We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Commentary |

Preoperative Hyponatremia Comment on “Preoperative Hyponatremia and Perioperative Complications”

Joseph A. Vassalotti, MD; Erin DuPree, MD
Arch Intern Med. 2012;172(19):1482-1483. doi:10.1001/2013.jamainternmed.2.
Text Size: A A A
Published online


In this issue of the Archives, Leung and colleagues1 present an interesting and important epidemiological analysis of almost 1 million patients who underwent surgery between January 1, 2005, and December 31, 2010, using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), a validated database with nearly 300 participating academic and community hospitals. They demonstrate that preoperative hyponatremia compared with a normal preoperative serum sodium level is significantly associated with a higher risk of perioperative 30-day mortality (adjusted odds ratio [aOR], 1.44) and increased morbidity (major coronary events [aOR, 1.21], wound infections [1.24], pneumonia [1.17], and approximately 1 additional adjusted median hospital day). Preoperative hyponatremia was common, defined as a serum sodium level less than 135 mEq/L (to convert to millimoles per liter, multiply by 1.0) within 90 days of surgery, occurring in 7.8% of patients, or 75 423 of 964 263. In addition, almost 89% of hyponatremia cases were mild, defined as a serum sodium level of 130 to 134 mEq/L. Although, as expected, the risk of death was directly related to the severity of the hyponatremia, somewhat surprisingly, nonemergency procedures and low-risk cases (as stratified by American Society of Anesthesia classes 1 and 2) were significantly associated with higher risk (aOR, 1.59 and 1.93, respectively). Increased risk in patients scheduled for elective surgery with mild and almost certainly asymptomatic hyponatremia presents an important opportunity for the internist performing preoperative medical consultation.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles