SFEBES2022 Poster Presentations Adrenal and Cardiovascular (66 abstracts)
Utility of point of care ultrasound (POCUS) as an adjunct investigation for guiding fluid management in severe hyponatraemia
Narendra Reddy 1,2 , Latif Rahman 1 , Shahriar Shafiq 1 , Salam Al-Alousi 1 , Faizanur Rahman 1 , Muhammad Sardar 1 , Faizal Aijaz 1 , Shailesh Gohil 1 , Ragini Bhake 1 & Miles Levy 1
1University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; 2University of Leicester, Leicester, United Kingdom
Background: The main dilemma in hyponatraemia management is that of fluid restriction vs fluid administration. Inappropriate fluid management may result in either cerebral oedema/death or permanent neurologic disability due to rapid sodium correction.
Objective: We explore the utility of point of care ultrasound (POCUS) as an adjunct tool for assessing 3-volume groups (Hypovolaemia, Euvolaemia & Hypervolaemia) in severe hyponatraemia (Na<120 mmol/l).
Methodology: Patients underwent POCUS1 at admission when Na<120, POCUS 2 when Na>130. US parameters: 1)>50% Inferior Venacava(IVC) compressibility 2)Left Ventricular contractility 3)Pulmonary oedema 4)Pleural effusion 5)Ascites. Hyponatraemia panel requested: U&E, Albumin, Cortisol, TSH, BNP, paired osmolalities & Urine Na. Clinician vs POCUS volume status assessments were compared(UHL QIP No:11408).
Results: n=18; Mean admission Na 112(106-118); Mean discharge Na 129(122-137). 11/18 on diuretics and 4/18 CKD, rendering urine lab measurements uninterpretable in 13/18. Clinician’s assessment: Hypovolaemia 12, Euvolaemia 4, Hypervolaemia 3, Indeterminate 1. POCUS1 assessment: Hypovolaemia 7, Euvolaemia 5, Hypervolaemia 3, Indeterminate 3. POCUS1 reliably guided fluid management in 14/18(78%) as evidenced by subsequent Na correction. 6/15(40%) of Clinician’s assessment did not correlate with POCUS1. POCUS1 was inaccurate in1/15(7%). POCUS1 findings normalised in 4/6 after Na correction in POCUS2. Discussion: At admission, POCUS guided better fluid management in 78% compared to Clinician’s assessment (55%). Advantages: a) Simple procedure (US probe and gel), b) Safe (lack of irradiation), c) Performed at bed side d) Quick (5- 8 minutes). Limitations: a) Requires expertise & b) Inter-user variability.
Conclusion: 1) POCUS is a useful adjunct to physical examination and biochemistry to guide fluid management in hyponatraemia patients. 2) Integrating Venous Excess Doppler Ultrasound (VEXUS) for portal vein flow & Velocity Tegral Index (VTI) (stroke volume) to IVC compressibility may enhance sensitivity & specificity in accurate fluid status assessment.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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