Hyponatremia in acute-phase response syndrome patients in general surgicalwards

Background: In surgical patients, hypoalbuminemia may occur as a component of acute-phase response (APR) syndrome, which we hypothesized could decreas e serum sodium levels. Aim: To compare the frequency of hyponatremia in adu lt surgical inpatients with or without APR syndrome, Methods: All the simul taneous plasma sodium and albumin results (n = 168), obtained from adults i n surgical wards and corresponding to a 6-month period, were searched in th e 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 ne utrophil left shift (greater than or equal to 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 hemog lobin (10.92 +/- 2.18 vs. 13.53 +/- 2.30 g/dl), and serum albumin levels (m edian, 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-positiv e patients (31.0 vs. 10.9%). Conclusion:The higher percentage of hyponatrem ia among APR-positive patients could be attributed to decreased serum album in levels associated with APR. Copyright (C) 2000 S. Karger AG. Basel.