Acute or admission hyponatremia, especially <130 mEq/l, in AHF patients is associated with greater diuretic requirements, higher incidence of serum creatinine increases, and a poorer outcome. Alternative treatments warrant evaluation in these patients.
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Authors | Tien M H Ng, Diana X Cao, Komal A Patel, Yee May Wong, Megha Prasad, Mimi Lou, Uri Elkayam |
Journal | Cardiology
(Cardiology)
Vol. 128
Issue 4
Pg. 333-42
( 2014)
ISSN: 1421-9751 [Electronic] Switzerland |
PMID | 24942293
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Diuretics
- Sodium
- Creatinine
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Topics |
- Acute Disease
- Aged
- Creatinine
(blood)
- Diuretics
(administration & dosage)
- Female
- Heart Failure
(complications, drug therapy)
- Hospitalization
- Humans
- Hyponatremia
(etiology)
- Incidence
- Male
- Middle Aged
- Prognosis
- Retrospective Studies
- Sodium
(blood)
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