Background: Overcorrection of serum sodium (SNa) during therapy of hyponatremia can result in osmotic demyelination syndrome. Our aim was to determine the relationship between the isotonic saline solution dose (ISSD) administered and the 24-h SNa increase (24SNa) in patients with hypovolemic hyponatremia (HH). Methods: Retrospective study of HH patients treated with ISS in a tertiary hospital of Madrid, Spain, between 1 January–30 May 2019. The 24-h ISSD received and corresponding 24SNa were calculated. The latter was classified as 3 groups: ≥8 mmol/L, ≥6 mmol/L, or <4 mmol/L. Multivariate regression analyses were performed and ROC curves calculated to study the relationship between ISSD and 24SNa. Results: Thirty patients were included, age 72 years (60–80), 50% were women. 24SNa was ≥8 mmol/L/24 h in 33%, ≥6 mmol/L/24 h in 50%, and <4 mmol/L/24 h in 30%. Median ISSD in each group was: 32 mL/kg/24 h (29–37), 31 mL/kg/24 h (25–33), and 20 mL/kg/24 h (14–22), respectively. An ISSD ≥ 30 mL/kg/24 h had an odds ratio (OR) of 16 (95% CI: 2.5–95.1; p = 0.004) for a 24SNa ≥8 mmol/L, with a sensitivity and specificity of 80%. Conclusions: The 24SNa depends on ISSD. An ISSD between 23–30 mL/kg/24 h seems to be safe and effective.

The definition of primary hyperaldosteronism (PA) has shifted, as progress has been made in understanding the disease. PA can be produced by unilateral or bilateral cortical adrenal hyperproduction of aldosterone, due to hyperplasia, aldosterone-secreting cell clusters, aldosterone-producing macro or micro adenoma/s, and combinations of the above, or by an aldosterone-producing carcinoma. PA is a highly prevalent disease, affecting close to 10% of the hypertensive population. However, PA is clearly underdiagnosed. The purpose of this review is to address current knowledge of PA’s clinical manifestations, as well as current methods of diagnosis. PA is associated with a higher cardiovascular morbidity and mortality than essential hypertension with similar blood pressure control. Young hypertensive patients, those with a first-degree relative with PA or ictus, and/or those with apnea/hypopnea syndrome, moderate/severe/resistant hypertension, adrenal incidentaloma, and/or hypokalemia should be screened for PA. PA can induce atrial fibrillation (AF), and those patients should also be screened for PA. We propose the use of the Captopril challenge test (CCT), oral salt loading, or intravenous salt loading for PA diagnosis, given their availability in the majority of hospital centers. CCT could be first-line, since it is safe and easy to perform.

Introducción: La desnutrición relacionada con la enfermedad tiene una elevada prevalencia, con consecuencias clínicas potencialmente graves para el paciente y de alto impacto económica para el sistema sanitario. Objetivos: Realizar una revisión de la literatura de los costes económicos de la desnutrición asociada a la enfermedad, analizar sus complicaciones y evaluar la utilidad de la nutrición enteral u oral bajo la perspectiva del análisis de costes. Métodos: Se llevó a cabo una revisión de la literatura hasta junio de 2016 sobre los costes económicos de la desnutrición y el análisis de costes del tratamiento nutricional, priorizando las revisiones sistemáticas, metaanálisis y ensayos clínicos aleatorizados. Resultados: Se identificaron 31 publicaciones, 15 sobre los costes de la desnutrición relacionada con la enfermedad y 16 de análisis de costes del tratamiento. La desnutrición relacionada con la enfermedad incrementa los costes sanitarios por una mayor estancia hospitalaria, mayor incidencia de complicaciones infecciosas y no infecciosas, mayor necesidad de tratamientos, incremento de los reingresos, estancias más prolongadas en unidades de cuidados intensivos y/o la necesidad de derivación al alta a centros de continuación de cuidados. Las publicaciones evaluadas sobre el tratamiento mediante suplementos nutricionales orales sugieren que los suplementos nutricionales orales son coste-efectivos y coste-útiles tanto en pacientes ambulatorios como en pacientes hospitalizados. Conclusiones: La desnutrición relacionada con la enfermedad produce un incremento de los costes sanitarios que podría minimizarse, entre otras formas, mediante un diagnóstico y tratamiento precoz de la misma, para lo cual los suplementos nutricionales orales constituyen una herramienta coste-eficaz y coste-útil.