Room 130 (Moscone Center)
Poster Board SUN-144
Design and Setting: Prospective multicentre observational study in two tertiary referral centers in Switzerland.
Methods: We show data of 175 consecutive patients with severe hypoosmolar hyponatremia (Na<125mmol/L) at presentation to the emergency department. In all patients, a standardized diagnostic evaluation was performed and patients were treated according to a diagnostic algorithm with fluid restriction or physiologic saline administration, respectively. Copeptin levels were compared between different aetiologies of hyponatremia.
Results: Median plasma copeptin levels in patients with primary polydipsia (n=17) were 3.8 [IQR 2.38- 5-79] pmol/L, in patients with diuretic induced hyponatremia (n=45) 13.21 [IQR 7.32-57.28] pmol/L, in patients with SIADH (n=56) 13.03 [IQR 5.61- 28.80] pmol/L, in patients with hypervolemic hyponatremia (n=25) 28.15 [IQR 10.85- 64.45] pmol/L and in patients with hypovolemic hyponatremia (n=32) 55.05 [IQR 23.42-126.1] pmol/L (p [KRUSKAL WALLIS] <0.0001). Copeptin levels were higher in patients requiring saline infusion (n=77) compared to patients requiring fluid restriction (n=98) (27.0 [IQR 10.0- 78.05] vs. 12.24 [IQR 5.35- 29.65], p< 0.001). A copeptin level >70 pmol/L allowed a diagnosis of hypovolemic or diuretic induced hyponatremia requiring saline infusion with a specificity of 91%. Similarly, a copeptin/urinary sodium ratio >1.84 could identify patients with a clear need of saline infusion with a specificity of 90.2%.
Conclusion: Plasma copeptin levels add diagnostic information in the differential diagnosis of patients with severe hyponatremia and identify a subset of patients with clear need for saline infusion. Used in combination with clinical algorithms, copeptin may provide a new tool for a more rapid and targeted treatment in patients with severe hyponatremia.
Disclosure: PS: Coinvestigator, Thermofischer (Brahms AG). BM: Consultant, BRAHMS/Thermofisher. Nothing to Disclose: NN, BW, IS, BA, MB, CAB, CN, RB, AB, AH, MC
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