Hyponatremia in Patients with Community Acquired Pneumonia

Authors

  • Lochan Karki Department of Internal Medicine, NAMS, Bir Hospital, Kathmandu, Nepal.
  • Bhawesh Thapa Department of Internal Medicine, NAMS, Bir Hospital, Kathmandu, Nepal.
  • Manoj Kumar Sah Department of Internal Medicine, NAMS, Bir Hospital, Kathmandu, Nepal.

DOI:

https://doi.org/10.31729/jnma.2821

Keywords:

CURB-65 score; hyponatremia; mortality.

Abstract

Introduction: Community acquired pneumonia is one the frequent cause of hospital admissions. Whereas, hyponatremia is a common electrolyte abnormality in hospitalized patients and has been shown to be associated with considerable morbidity and mortality. We aim to studyt the association of hyponatremia with community acquired pneumonia in terms of morbidity and mortality.
Methods: A prospective observational hospital based study was conducted in a hospital for a year. All patients with a diagnosis of community acquired pneumonia and admitted in medicine ward, were included. Patients with diarrhea, known Chronic Kidney Disease, Heart Failure, Cirrhosis of Liver, Malignancy, taking diuretics, chemical pneumonitis, interstitial pneumonias and other debilitating disease were excluded.
Results: Among the 72 cases of CAP, 61% were females and 39% were males. The mean age of patients was 51.3 years, 22 (30.55%) patients had severe CAP. A total of 7 cases expired with an overall mortality of 13.7%. The mortality risk increased with increasing CURB-65 score; CURB-65 score 0, 0%; CURB-65 score 1, 0%; CURB-65 score 2, 0%; CURB-65 score 3, 10%; CURB-65 score 4, 33%; CURB-65 score 5, 100%. i.e higher the CURB-65 score, higher the death rate of CAP patients (p<0.05). Hyponatremia was a common occurrence at hospital admission with an incidence of 36.11%. Hyponatremia at hospital admission was also associated with a longer length of hospital stay in cured CAP patients. The mean length of hospital stay was 4.3 days.
Conclusions: High CURB-65 scores and lower values of serum sodium at admission in patients of CAP are associated with adverse outcomes both in terms of mortality and longer length of hospital stay. CURB-65 score should be incorporated into assessment of CAP and sodium of the patients during admission. 
Keywords: CURB-65 score; hyponatremia; mortality. | PubMed

References

Garibaldi RA. Epidemiology of community-acquired
respiratory tract infections in adults: incidence, etiology,
and impact. The American journal of medicine. 1985 Jun
28;78(6):32-7.
2. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG,
Campbell GD, Dean NC, et al. Infectious Diseases Society
of America/American Thoracic Society consensus
guidelines on the management of community-acquired
pneumonia in adults. Clinical infectious diseases. 2007 Mar
1;44(Supplement 2):S27-72
3. Shah BA, Ahmed W, Dhobi GN, Shah NN, Khursheed SQ,
Haq I. Validity of pneumonia severity index and CURB-65
severity scoring systems in community acquired pneumonia
in an Indian setting. The Indian journal of chest diseases &
allied sciences. 2010 Jan;52(1):9.
4. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA,
Singer DE, Coley CM, Marrie TJ, Kapoor WN. A prediction
rule to identify low-risk patients with community-acquired
pneumonia. New England journal of medicine. 1997 Jan
23;336(4):243-50.
5. Ellison DH, Berl T. Clinical practice. The syndrome
ofinappropriate antidiuresis. New England Journal of
Medicine. 2007;356 2064–2072.
6. Ewig S, Torres A, Woodhead M. Assessment of pneumonia
severity: a European perspective. European Respiratory
Journal. 2006 Jan 1;27(1):6-8.
7. Macfarlane JT, Boldy D. 2004 update of BTS pneumonia
guidelines: what’s new?. Thorax. 2004 May 1;59(5):364-6.
8. Shah BA, Singh G, Naik MA, Dhobi GN. Bacteriological
and clinical profile of Community acquired pneumonia in
hospitalized patients. Lung India. 2010 Apr 1;27(2):54.
9. Neill AM, Martin IR, Weir R, Anderson R, Chereshsky A,
Epton MJ, et al.Community acquired pneumonia: aetiology
and usefulness of severity criteria on admission. Thorax.
1996 Oct 1;51(10):1010-6.
10. Nair, V., Niederman, M. S., Masani, N., & Fishbane,
S. Hyponatremia in community-acquired pneumonia.
American journal of nephrology. 2007;27(2): 184-190.
11. Mirsaeidi M, Peyrani P, Aliberti S, Filardo G, Bordon J,
Blasi F, et al. Thrombocytopenia and thrombocytosis at
time of hospitalization predict mortality in patients with
community-acquired pneumonia. Chest Journal. 2010 Feb
1;137(2):416-20.
12. Prina E, Ferrer M, Ranzani OT, Polverino E, Cillóniz C,
Moreno E, et al. Thrombocytosis is a marker of poor outcome
in community-acquired pneumonia. Chest Journal. 2013 Mar
1;143(3):767-75.

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Published

2016-06-30

How to Cite

Karki, L., Thapa, B., & Sah, M. K. (2016). Hyponatremia in Patients with Community Acquired Pneumonia. Journal of Nepal Medical Association, 54(202), 67–71. https://doi.org/10.31729/jnma.2821

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