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

Ana Ortolá Buigues; Emilia Gómez-Hoyos; María Dolores Ballesteros Pomar; Alfonso Vidal Casariego; Yaiza García Delgado; María Julia Ocón Bretón; Ángel Luis Abad González; Luis Miguel Luengo Pérez; Pilar Matía Martín; María José Tapia Guerrero; María Dolores Del Olmo García; Ana Herrero Ruiz; Julia Álvarez Hernández; Cristina Tejera Pérez; Alejandra Herranz Antolín; Carmen Tenorio Jiménez; María Victoria García Zafra; Francisco Botella Romero; María Argente Pla; Miguel Ángel Martínez Olmos; Irene Bretón Lemes; Isabelle Runkle De la Vega; Daniel De Luis Román

doi:10.1016/j.endinu.2021.02.006

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

Endocrinol Diabetes Nutr (Engl Ed). 2021 Jul 6:S2530-0164(21)00123-3. doi: 10.1016/j.endinu.2021.02.006. Online ahead of print.

[Article in English, Spanish]

Authors

Ana Ortolá Buigues¹, Emilia Gómez-Hoyos², María Dolores Ballesteros Pomar³, Alfonso Vidal Casariego³, Yaiza García Delgado⁴, María Julia Ocón Bretón⁵, Ángel Luis Abad González⁶, Luis Miguel Luengo Pérez⁷, Pilar Matía Martín⁸, María José Tapia Guerrero⁹, María Dolores Del Olmo García¹⁰, Ana Herrero Ruiz¹¹, Julia Álvarez Hernández¹², Cristina Tejera Pérez¹³, Alejandra Herranz Antolín¹⁴, Carmen Tenorio Jiménez¹⁵, María Victoria García Zafra¹⁶, Francisco Botella Romero¹⁷, María Argente Pla¹⁸, Miguel Ángel Martínez Olmos¹⁹, Irene Bretón Lemes²⁰, Isabelle Runkle De la Vega⁸, Daniel De Luis Román²

Affiliations

¹ Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain. Electronic address: anaortola@hotmail.com.
² Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain.
³ Endocrinology and Nutrition Department, Complejo Asistencial Universitario de León, León, Spain.
⁴ Endocrinology and Nutrition Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain.
⁵ Endocrinology and Nutrition Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
⁶ Endocrinology and Nutrition Department, Hospital General Universitario de Alicante, Alicante, Spain.
⁷ Endocrinology and Nutrition Department, Hospital Universitario Infanta Cristina, Badajoz, Spain.
⁸ Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria San Carlos (IDISSC), Madrid, Spain.
⁹ Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, Málaga, Spain.
¹⁰ Endocrinology and Nutrition Department, Hospital Universitario Severo Ochoa, Leganés, Spain.
¹¹ Endocrinology and Nutrition Department, Hospital Clínico Universitario de Salamanca, Salamanca, Spain.
¹² Endocrinology and Nutrition Department, Hospital Universitario Príncipe de Asturias, Getafe, Spain.
¹³ Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain.
¹⁴ Endocrinology and Nutrition Department, Hospital Universitario de Guadalajara, Guadalajara, Spain.
¹⁵ Endocrinology and Nutrition Department, Complejo Hospitalario de Jaén, Jaén, Spain.
¹⁶ Endocrinology and Nutrition Department, Hospital General Universitario Santa Lucía, Cartagena, Spain.
¹⁷ Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
¹⁸ Endocrinology and Nutrition Department, Hospital Universitario y Politécnico de La Fe, Valencia, Spain.
¹⁹ Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.
²⁰ Endocrinology and Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.

PMID: 34244097
DOI: 10.1016/j.endinu.2021.02.006

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.

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.