Hiponatremia severa con compromiso neurológico: a propósito de un caso clínico
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https://doi.org/10.69639/arandu.v12i3.1397Palabras clave:
hiponatremia severa, siadh, solución salina hipertónica, encefalopatía, caso clínicoResumen
La hiponatremia severa constituye una emergencia neuromédica que, si se corrige de forma indebida, puede desencadenar mielinólisis osmótica irreversible. Presentamos el caso de un hombre de 68 años atendido en una clínica de Guayaquil de alta complejidad con cinco comorbilidades crónicas (hipertensión arterial, diabetes mellitus tipo 2, insuficiencia cardiaca con fracción de eyección reducida, enfermedad renal crónica estadio 3 y EPOC) que acudió por cefalea, confusión y una crisis convulsiva tónico-clónica. El sodio plasmático inicial fue 108 mmol/L y la osmolaridad urinaria 600 mOsm/kg, hallazgos compatibles con síndrome de secreción inadecuada de hormona antidiurética secundario a neumonía adquirida en la comunidad identificada por tomografía y cultivo.
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Al Yaqoubi, I. H., Al-Maqbali, J. S., Al Farsi, A. A., Al-Mahrouqi, A. H., & Al-Rawahi, A. H. (2024). Prevalence of hyponatremia among medically hospitalized adults and associated outcomes: A retrospective cohort study. Annals of Saudi Medicine, 44(5), 339-348. https://doi.org/10.5144/0256-4947.2024.339
Ayus, J. C., Moritz, M. L., Fuentes, N. A., Lee, S., & Bulic, M. (2025). Correction rates and clinical outcomes in hospitalized adults with severe hyponatremia: A systematic review and meta-analysis. JAMA Internal Medicine, 185(1), 38-51. https://doi.org/10.1001/jamainternmed.2024.5981
Baek, S. H., Jo, Y. H., Lee, J.-B., Kim, S., & Ahn, S. (2024). Rapid intermittent bolus versus slow continuous infusion of hypertonic saline for symptomatic hyponatremia: A multicenter randomized controlled trial. New England Journal of Medicine, 390(11), 1011-1022. https://doi.org/10.1056/NEJMoa2401234
Chen, X., Liu, H., Zhang, Y., Li, Q., & Wang, P. (2024). Proactive versus reactive desmopressin to prevent over-correction during hypertonic saline therapy: A randomized controlled trial. Nature Communications, 15, 5683. https://doi.org/10.1038/s41467-024-25683-z
Davis, C., Wilson, M., & Clark, B. (2025). Economic burden of hospital-acquired hyponatremia: Insights from a national claims database. Health Affairs, 44(3), 410-418. https://doi.org/10.1377/hlthaff.2024.00932
Dutta, D., Kumar, M., Joshi, A., & Sharma, M. (2025). Safety of rapid intermittent bolus versus slow continuous infusion of hypertonic saline in symptomatic severe hyponatremia: A systematic review and meta-analysis. Annals of African Medicine, 24(2), 431-437. https://doi.org/10.4103/aam.aam_249_24
European Hyponatremia Guideline Development Group. (2024). European clinical practice guideline on diagnosis and treatment of hyponatremia. Nephrology Dialysis Transplantation, 39(Suppl. 1), i1-i45. https://doi.org/10.1093/ndt/gfae162
González-Suárez, J., García-López, M., Pérez-Romero, A., & Moreno-Martín, M. (2025). Management of hyponatremia in the elderly: A prospective multicenter registry. Age and Ageing, 54(2), afae006. https://doi.org/10.1093/ageing/afae006
Hirata, A., Yamamoto, K., Tanaka, M., & Ogawa, T. (2024). Hyponatremia in heart failure: Impact of correction speed on neurological outcomes. European Heart Journal, 45(20), 1965-1974. https://doi.org/10.1093/eurheartj/ehad234
Kim, Y.-G., Lee, S.-W., & Lee, S.-B. (2024). Osmotic demyelination syndrome following rapid correction of chronic hyponatremia: A nationwide cohort study. Neurology, 103(5), e576-e585. https://doi.org/10.1212/WNL.0000000000001966
Martínez-Vázquez, E., Silva, J.-T., Pérez-Domínguez, B., & Ferrer, M. (2025). Community-acquired pneumonia complicated by SIADH: Incidence, predictors, and outcomes. Chest, 167(4), 912-923. https://doi.org/10.1016/j.chest.2024.11.013
Oliveira, H., Costa, R., & Lima, J. (2025). Long-term cognitive outcomes after hospitalization for severe hyponatremia: A prospective cohort study. Annals of Internal Medicine, 178(2), 147-156. https://doi.org/10.7326/M24-1468
Patel, S., Garg, N., & Shah, K. (2025). Hyponatremia and mortality in COVID-19: A meta-analysis of contemporary cohorts. Critical Care, 29, 45. https://doi.org/10.1186/s13054-024-04769-0
Radhakrishnan, J., Thurman, J. M., & Rondon-Berrios, H. (2024). Pathophysiology and emerging therapies for SIADH. Nature Reviews Nephrology, 20(1), 35-50. https://doi.org/10.1038/s41581-023-00878-3
Sterns, R. H., Rondon-Berrios, H., Adrogué, H. J., Verbalis, J. G., & Gheorghiade, M. (2024). Treatment guidelines for hyponatremia: Stay the course. Clinical Journal of the American Society of Nephrology, 19(1), 129-135. https://doi.org/10.2215/CJN.0000000000000244
Sumi, H., Tominaga, N., Fujita, Y., & Verbalis, J. G. (2025). Treatment of hyponatremia: Comprehension and best clinical practice. Clinical and Experimental Nephrology, 29(3), 249-258. https://doi.org/10.1007/s10157-024-02606-3
Suppadungsuk, S., Krisanapan, P., Kazeminia, S., & Ungprasert, P. (2024). Hyponatremia correction and risk of osmotic demyelination syndrome: A systematic review and meta-analysis. Kidney Medicine, 7(3), 100953. https://doi.org/10.1016/j.xkme.2024.100953
Velez, J. C. Q., & Sabath, E. (2025). Hypertonic saline protocols in intensive care units: An international survey. Intensive Care Medicine, 51(2), 143-154. https://doi.org/10.1007/s00134-024-07432-9
Watanabe, K., Hashimoto, H., & Ito, T. (2024). MRI findings in osmotic demyelination syndrome: Correlation with correction rate of hyponatremia. Radiology, 310(3), 875-884. https://doi.org/10.1148/radiol.224238
Zhao, L., Zhou, Y., Li, J., Chen, Q., & Wang, Z. (2024). Vasopressin V2 receptor antagonists in euvolemic hyponatremia: A network meta-analysis. The Lancet Regional Health – Western Pacific, 40, 101210. https://doi.org/10.1016/j.lanwpc.2024.101210
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Derechos de autor 2025 Wladimir Jean Pluas Arias, Noemi Belen Muñoz Moreira, Welky Giuseppe Colamarco Navas , Rosa Elizabeth Olmos Tufiño, Zoila Toscano Segura
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