18100006006 THESIS
TITLE:
“ETIOLOGY,MANAGEMENT AND OUTCOME IN PATIENTS WITH HYPONATREMIA IN ICU KIMS,NARKETPALLY”
INTRODUCTION:
Hyponatremia is the most common electrolyte disorder among hospitalized patients and has been associated with increased mortality. Hyponatremia is defined as a serum sodium concentration (Na+) less than 135 mEq/L
Serum sodium levels and serum osmolality are normally maintained under precise control by homeostatic mechanisms involving thirst, anti-diuretic hormone and the renal handling of filtered sodium. Hyponatremia occurs in a broad spectrum of patients who are asymptomatic or critically ill.
Patients in whom the serum sodium concentration is greater than 130 mEq/L are usually asymptomatic, whereas those in whom these values are lower may have symptoms. Clinical symptoms vary from individual to individual. Majority of patients with hyponatremia are asymptomatic. Most patients with hyponatremia have non-specific symptoms or symptoms due to an underlying disease or disorder. The clinical manifestations of hyponatremia are produced by brain swelling and are primarily a function of the rate of fall of serum sodium concentration and not the absolute level. Symptoms occurring early in hyponatremia is usually anorexia, nausea, vomiting. Some patients may have headache and irritability. As serum sodium levels falls further patients develop neuropsychiatry symptoms.
These symptoms range from restlessness, altered consciousness, lethargy, seizures to coma. As the symptomatology vary markedly, the diagnosis of hyponatremia is difficult to establish. Prompt recognition and optimal management of hyponatremia in hospitalized patients may reduce in-hospital mortality and symptom severity, allow for less intensive hospital care, decrease the duration of hospitalization and associated costs and improve the treatment of underlying co morbid conditions and patients’ quality of life. So the treating clinician should have a high index of suspicion to diagnose hyponatremia.
There are serious neurological sequelae associated with hyponatremia and its management. The possible causes of hyponatremia should always be sought in every case. The presence of symptoms and duration of hyponatremia guide the treatment strategy. Thorough evaluation for hyponatremia mandates accurate history taking and clinical examination along with various investigations.
AIM:
To study etiology, management and outcome in
patients with
hyponatremia in ICU KIMS, Narketpally.
OBJECTIVES:
To
determine the etiology of clinically significant hyponatremia in ICU patients
To
study the management given to these patients
To
observe the outcome in these patients
To
study the various diseases associated with hyponatremia
PATIENTS
AND METHODS
Place of study - Intensive
Care Unit in Kamineni Institute Of
Medical
Sciences
Period
of study - oct 2018 – sept2020
Type of study -
prospective study
Study population - 60 patients
THE LABORATORY
The Biochemistry lab is a standardized laboratory. The methods used for estimation are:
1. Serum
Sodium – HILITE/Transaminase
2. Serum
Potassium – I.S.ELECTRODE (Ion selective
Electrophoresis)
3. UREA –
Glutaraldehyde LDH
4. Creatinine
– Jaffe Kinetic
5. SUGAR –
(GOD/POD/Glucose oxidase peroxidase)
6. LFT –
Enzymes – kinetic
7. TFT –
Automated ELISA reader
8. Urine Na – I.S.ELECTRODE
9. Urine K – I.S.ELECTRODE
10. Lipids –
ENZYMATIC METHOD
INCLUSION CRITERIA:
All patients greater than 13 years of age
All patients with sodium values less than 130mmol/l
EXCLUSION CRITERIA:
Patients with age less than 13 years
Patients who are treated with mannitol and osmotic diuretics
LINK TO COMPLETE THESIS WITH MASTER CHART:
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