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Jason D. Woodfine - One of the best experts on this subject based on the ideXlab platform.
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Criteria for Hyponatremic Overcorrection: Systematic Review and Cohort Study of Emergently Ill Patients
Journal of General Internal Medicine, 2020Co-Authors: Jason D. Woodfine, Carl WalravenAbstract:Background Hyponatremia is the most common electrolyte disturbance amongst hospitalized patients. An overly rapid rate of correction of chronic hyponatremia is believed to increase the risk of poor clinical outcomes including osmotic demyelination syndrome (ODS). There is disagreement in the literature regarding the definition of hyponatremic Overcorrection. Methods We performed a systematic review of all English language studies to identify those that calculated sodium correction rate and classified patients’ Overcorrection status. We then identified all patients who presented to our hospital’s emergency department between 2003 and 2015 with a corrected serum sodium ≤ 116 mmol/L. All methods from the systematic review for sodium correction rate calculation and Overcorrection status were applied to this cohort. Results We identified 24 studies citing 9 distinct sodium correction rate methods and 14 criteria for Overcorrection. Six hundred twenty-four patients presenting with severe hyponatremia (median initial value 113 mMol) were identified. Depending on the method used, the median sodium correction rates in our cohort ranged from 0.271 to 1.13 mmol/L per hour. The proportion of patients classified with Overcorrection with the different criteria varied almost 11-fold, ranging from 8.5 to 89.9%. Conclusion Published methods disagree regarding the calculation of sodium correction rates and the definition of hyponatremic Overcorrection. This leads to wide variations in sodium correction rates and the prevalence of Overcorrection in patient cohorts. Definitions based on ODS risk are needed.
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criteria for hyponatremic Overcorrection systematic review and cohort study of emergently ill patients
Journal of General Internal Medicine, 2020Co-Authors: Jason D. Woodfine, Carl Van WalravenAbstract:Hyponatremia is the most common electrolyte disturbance amongst hospitalized patients. An overly rapid rate of correction of chronic hyponatremia is believed to increase the risk of poor clinical outcomes including osmotic demyelination syndrome (ODS). There is disagreement in the literature regarding the definition of hyponatremic Overcorrection. We performed a systematic review of all English language studies to identify those that calculated sodium correction rate and classified patients’ Overcorrection status. We then identified all patients who presented to our hospital’s emergency department between 2003 and 2015 with a corrected serum sodium ≤ 116 mmol/L. All methods from the systematic review for sodium correction rate calculation and Overcorrection status were applied to this cohort. We identified 24 studies citing 9 distinct sodium correction rate methods and 14 criteria for Overcorrection. Six hundred twenty-four patients presenting with severe hyponatremia (median initial value 113 mMol) were identified. Depending on the method used, the median sodium correction rates in our cohort ranged from 0.271 to 1.13 mmol/L per hour. The proportion of patients classified with Overcorrection with the different criteria varied almost 11-fold, ranging from 8.5 to 89.9%. Published methods disagree regarding the calculation of sodium correction rates and the definition of hyponatremic Overcorrection. This leads to wide variations in sodium correction rates and the prevalence of Overcorrection in patient cohorts. Definitions based on ODS risk are needed.
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Derivation and Validation of a Novel Risk Score to Predict Overcorrection of Severe Hyponatremia: The Severe Hyponatremia Overcorrection Risk (SHOR) Score.
Clinical journal of the American Society of Nephrology : CJASN, 2019Co-Authors: Jason D. Woodfine, Manish M. Sood, Thomas E. Macmillan, Rodrigo B. Cavalcanti, Carl Van WalravenAbstract:Background and objectives Osmotic demyelination syndrome is the most concerning complication of severe hyponatremia, occurring with an overly rapid rate of serum sodium correction. There are limited clinical tools to aid in identifying individuals at high risk of Overcorrection with severe hyponatremia. Design, setting, participants, & measurements We identified all patients who presented to a tertiary-care hospital emergency department in Ottawa, Canada (catchment area 1.2 million) between January 1, 2003 and December 31, 2015, with serum sodium (corrected for glucose levels) Results A total of 623 patients presented with severe hyponatremia (mean initial value 112 mmol/L; SD 3.2). The prevalence of no, unlikely, possible, and definite Overcorrection was 72%, 4%, 10%, and 14%, respectively. Overcorrection was independently associated with decreased level of consciousness (2 points), vomiting (2 points), severe hypokalemia (1 point), hypotonic urine (4 points), volume overload (−5 points), chest tumor (−5 points), patient age (−1 point per decade, over 50 years), and initial sodium level ( Conclusions In patients presenting with severe hyponatremia, Overcorrection was common and predictable using baseline information. Further external validation of the SHOR is required before generalized use.
Carl Van Walraven - One of the best experts on this subject based on the ideXlab platform.
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criteria for hyponatremic Overcorrection systematic review and cohort study of emergently ill patients
Journal of General Internal Medicine, 2020Co-Authors: Jason D. Woodfine, Carl Van WalravenAbstract:Hyponatremia is the most common electrolyte disturbance amongst hospitalized patients. An overly rapid rate of correction of chronic hyponatremia is believed to increase the risk of poor clinical outcomes including osmotic demyelination syndrome (ODS). There is disagreement in the literature regarding the definition of hyponatremic Overcorrection. We performed a systematic review of all English language studies to identify those that calculated sodium correction rate and classified patients’ Overcorrection status. We then identified all patients who presented to our hospital’s emergency department between 2003 and 2015 with a corrected serum sodium ≤ 116 mmol/L. All methods from the systematic review for sodium correction rate calculation and Overcorrection status were applied to this cohort. We identified 24 studies citing 9 distinct sodium correction rate methods and 14 criteria for Overcorrection. Six hundred twenty-four patients presenting with severe hyponatremia (median initial value 113 mMol) were identified. Depending on the method used, the median sodium correction rates in our cohort ranged from 0.271 to 1.13 mmol/L per hour. The proportion of patients classified with Overcorrection with the different criteria varied almost 11-fold, ranging from 8.5 to 89.9%. Published methods disagree regarding the calculation of sodium correction rates and the definition of hyponatremic Overcorrection. This leads to wide variations in sodium correction rates and the prevalence of Overcorrection in patient cohorts. Definitions based on ODS risk are needed.
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Derivation and Validation of a Novel Risk Score to Predict Overcorrection of Severe Hyponatremia: The Severe Hyponatremia Overcorrection Risk (SHOR) Score.
Clinical journal of the American Society of Nephrology : CJASN, 2019Co-Authors: Jason D. Woodfine, Manish M. Sood, Thomas E. Macmillan, Rodrigo B. Cavalcanti, Carl Van WalravenAbstract:Background and objectives Osmotic demyelination syndrome is the most concerning complication of severe hyponatremia, occurring with an overly rapid rate of serum sodium correction. There are limited clinical tools to aid in identifying individuals at high risk of Overcorrection with severe hyponatremia. Design, setting, participants, & measurements We identified all patients who presented to a tertiary-care hospital emergency department in Ottawa, Canada (catchment area 1.2 million) between January 1, 2003 and December 31, 2015, with serum sodium (corrected for glucose levels) Results A total of 623 patients presented with severe hyponatremia (mean initial value 112 mmol/L; SD 3.2). The prevalence of no, unlikely, possible, and definite Overcorrection was 72%, 4%, 10%, and 14%, respectively. Overcorrection was independently associated with decreased level of consciousness (2 points), vomiting (2 points), severe hypokalemia (1 point), hypotonic urine (4 points), volume overload (−5 points), chest tumor (−5 points), patient age (−1 point per decade, over 50 years), and initial sodium level ( Conclusions In patients presenting with severe hyponatremia, Overcorrection was common and predictable using baseline information. Further external validation of the SHOR is required before generalized use.
Ohjin Kwon - One of the best experts on this subject based on the ideXlab platform.
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increased preoperative medial and lateral laxity is a predictor of Overcorrection in open wedge high tibial osteotomy
Knee Surgery Sports Traumatology Arthroscopy, 2020Co-Authors: Jungu Park, Jongmin Kim, Bumsik Lee, Sangmin Lee, Ohjin Kwon, Seongil BinAbstract:This study aimed at determining whether Overcorrection after open wedge high tibial osteotomy (OWHTO) would be predicted by the magnitude of preoperative medial and lateral coronal soft tissue laxity around the knee joint. Overall, 68 knees of 62 patients who underwent OWHTO for primary medial osteoarthritis were retrospectively reviewed. The mechanical hip–knee–ankle (HKA) axis, weight-bearing line (WBL) ratio, medial proximal tibial angle (MPTA), joint line obliquity, coronal subluxation, and joint line convergence angle (JLCA) were measured on full-weight-bearing long-standing HKA radiographs preoperatively and at 1 year postoperatively. The varus valgus stress angle was measured on preoperative radiographs. The correction amount due to soft tissue factors was calculated as the difference between the WBL ratio on postoperative 1-year radiographs and that on virtually corrected preoperative radiographs with the same amount of MPTA at 1 year postoperatively. The patients were grouped according to the presence or absence of a ≥ 10% Overcorrection of WBL ratio (Overcorrection or expected correction). Multiple logistic regression analysis was performed to identify the preoperative risk factors of Overcorrection. The average WBL ratio was corrected from 19.0 ± 13.5% preoperatively to 61.6 ± 9.1% postoperatively (P 10% was confirmed in 17 patients (28%). The preoperative JLCA and valgus stress angle were significantly greater in the Overcorrection group than in the expected correction group: 5.0 ± 1.7° vs. 3.4 ± 1.9° (P = 0.003) and 2.4 ± 1.0° vs. 1.3 ± 1.2° (P = 0.002), respectively. Among the radiologic parameters, the presence of both ≥ 4° JLCA and ≥ 1.5° valgus stress angle was the only significant risk factor for Overcorrection from soft tissue factors (P = 0.006; odds ratio, 30.2). The magnitude of both medial and lateral coronal soft tissue laxity was a predictor of Overcorrection from soft tissue factors after OWHTO. Overcorrection was more likely to occur in cases with both ≥ 4° JLCA and ≥ 1.5° valgus stress angle. III.
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Increased preoperative medial and lateral laxity is a predictor of Overcorrection in open wedge high tibial osteotomy
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Jungu Park, Ohjin KwonAbstract:Purpose This study aimed at determining whether Overcorrection after open wedge high tibial osteotomy (OWHTO) would be predicted by the magnitude of preoperative medial and lateral coronal soft tissue laxity around the knee joint. Methods Overall, 68 knees of 62 patients who underwent OWHTO for primary medial osteoarthritis were retrospectively reviewed. The mechanical hip–knee–ankle (HKA) axis, weight-bearing line (WBL) ratio, medial proximal tibial angle (MPTA), joint line obliquity, coronal subluxation, and joint line convergence angle (JLCA) were measured on full-weight-bearing long-standing HKA radiographs preoperatively and at 1 year postoperatively. The varus valgus stress angle was measured on preoperative radiographs. The correction amount due to soft tissue factors was calculated as the difference between the WBL ratio on postoperative 1-year radiographs and that on virtually corrected preoperative radiographs with the same amount of MPTA at 1 year postoperatively. The patients were grouped according to the presence or absence of a ≥ 10% Overcorrection of WBL ratio (Overcorrection or expected correction). Multiple logistic regression analysis was performed to identify the preoperative risk factors of Overcorrection. Results The average WBL ratio was corrected from 19.0 ± 13.5% preoperatively to 61.6 ± 9.1% postoperatively ( P 10% was confirmed in 17 patients (28%). The preoperative JLCA and valgus stress angle were significantly greater in the Overcorrection group than in the expected correction group: 5.0 ± 1.7° vs. 3.4 ± 1.9° ( P = 0.003) and 2.4 ± 1.0° vs. 1.3 ± 1.2° ( P = 0.002), respectively. Among the radiologic parameters, the presence of both ≥ 4° JLCA and ≥ 1.5° valgus stress angle was the only significant risk factor for Overcorrection from soft tissue factors ( P = 0.006; odds ratio, 30.2). Conclusions The magnitude of both medial and lateral coronal soft tissue laxity was a predictor of Overcorrection from soft tissue factors after OWHTO. Overcorrection was more likely to occur in cases with both ≥ 4° JLCA and ≥ 1.5° valgus stress angle. Level of evidence III.
Hye Sun Gwak - One of the best experts on this subject based on the ideXlab platform.
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Risk factors for sodium Overcorrection in non-hypovolemic hyponatremia patients treated with tolvaptan.
European journal of clinical pharmacology, 2020Co-Authors: Yukyung Kim, Nari Lee, Kyung Eun Lee, Hye Sun GwakAbstract:In this study, the risk factors associated with sodium Overcorrection were investigated with an optimal cutoff for baseline serum sodium for use in daily clinical practice. Electronic medical records of patients who received tolvaptan for non-hypovolemic hyponatremia were reviewed. Demographic and clinical data including age, sex, weight, height, comorbidity, cause of hyponatremia, hypertonic saline use, and comedication were collected. Baseline laboratory parameters measured included serum sodium, serum potassium, serum creatinine, blood urea nitrogen, serum tonicity, ALT, AST, and urine osmolality. The primary outcome was the Overcorrection of serum sodium, which was defined as an increase in serum sodium by more than 10 mmol/L in 24 h. From a total of 77 patients included in the analysis, 24 (31.2%) showed sodium Overcorrection (> 10 mmol/L/24 h); 2 (2.6%) in heart failure cohort, 17 (22.1%) in SIADH cohort, and 5 (6.5%) in unknown cause cohort. More than half of patients (51.9%) were administered hypertonic saline prior to tolvaptan. Hypertension, cancer, diuretics, baseline serum sodium, and SIADH were associated with the risk of Overcorrection in the univariable analysis. Significant factors for the Overcorrection from multivariable analysis were lower body mass index, presence of cancer (adjusted odds ratio, 10.87; 95% CI, 1.23–96.44), and lower serum sodium at baseline (adjusted odds ratio, 0.76 for every 1 mEq/L increase; 95% CI, 0.61–0.94). The Overcorrection of hyponatremia in non-hypovolemic patients treated with tolvaptan was significantly associated with lower body mass index, presence of cancer, and lower serum sodium at baseline. In subgroup analysis using SIADH patients, baseline sodium and cancer were found to be significant factors of Overcorrection.
Jungu Park - One of the best experts on this subject based on the ideXlab platform.
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increased preoperative medial and lateral laxity is a predictor of Overcorrection in open wedge high tibial osteotomy
Knee Surgery Sports Traumatology Arthroscopy, 2020Co-Authors: Jungu Park, Jongmin Kim, Bumsik Lee, Sangmin Lee, Ohjin Kwon, Seongil BinAbstract:This study aimed at determining whether Overcorrection after open wedge high tibial osteotomy (OWHTO) would be predicted by the magnitude of preoperative medial and lateral coronal soft tissue laxity around the knee joint. Overall, 68 knees of 62 patients who underwent OWHTO for primary medial osteoarthritis were retrospectively reviewed. The mechanical hip–knee–ankle (HKA) axis, weight-bearing line (WBL) ratio, medial proximal tibial angle (MPTA), joint line obliquity, coronal subluxation, and joint line convergence angle (JLCA) were measured on full-weight-bearing long-standing HKA radiographs preoperatively and at 1 year postoperatively. The varus valgus stress angle was measured on preoperative radiographs. The correction amount due to soft tissue factors was calculated as the difference between the WBL ratio on postoperative 1-year radiographs and that on virtually corrected preoperative radiographs with the same amount of MPTA at 1 year postoperatively. The patients were grouped according to the presence or absence of a ≥ 10% Overcorrection of WBL ratio (Overcorrection or expected correction). Multiple logistic regression analysis was performed to identify the preoperative risk factors of Overcorrection. The average WBL ratio was corrected from 19.0 ± 13.5% preoperatively to 61.6 ± 9.1% postoperatively (P 10% was confirmed in 17 patients (28%). The preoperative JLCA and valgus stress angle were significantly greater in the Overcorrection group than in the expected correction group: 5.0 ± 1.7° vs. 3.4 ± 1.9° (P = 0.003) and 2.4 ± 1.0° vs. 1.3 ± 1.2° (P = 0.002), respectively. Among the radiologic parameters, the presence of both ≥ 4° JLCA and ≥ 1.5° valgus stress angle was the only significant risk factor for Overcorrection from soft tissue factors (P = 0.006; odds ratio, 30.2). The magnitude of both medial and lateral coronal soft tissue laxity was a predictor of Overcorrection from soft tissue factors after OWHTO. Overcorrection was more likely to occur in cases with both ≥ 4° JLCA and ≥ 1.5° valgus stress angle. III.
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Increased preoperative medial and lateral laxity is a predictor of Overcorrection in open wedge high tibial osteotomy
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Jungu Park, Ohjin KwonAbstract:Purpose This study aimed at determining whether Overcorrection after open wedge high tibial osteotomy (OWHTO) would be predicted by the magnitude of preoperative medial and lateral coronal soft tissue laxity around the knee joint. Methods Overall, 68 knees of 62 patients who underwent OWHTO for primary medial osteoarthritis were retrospectively reviewed. The mechanical hip–knee–ankle (HKA) axis, weight-bearing line (WBL) ratio, medial proximal tibial angle (MPTA), joint line obliquity, coronal subluxation, and joint line convergence angle (JLCA) were measured on full-weight-bearing long-standing HKA radiographs preoperatively and at 1 year postoperatively. The varus valgus stress angle was measured on preoperative radiographs. The correction amount due to soft tissue factors was calculated as the difference between the WBL ratio on postoperative 1-year radiographs and that on virtually corrected preoperative radiographs with the same amount of MPTA at 1 year postoperatively. The patients were grouped according to the presence or absence of a ≥ 10% Overcorrection of WBL ratio (Overcorrection or expected correction). Multiple logistic regression analysis was performed to identify the preoperative risk factors of Overcorrection. Results The average WBL ratio was corrected from 19.0 ± 13.5% preoperatively to 61.6 ± 9.1% postoperatively ( P 10% was confirmed in 17 patients (28%). The preoperative JLCA and valgus stress angle were significantly greater in the Overcorrection group than in the expected correction group: 5.0 ± 1.7° vs. 3.4 ± 1.9° ( P = 0.003) and 2.4 ± 1.0° vs. 1.3 ± 1.2° ( P = 0.002), respectively. Among the radiologic parameters, the presence of both ≥ 4° JLCA and ≥ 1.5° valgus stress angle was the only significant risk factor for Overcorrection from soft tissue factors ( P = 0.006; odds ratio, 30.2). Conclusions The magnitude of both medial and lateral coronal soft tissue laxity was a predictor of Overcorrection from soft tissue factors after OWHTO. Overcorrection was more likely to occur in cases with both ≥ 4° JLCA and ≥ 1.5° valgus stress angle. Level of evidence III.
