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Báo cáo y học: "Treatment of euvolemic hyponatremia in the intensive care unit by urea"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Treatment of euvolemic hyponatremia in the intensive care unit by urea. | Decaux et al. Critical Care 2010 14 R184 http ccforum.eom content 14 5 R184 c CRITICAL CARE RESEARCH Open Access Treatment of euvolemic hyponatremia in the intensive care unit by urea z P s 1 1 1 1.2 Guy Decaux Caroline Andres Fabrice Gankam Kengne Alain Soupart Abstract Introduction Hyponatremia in the intensive care unit ICU is most commonly related to inappropriate secretion of antidiuretic hormone SIADH . Fluid restriction is difficult to apply in these patients. We wanted to report the treatment of hyponatremia with urea in these patients. Methods Two groups of patients are reported. The first one is represented by a retrospective study of 50 consecutive patients with mild hyponatremia treated with urea. The second group is presented by a series of 35 consecutive patients with severe hyponatremia acquired outside the hospital 115 mEq L who where treated by isotonic saline and urea 0.5 to 1 g kg day administered usually by gastric tube. Results In the first group with mild hyponatremia 128 4 mEq L the serum sodium SNa increased to a mean value of 135 4 mEq L P 0.001 after two days of urea therapy 46 25 g day despite a large fluid intake 2 L day . The mean duration of urea therapy was six days from 2 to 42 days . Six patients developed hyponatremia again once the urea was stopped which necessitated its reintroduction. Six patients developed hypernatremia maximum value 155 mEq L . In the second group SNa increased from 111 3 mEq L to 122 4 mEq L in one day P 0.001 . All the patients with neurological symptoms made a rapid recovery. No side effects were observed. Conclusions These data show that urea is a simple and inexpensive therapy to treat euvolemic hyponatremia in the ICU. Introduction In the intensive care unit hyponatremia occurs frequently and is associated with an increased mortality 1-4 . It is mostly related to the presence of inappropriate antidiuresis due to an excess of ADH. Management of this condition usually implies water restriction. This is of