Hyponatremia in acute-phase response syndrome patients in general surgical wards.
BACKGROUND
In surgical patients, hypoalbuminemia may occur as a component of acute-phase response (APR) syndrome, which we hypothesized could decrease serum sodium levels.


OBJECTIVE
To compare the frequency of hyponatremia in adult surgical inpatients with or without APR syndrome.


METHODS
All the simultaneous plasma sodium and albumin results (n = 168), obtained from adults in surgical wards and corresponding to a 6-month period, were searched in the hospital mainframe. Other relevant laboratory and clinical data were also registered. APR was ascertained by the presence of major physical trauma, surgery or infection, plus hypoalbuminemia (serum albumin <3.5 g/dl) and neutrophil left shift (>/=7% of band count) associated with peripheral leukopenia (white blood cells <4, 000/mm(3)) or leukocytosis (WBC >9,000/mm(3)). Hyponatremia was defined by serum sodium concentration <135 mEq/l.


RESULTS
APR-positive patients (n = 113) had lower blood hemoglobin (10.92 +/- 2.18 vs. 13.53 +/- 2.30 g/dl), and serum albumin levels (median, range: 2.8, 1.9-3.4 vs. 3.7, 3.5-4.2 g/dl) than APR-negative (n = 55) ones, the same occurring in relation to antibiotics (54.8 vs. 10. 9%) and intravenous 5% dextrose in water (55.7 vs. 20.0%) or isotonic saline (46.0 vs. 9.1%) infusion. The hyponatremia frequency was higher among APR-positive patients (31.0 vs. 10.9%).


CONCLUSIONS
The higher percentage of hyponatremia among APR-positive patients could be attributed to decreased serum albumin levels associated with APR.
Ferreira da Cunha
D
D
Nutrition Division, Department of Internal Medicine, Medical School of Uberaba, Brazil. dfcnutro@mednet.com.br
Pontes Monteiro
J
J
Modesto dos Santos
V
V
Araújo Oliveira
F
F
Freire de Carvalho da Cunha
S
S
D000210:Acute-Phase Reaction / Q000097:blood / Q000150:complications*; D016022:Case-Control Studies; D005260:Female; D006757:Hospital Units; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D013514:Surgical Procedures, Operative
D012709:Serum Albumin