The Hospitalist’s Role in the Perioperative Management of Hyponatremia-References

References

Pdf Summary

The provided references support a comprehensive review of the hospitalist’s role in managing hyponatremia in the perioperative period. Hyponatremia, a common electrolyte disturbance characterized by low serum sodium levels, is linked to increased perioperative complications, including higher in-hospital mortality and postoperative morbidity across various surgeries such as spinal fusions and joint arthroplasties (4-6, 8-9). It also correlates with bone loss and fractures, highlighting broader systemic effects (2). Accurate diagnosis requires distinguishing true hyponatremia from pseudohyponatremia and understanding the patient’s volume status through clinical and laboratory assessments, including fractional uric acid excretion (14-17, 24). The pathophysiology often involves inappropriate antidiuretic hormone secretion and impaired water excretion in conditions like hypopituitarism and myxedema (21-22).<br /><br />Hospitalists play a critical role in identifying hyponatremia, elucidating its etiology, and managing it to prevent rapid correction complications, notably osmotic demyelination syndrome. Treatment approaches include careful administration of hypertonic saline, vasopressin receptor antagonists like tolvaptan and conivaptan, and addressing underlying causes such as diuretic use or psychogenic polydipsia (26-28, 30-31). The literature emphasizes a strategic correction of profound hyponatremia while avoiding harm (31). Additionally, conditions like cerebral salt wasting require nuanced understanding due to differing pathogenesis and treatment (33-34).<br /><br />Overall, the hospitalist’s involvement spans preoperative evaluation, perioperative monitoring, and tailored management of hyponatremia to optimize surgical outcomes, reduce complications, and enhance patient safety. This multidisciplinary focus supported by evidence-based guidelines and expert recommendations is vital in addressing the silent epidemic of hyponatremia in hospitalized surgical patients.

Keywords

hospitalist role

hyponatremia

perioperative period

electrolyte disturbance

perioperative complications

serum sodium levels

osmotic demyelination syndrome

hypertonic saline treatment

vasopressin receptor antagonists

cerebral salt wasting