Frequência e preditores de hipercorreção do sódio sérico em pacientes internados com hiponatremia grave.
| Autor(a) principal: | |
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| Data de Publicação: | 2023 |
| Tipo de documento: | Dissertação |
| Idioma: | por |
| Título da fonte: | Repositório Institucional da UFBA |
| Texto Completo: | https://repositorio.ufba.br/handle/ri/39033 |
Resumo: | Introdução: Hipercorreção de hiponatremia ocorre quando a velocidade de correção recomendada é superada e pode se complicar com desmielinização osmótica. Dados sobre a frequência e os preditores de hipercorreção de hiponatremia grave ainda são escassos. Objetivos: Avaliar a frequência de hipercorreção de hiponatremia grave em dois centros brasileiros. Métodos: Estudo de coorte retrospectiva a partir da revisão de prontuários eletrônicos de pacientes internados entre Janeiro de 2016 e Julho de 2019 com sódio sérico admissional < 120 mEq/L (n = 362). Hipercorreção foi definida como uma elevação no sódio sérico > 8 mEq/L em 24 horas e/ou > 18 mEq/L em 48 horas. Preditores de hipercorreção foram identificados através de regressão logística multivariada. Resultados: A média de idade foi 75,6 ± 13,6 anos, 65,5% eram mulheres. Na chegada ao pronto socorro (PS), a média do sódio sérico inicial foi de 113,3 ± 4,9 mEq/L (94 a 119). No PS, 73,2% dos pacientes foram tratados com NaCl 0,9% e o volume médio foi de 495 ± 393 ml. A frequência de hipercorreção foi de 38,7% dos casos (140 pacientes). Em modelo de regressão logística multivariada, um sódio admissional < 113 meEq/L (OR 2,4; p < 0,001), idade < 75 anos (OR 1,96; p = 0,005) e receber volume NaCl 0,9% ≥ 500 ml no PS (OR 2,1; p = 0,007) foram associados a um aumento na chance de hipercorreção; ter câncer (OR 0,45; p = 0,008) e usar furosemida durante a internação (OR 0,52; p = 0,008) reduziram essa chance. Conclusões: Hipercorreção de hiponatremia grave ocorre com elevada frequência em pacientes internados. O volume de NaCl 0,9% administrado no PS é um fator de risco modificável para ocorrência de hipercorreção. Quanto mais grave for a hiponatremia, maior deve ser a cautela ao tentar corrigir o distúrbio. A administração de mais de 500 ml de NaCl 0,9% ̈no PS dobrou a chance de hipercorreção. |
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2024-02-19T13:28:59Z2024-02-19T13:28:59Z2023-12-04REIS, Lívia de Azevêdo Cerqueira. Frequência e preditores de hipercorreção do sódio sérico em pacientes internados com hiponatremia grave. 2023. 97 f. Dissertação (Mestrado) - Universidade Federal da Bahia, Faculdade de Medicina da Bahia, Programa de Pós-Graduação em Ciências da Saúde, Salvador, 2023.https://repositorio.ufba.br/handle/ri/39033Introdução: Hipercorreção de hiponatremia ocorre quando a velocidade de correção recomendada é superada e pode se complicar com desmielinização osmótica. Dados sobre a frequência e os preditores de hipercorreção de hiponatremia grave ainda são escassos. Objetivos: Avaliar a frequência de hipercorreção de hiponatremia grave em dois centros brasileiros. Métodos: Estudo de coorte retrospectiva a partir da revisão de prontuários eletrônicos de pacientes internados entre Janeiro de 2016 e Julho de 2019 com sódio sérico admissional < 120 mEq/L (n = 362). Hipercorreção foi definida como uma elevação no sódio sérico > 8 mEq/L em 24 horas e/ou > 18 mEq/L em 48 horas. Preditores de hipercorreção foram identificados através de regressão logística multivariada. Resultados: A média de idade foi 75,6 ± 13,6 anos, 65,5% eram mulheres. Na chegada ao pronto socorro (PS), a média do sódio sérico inicial foi de 113,3 ± 4,9 mEq/L (94 a 119). No PS, 73,2% dos pacientes foram tratados com NaCl 0,9% e o volume médio foi de 495 ± 393 ml. A frequência de hipercorreção foi de 38,7% dos casos (140 pacientes). Em modelo de regressão logística multivariada, um sódio admissional < 113 meEq/L (OR 2,4; p < 0,001), idade < 75 anos (OR 1,96; p = 0,005) e receber volume NaCl 0,9% ≥ 500 ml no PS (OR 2,1; p = 0,007) foram associados a um aumento na chance de hipercorreção; ter câncer (OR 0,45; p = 0,008) e usar furosemida durante a internação (OR 0,52; p = 0,008) reduziram essa chance. Conclusões: Hipercorreção de hiponatremia grave ocorre com elevada frequência em pacientes internados. O volume de NaCl 0,9% administrado no PS é um fator de risco modificável para ocorrência de hipercorreção. Quanto mais grave for a hiponatremia, maior deve ser a cautela ao tentar corrigir o distúrbio. A administração de mais de 500 ml de NaCl 0,9% ̈no PS dobrou a chance de hipercorreção.Introduction: Overcorrection of hyponatremia occurs when the recommended correc- tion rate is exceeded and can be complicated by osmotic demyelination. Data on the frequency and predictors of severe hyponatremia overcorrection are still limited. Objectives: To assess the frequency of severe hyponatremia overcorrection in two Brazilian centers. Methods: Ret- rospective cohort study based on the review of electronic medical records of patients admitted between January 2016 and July 2019 with admission serum sodium < 120 mEq/L (n = 362). Overcorrection was defined as an increase in serum sodium > 8 mEq/L in 24 hours and/or > 18 mEq/L in 48 hours. Overcorrection predictors were identified through multivariate logistic re- gression. Results: The mean age was 75.6 ± 13.6 years, and 65.5% were women. On arrival at the emergency room (ER), the mean initial serum sodium was 113.3 ± 4.9 mEq/L (range 94 to 119). In the ER, 73.2% of patients were treated with 0.9% NaCl, and the average volume was 495 ± 393 ml. The frequency of overcorrection was 38.7% of cases (140 patients). In a multi- variate logistic regression model, admission sodium < 113 mEq/L (OR 2.4; p < 0.001), age < 75 years (OR 1.96; p = 0.005) and receiving ≥ 500 ml of 0.9% NaCl in the ER (OR 2.1; p = 0.007) were associated with an increased chance of overcorrection; having cancer (OR 0.45; p = 0.008) and using furosemide during hospitalization (OR 0.52; p = 0.008) reduced this chance. Conclusions: Overcorrection of severe hyponatremia occurs with high frequency in hospital- ized patients. The volume of 0.9% NaCl administered in the ER is a modifiable risk factor for overcorrection. The more severe the hyponatremia, the more caution should be exercised when trying to correct the disorder. Administering more than 500 ml of 0.9% NaCl in the ER doubled the chance of overcorrection.porUniversidade Federal da BahiaPós-Graduação em Ciências da Saúde (POS_CIENCIAS_SAUDE) UFBABrasilFaculdade de Medicina da BahiaHyponatremiaOvercorrectionOsmotic demyelination syndromeCentral pontine myelinolysisCNPQ::CIENCIAS DA SAUDECNPQ::CIENCIAS DA SAUDE::MEDICINAHiponatremiaHipercorreçãoSíndrome de desmielinização osmóticaMielinólise central da ponteFrequência e preditores de hipercorreção do sódio sérico em pacientes internados com hiponatremia grave.Frequency and predictors of serum sodium overcorrection in hospitalized patients with severe hyponatremiaMestrado Acadêmicoinfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/publishedVersionRocha, Paulo Novishttps://orcid.org/0000-0001-9598-6711http://lattes.cnpq.br/2974874082234741Rocha, Paulo Novishttps://orcid.org/0000-0001-9598-6711http://lattes.cnpq.br/2974874082234741Martinelli, Reinaldo Pessoahttps://orcid.org/0000-0003-1919-0919http://lattes.cnpq.br/0444766267396767Silveira, Marcelo Augusto Duartehttp://lattes.cnpq.br/5232373942488987Neves, Carolina Larahttp://lattes.cnpq.br/7832085382757100http://lattes.cnpq.br/1171403051176832Reis, Lívia de Azevêdo CerqueiraAdrogué H J and Madias N E. 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Hyponatremia and Worsening Sodium Levels Are Associated With Long-Term Outcome in Patients Hospitalized for Acute Heart Failure. Journal of the American Heart Association, 5 (3):e002668, 2016.reponame:Repositório Institucional da UFBAinstname:Universidade Federal da Bahia (UFBA)instacron:UFBAinfo:eu-repo/semantics/openAccessORIGINALLivia de Azevedo. TCC. Dissertação.pdfLivia de Azevedo. TCC. 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| dc.title.pt_BR.fl_str_mv |
Frequência e preditores de hipercorreção do sódio sérico em pacientes internados com hiponatremia grave. |
| dc.title.alternative.pt_BR.fl_str_mv |
Frequency and predictors of serum sodium overcorrection in hospitalized patients with severe hyponatremia |
| title |
Frequência e preditores de hipercorreção do sódio sérico em pacientes internados com hiponatremia grave. |
| spellingShingle |
Frequência e preditores de hipercorreção do sódio sérico em pacientes internados com hiponatremia grave. Reis, Lívia de Azevêdo Cerqueira CNPQ::CIENCIAS DA SAUDE CNPQ::CIENCIAS DA SAUDE::MEDICINA Hiponatremia Hipercorreção Síndrome de desmielinização osmótica Mielinólise central da ponte Hyponatremia Overcorrection Osmotic demyelination syndrome Central pontine myelinolysis |
| title_short |
Frequência e preditores de hipercorreção do sódio sérico em pacientes internados com hiponatremia grave. |
| title_full |
Frequência e preditores de hipercorreção do sódio sérico em pacientes internados com hiponatremia grave. |
| title_fullStr |
Frequência e preditores de hipercorreção do sódio sérico em pacientes internados com hiponatremia grave. |
| title_full_unstemmed |
Frequência e preditores de hipercorreção do sódio sérico em pacientes internados com hiponatremia grave. |
| title_sort |
Frequência e preditores de hipercorreção do sódio sérico em pacientes internados com hiponatremia grave. |
| author |
Reis, Lívia de Azevêdo Cerqueira |
| author_facet |
Reis, Lívia de Azevêdo Cerqueira |
| author_role |
author |
| dc.contributor.advisor1.fl_str_mv |
Rocha, Paulo Novis |
| dc.contributor.advisor1ID.fl_str_mv |
https://orcid.org/0000-0001-9598-6711 |
| dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/2974874082234741 |
| dc.contributor.referee1.fl_str_mv |
Rocha, Paulo Novis |
| dc.contributor.referee1ID.fl_str_mv |
https://orcid.org/0000-0001-9598-6711 |
| dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/2974874082234741 |
| dc.contributor.referee2.fl_str_mv |
Martinelli, Reinaldo Pessoa |
| dc.contributor.referee2ID.fl_str_mv |
https://orcid.org/0000-0003-1919-0919 |
| dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/0444766267396767 |
| dc.contributor.referee3.fl_str_mv |
Silveira, Marcelo Augusto Duarte |
| dc.contributor.referee3Lattes.fl_str_mv |
http://lattes.cnpq.br/5232373942488987 |
| dc.contributor.referee4.fl_str_mv |
Neves, Carolina Lara |
| dc.contributor.referee4Lattes.fl_str_mv |
http://lattes.cnpq.br/7832085382757100 |
| dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/1171403051176832 |
| dc.contributor.author.fl_str_mv |
Reis, Lívia de Azevêdo Cerqueira |
| contributor_str_mv |
Rocha, Paulo Novis Rocha, Paulo Novis Martinelli, Reinaldo Pessoa Silveira, Marcelo Augusto Duarte Neves, Carolina Lara |
| dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS DA SAUDE CNPQ::CIENCIAS DA SAUDE::MEDICINA |
| topic |
CNPQ::CIENCIAS DA SAUDE CNPQ::CIENCIAS DA SAUDE::MEDICINA Hiponatremia Hipercorreção Síndrome de desmielinização osmótica Mielinólise central da ponte Hyponatremia Overcorrection Osmotic demyelination syndrome Central pontine myelinolysis |
| dc.subject.por.fl_str_mv |
Hiponatremia Hipercorreção Síndrome de desmielinização osmótica Mielinólise central da ponte |
| dc.subject.other.pt_BR.fl_str_mv |
Hyponatremia Overcorrection Osmotic demyelination syndrome Central pontine myelinolysis |
| description |
Introdução: Hipercorreção de hiponatremia ocorre quando a velocidade de correção recomendada é superada e pode se complicar com desmielinização osmótica. Dados sobre a frequência e os preditores de hipercorreção de hiponatremia grave ainda são escassos. Objetivos: Avaliar a frequência de hipercorreção de hiponatremia grave em dois centros brasileiros. Métodos: Estudo de coorte retrospectiva a partir da revisão de prontuários eletrônicos de pacientes internados entre Janeiro de 2016 e Julho de 2019 com sódio sérico admissional < 120 mEq/L (n = 362). Hipercorreção foi definida como uma elevação no sódio sérico > 8 mEq/L em 24 horas e/ou > 18 mEq/L em 48 horas. Preditores de hipercorreção foram identificados através de regressão logística multivariada. Resultados: A média de idade foi 75,6 ± 13,6 anos, 65,5% eram mulheres. Na chegada ao pronto socorro (PS), a média do sódio sérico inicial foi de 113,3 ± 4,9 mEq/L (94 a 119). No PS, 73,2% dos pacientes foram tratados com NaCl 0,9% e o volume médio foi de 495 ± 393 ml. A frequência de hipercorreção foi de 38,7% dos casos (140 pacientes). Em modelo de regressão logística multivariada, um sódio admissional < 113 meEq/L (OR 2,4; p < 0,001), idade < 75 anos (OR 1,96; p = 0,005) e receber volume NaCl 0,9% ≥ 500 ml no PS (OR 2,1; p = 0,007) foram associados a um aumento na chance de hipercorreção; ter câncer (OR 0,45; p = 0,008) e usar furosemida durante a internação (OR 0,52; p = 0,008) reduziram essa chance. Conclusões: Hipercorreção de hiponatremia grave ocorre com elevada frequência em pacientes internados. O volume de NaCl 0,9% administrado no PS é um fator de risco modificável para ocorrência de hipercorreção. Quanto mais grave for a hiponatremia, maior deve ser a cautela ao tentar corrigir o distúrbio. A administração de mais de 500 ml de NaCl 0,9% ̈no PS dobrou a chance de hipercorreção. |
| publishDate |
2023 |
| dc.date.issued.fl_str_mv |
2023-12-04 |
| dc.date.accessioned.fl_str_mv |
2024-02-19T13:28:59Z |
| dc.date.available.fl_str_mv |
2024-02-19T13:28:59Z |
| dc.type.driver.fl_str_mv |
Mestrado Acadêmico info:eu-repo/semantics/masterThesis |
| dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
| format |
masterThesis |
| status_str |
publishedVersion |
| dc.identifier.citation.fl_str_mv |
REIS, Lívia de Azevêdo Cerqueira. Frequência e preditores de hipercorreção do sódio sérico em pacientes internados com hiponatremia grave. 2023. 97 f. Dissertação (Mestrado) - Universidade Federal da Bahia, Faculdade de Medicina da Bahia, Programa de Pós-Graduação em Ciências da Saúde, Salvador, 2023. |
| dc.identifier.uri.fl_str_mv |
https://repositorio.ufba.br/handle/ri/39033 |
| identifier_str_mv |
REIS, Lívia de Azevêdo Cerqueira. Frequência e preditores de hipercorreção do sódio sérico em pacientes internados com hiponatremia grave. 2023. 97 f. Dissertação (Mestrado) - Universidade Federal da Bahia, Faculdade de Medicina da Bahia, Programa de Pós-Graduação em Ciências da Saúde, Salvador, 2023. |
| url |
https://repositorio.ufba.br/handle/ri/39033 |
| dc.language.iso.fl_str_mv |
por |
| language |
por |
| dc.relation.references.pt_BR.fl_str_mv |
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Universidade Federal da Bahia |
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UFBA |
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Brasil |
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Faculdade de Medicina da Bahia |
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Universidade Federal da Bahia |
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