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Diagnosis and treatment of hyponatremia: a systematic review of clinical practice guidelines and consensus statements

Overview of attention for article published in BMC Medicine, December 2014
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1 tweeter
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1 Facebook page

Citations

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51 Dimensions

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168 Mendeley
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1 CiteULike
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Title
Diagnosis and treatment of hyponatremia: a systematic review of clinical practice guidelines and consensus statements
Published in
BMC Medicine, December 2014
DOI 10.1186/s12916-014-0231-1
Pubmed ID
Authors

Evi V Nagler, Jill Vanmassenhove, Sabine N van der Veer, Ionut Nistor, Wim Van Biesen, Angela C Webster, Raymond Vanholder

Abstract

BackgroundHyponatremia is a common electrolyte disorder. Multiple organizations have published guidance documents to assist clinicians in managing hyponatremia. We aimed to explore the scope, content, and consistency of these documents.MethodsWe searched MEDLINE, EMBASE, and websites of guideline organizations and professional societies to September 2014 without language restriction for Clinical Practice Guidelines (defined as any document providing guidance informed by systematic literature review) and Consensus Statements (any other guidance document) developed specifically to guide differential diagnosis or treatment of hyponatremia. Four reviewers appraised guideline quality using the 23-item AGREE II instrument, which rates reporting of the guidance development process across six domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. Total scores were calculated as standardized averages by domain.ResultsWe found ten guidance documents; five clinical practice guidelines and five consensus statements. Overall, quality was mixed: two clinical practice guidelines attained an average score of >50% for all of the domains, three rated the evidence in a systematic way and two graded strength of the recommendations. All five consensus statements received AGREE scores below 60% for each of the specific domains.The guidance documents varied widely in scope. All dealt with therapy and seven included recommendations on diagnosis, using serum osmolality to confirm hypotonic hyponatremia, and volume status, urinary sodium concentration, and urinary osmolality for further classification of the hyponatremia. They differed, however, in classification thresholds, what additional tests to consider, and when to initiate diagnostic work-up. Eight guidance documents advocated hypertonic NaCl in severely symptomatic, acute onset (<48 h) hyponatremia. In chronic (>48 h) or asymptomatic cases, recommended treatments were NaCl 0.9%, fluid restriction, and cause-specific therapy for hypovolemic, euvolemic, and hypervolemic hyponatremia, respectively. Eight guidance documents recommended limits for speed of increase of sodium concentration, but these varied between 8 and 12 mmol/L per 24 h. Inconsistencies also existed in the recommended dose of NaCl, its initial infusion speed, and which second line interventions to consider.ConclusionsCurrent guidance documents on the assessment and treatment of hyponatremia vary in methodological rigor and recommendations are not always consistent.

Twitter Demographics

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Mendeley readers

The data shown below were compiled from readership statistics for 168 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Brazil 2 1%
Netherlands 1 <1%
United States 1 <1%
Unknown 164 98%

Demographic breakdown

Readers by professional status Count As %
Student > Bachelor 28 17%
Student > Master 25 15%
Researcher 20 12%
Other 19 11%
Student > Postgraduate 17 10%
Other 47 28%
Unknown 12 7%
Readers by discipline Count As %
Medicine and Dentistry 95 57%
Nursing and Health Professions 16 10%
Pharmacology, Toxicology and Pharmaceutical Science 8 5%
Agricultural and Biological Sciences 5 3%
Business, Management and Accounting 3 2%
Other 18 11%
Unknown 23 14%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 21 January 2015.
All research outputs
#9,611,922
of 12,517,134 outputs
Outputs from BMC Medicine
#1,858
of 2,010 outputs
Outputs of similar age
#168,260
of 271,036 outputs
Outputs of similar age from BMC Medicine
#12
of 13 outputs
Altmetric has tracked 12,517,134 research outputs across all sources so far. This one is in the 19th percentile – i.e., 19% of other outputs scored the same or lower than it.
So far Altmetric has tracked 2,010 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 33.9. This one is in the 6th percentile – i.e., 6% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 271,036 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 32nd percentile – i.e., 32% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 13 others from the same source and published within six weeks on either side of this one. This one is in the 7th percentile – i.e., 7% of its contemporaries scored the same or lower than it.