Hyponatremia is the commonest electrolyte abnormality in hospitalized patients [
[1]
]. Patients with decompensated heart failure (HF) commonly have electrolyte abnormalities,
due to the activation of several neurohumoral mechanisms, in addition to effect of
drugs especially diuretics [
[2]
]. Hyponatremia is evident on hospital admission in ~15–25% of patients with decompensated HF [
3
,
4
,
5
,
6
], and to a similar extent throughout hospitalization [
7
,
8
]. Although extensively studied in HF, the majority of research focused on the prognostic
value of hyponatremia on admission [
[3]
], behavior of sodium (Na+) level from admission to discharge [
[6]
], and decreasing Na+ after discharge [
[9]
], and in those instances, hyponatremia was found to be associated with worse outcomes.
We have recently studied the prognostic value of discharge hyponatremia in patients
with decompensated HF and normal admission Na+, and found that in those subset of patients, discharge hyponatremia is apparently
benign; limiting our conclusion to subjects with mild hyponatremia since their median
discharge Na+ was 132 meq/L [
[10]
]. We speculated that this is due to effect of Na+-wasting diuretics since the “discharge hyponatremia” group had evidence of a significantly
higher weight loss, greater reduction in inferior vena cava diameter and higher blood
urea nitrogen (BUN)/creatinine, compared with “discharge normonatremia” group [
[10]
]. We also found that in decompensated HF, subjects with hospital-acquired hyponatremia
(hyponatremia that develops in-hospital in those with normal admission Na+) had better outcomes than those with community-acquired hyponatremia (hyponatremia
on presentation) [
[11]
]. Herein, we aim to confirm our speculation of the association between discharge hyponatremia
and diuretic therapy in subjects with normal Na+ on admission.Keywords
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References
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Article info
Publication history
Published online: December 21, 2017
Accepted:
December 18,
2017
Received:
November 29,
2017
Footnotes
☆No funding has been received for this manuscript.
Identification
Copyright
© 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
