Protección miocárdica con custodiol y trastornos de la osmolalidad

Abstract

Introduction: Hyponatremia and osmolality disorders have been identified as independent predictors of increased morbidity, mortality and length of hospital stay in patients after cardiac surgery. Administration of Custodiol for myocardial protection may alter serum sodium levels and thereby alter the effective plasma osmolality. We evaluated the relationship between administration of Custodiol, and the fluctuation of sodium concentration and plasma osmolality in heart surgery patients. Methods: In this retrospective analysis we reviewed 91 patients who underwent cardiac surgery from 2013 to 2014 in the Fundación Cardioinfantil. Custodiol was administered to all patients. Sodium levels were analyzed and effective plasma osmolality was calculated before, during and after the surgical procedure. Results: All patients were normonatremic at start of surgery. 93.47% of patients developed hyponatremia after administering Custodiol with a significant decrease in mean serum sodium 12.43 mEq/l (P <0.001). Upon completion of the surgical procedure average effective plasma osmolality was 278.47 ± 8.11 mOsm/L (median=278) and the mean serum sodium was 135.35 ± 4.18 mEq / L (median=135). Presenting a significant difference before and after cardiopulmonary bypass (p<0.001, repeated measures ANOVA Friedman, CM). Conclusions: The use of Custodiol produces a significant decrease on the effective plasmatic osmolality and serum sodium. However the median of effective plasmatic osmolality and serum sodium are in normal range at the end of the cardiac surgery. It is not recommended as a routine to treat the hyponatremia caused by the use of Custodiol during the cardiopulmonary bypass.