Etiología de hiponatremia en pacientes con nutrición enteral. Morbimortalidad asociada.
Hyponatremia is the most common hydroelectrolyte disorder in clinical practice, defined as a reduction in serum sodium concentration or natremia (NaS). As for the mechanism involved, it is a dysregulation of the water balance, fundamentally due to a net gain of water without this implying a greater...
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| Formato: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2024 |
| País: | España |
| Recursos: | Universidad de Valladolid |
| Repositorio: | UVaDOC. Repositorio Documental de la Universidad de Valladolid |
| OAI Identifier: | oai:uvadoc.uva.es:10324/66843 |
| Acesso em linha: | https://doi.org/10.35376/10324/66843 https://uvadoc.uva.es/handle/10324/66843 |
| Access Level: | acceso abierto |
| Palavra-chave: | Medicina Interna Hyponatremia Hiponatremia Enteral feeding Nutrición enteral Malnutrition Desnutrición 3205 Medicina Interna |
| Resumo: | Hyponatremia is the most common hydroelectrolyte disorder in clinical practice, defined as a reduction in serum sodium concentration or natremia (NaS). As for the mechanism involved, it is a dysregulation of the water balance, fundamentally due to a net gain of water without this implying a greater or lesser amount of body sodium. The main objective of the study is to know the type and etiology of hyponatremia in non-critically ill patients with total enteral tube feeding (TEN).The secondary objectives are: 1) describe the type of treatment prescribed and its effectiveness; 2) assess the morbidity and mortality associated with the presence of hyponatremia. This is a prospective, case-control study carried out in a single center. 174 non-critical hospitalized patients who required initiation of TEN were included during a period of 24 months. They were assessed by the Clinical Nutrition Unit of the University Clinical Hospital of Valladolid (HCUV) during routine clinical practice. The administration of TEN and clinical-analytical monitoring had to follow the study protocol. Demographic data, pathology data that led to hospital admission, anthropometric and nutritional assessment variables, EN composition, clinical data related to hyponatremia, and analytical data were collected for all patients. Regarding the results, the most frequent main diagnosis that led to hospital admission in both groups was infectious pathology. With respect to the state nutritional prior to the start of TEN, more than half of the patients in both groups were malnourished. 62.1% of patients had hyponatremia at the start of TEN and 37.9% developed it during its administration. The frequency of severe hyponatremia (< 120 mmol/L) was 1.1%. The most common type of hyponatremia was euvolemic, followed by hypovolemic and hypervolemic. In patients with euvolemic hyponatremia, 19.7% was secondary to a physiological elevation of ADH (pain, nausea, post-surgery stress) and the rest (65.8%) to SIADH. Thus, SIADH was the most common etiology of hyponatremia in patients with TEN. Approximately one third of the patients died during the hospitalization period in both groups, without significant differences. Deceased patients were older compared to those who did not die, and there was also a greater frequency of marked hyponatremia (NaS < 130 mmol/L) at the start of TEN in deceased patients compared to non-deceased patients (18.8% vs. 7.2; p=0.037). About hospital length of stay, the median was 22 [12-44] days. Regarding the presence of hyponatremia, no association was found with hospital stay. To conclude, approximately two-thirds of patients with TEN who presented hyponatremia did so at the beginning of TEN. Euvolemic hyponatremia was the most common type of hyponatremia and SIADH was the main etiology. With regard to their treatment, the vast majority was adjusted to the type and etiology of hyponatremia, reaching eunatremia within a week in almost eighty percent. On the other hand, the presence of marked hyponatremia (NaS < 130 mmol/L) at the start of EN could negatively influence in-hospital mortality. |
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