Analyse de l'incidence des dysnatrémies et des mécanismes et symptômes des hyponatrémies profondes, dans un service d'accueil des urgences sur une période de 18 mois: étude portant sur 43092 patients dont 361 dossiers d'hyponatrémie profonde

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(1)Analyse de l’incidence des dysnatrémies et des mécanismes et symptômes des hyponatrémies profondes, dans un service d’accueil des urgences sur une période de 18 mois: étude portant sur 43092 patients dont 361 dossiers d’hyponatrémie profonde Marie Drogrey. To cite this version: Marie Drogrey. Analyse de l’incidence des dysnatrémies et des mécanismes et symptômes des hyponatrémies profondes, dans un service d’accueil des urgences sur une période de 18 mois: étude portant sur 43092 patients dont 361 dossiers d’hyponatrémie profonde. Médecine humaine et pathologie. 2017. �dumas-01889182�. HAL Id: dumas-01889182 https://dumas.ccsd.cnrs.fr/dumas-01889182 Submitted on 5 Oct 2018. HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers.. L’archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d’enseignement et de recherche français ou étrangers, des laboratoires publics ou privés..

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(142) # ,20#*#_#0(3'**#2`^_c#2*#a_"=!#+ 0#`^_d3,2-2*"#_acacf.2'#,21=2="+'1 ",1 *# 1#04'!# "Q30%#,!#M ,20=+'# =2= "-1=# d^ fd_ $-'1 !&#8 ba ^g` .2'#,21 "'$$=0#,21 "3 $'2 "# .11%#1 36 30%#,!#1 0=.=2=1 .-30 !#02',1 .2'#,21M , !1 "# .11%#1+3*2'.*#1K*4*#30"#,20=+'#*.*31 11#=2=0#2#,3#M ,20=+'#*.*31 11# #,0#%'120=# =2'2 "# _^_ ++-*T M ,20=+'# * .*31 &32# +#130=# 130 !#22# .=0'-"#=2'2"#`^b++-*T M +(-0'2="#1,20=+'#1"-1=#11#1'23,2#,20#_aa#2 _bd++-*T W'%30#_#22 *#3_XM (B8'(%1#%''"!&&!'%1 &(AB>AH>CABF(DB>BC>CABG Distribution en fréquence pour Na De(>=) à(<) Nombre Normale Nombre. . 101,000. 105,120. 5. 105,120. 109,240. 8. 1,466E-11 2,852E-8. 109,240. 113,360. 30. 2,150E-5. 113,360. 117,480. 52. ,006. 117,480. 121,600. 133. ,725. 121,600. 125,720. 283. 32,910. 125,720. 129,840. 734. 595,392. 129,840. 133,960. 2285. 4340,756. 133,960. 138,080. 11789. 12883,538. 138,080. 142,200. 22230. 15675,427. 142,200. 146,320. 5075. 7829,144. 146,320. 150,440. 321. 1597,669. 150,440. 154,560. 62. 132,005. 154,560. 158,680. 29. 4,368. 158,680. 162,800. 18. ,057. 162,800. 166,920. 14. 2,954E-4. 166,920. 171,040. 13. 5,944E-7. 171,040. 175,160. 4. 4,641E-10. 175,160. 179,280. 3. 0,000. 179,280. 183,400. 1. 0,000. 183,400. 187,520. 1. 0,000. 187,520. 191,640. 1. 0,000. 191,640. 195,760. 0. 0,000. 195,760. 199,880. 0. 0,000. 199,880. 204,000. 1. 0,000. Total. 43092. 43092,000. .

(143) (%B8&'"%. `^ &%1#%''"!&&!'%1 &(AB>AH>CABF(DB>BC>CABG. ?+(&"!&+'%2 &!'%1 &KBBA. "> 'LBHA. "> @. 7000. 6000. Nombre. 5000. 4000. 3000. 2000. 1000. 0. 110. 120. 130. 140. 150. 160. 170. Na. . "%

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(145) `_. (%C8&'%('"!&,#"!'%1 &!"!'"!(!)(; & "'1 4000 3500. Nombre. 3000 2500 2000 1500 1000 500 0. Osmol eff < 275. Osmol eff > 275. Niveau osmol. . (%D8"%%1'"!!'%; & "'1';,#"!'%1 340. Osmol eff. 320 300 280 260 240 220 200 100. . 105. 110. 115. Na. 120. 125. 130. 135. .

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(150) à. (%F8%1)!;,#%!'%1 ';,#%"& "'1&"!&&"!. (C8%1)!;,#%!'%1 ';,#%"& "'1&"!&&"!9 Tableau “résum é” pour Osm ol haute, Saison Manquants 227. Tableau “résum é” pour HyperNa, Saison 0 Manquants. DDL. 3. DDL. 3. Chi 2. 53,897. Chi 2. 54,130. p (Chi 2). <,0001. p (Chi 2). <,0001. G-carré. 55,770. G-carré. 56,194. p (G-carré). <,0001. p (G-carré). <,0001. Coef. de contingence. ,035. Coef. de contingence. V de Cramer. ,035. V de Cramer. Fréquences observ. pour HyperNa, Saison automne été hiver printemps. Totaux. ,036 ,036. Fréquences observ. pour Osm ol haute, Saison automne été hiver printemps. 631. 233. 179. 1505. Na < 145. 12809 14280. 7190. 7308. 41587. Osmol eff < 300. 12489 13908. 7033. 7154. 40584. Totaux. 13271 14911. 7423. 7487. 43092. Totaux. 13213 14819. 7388. 7445. 42865. Na > 145. 462. 724. Totaux. Osmol eff > 300. 911. 355. 291. 2281. . Q=23"#"#*.0=4*#,!#"#1&7.-,20=+'#140'#11#*-,*#11'1-,1K,Q.1+-,20="# "'$$=0#,!#122'12'/3#W.j^K_cXM .0=4*#,!#=2'2"#fKbgh1-'2da`.2'#,21130ebbc3.0',2#+.1KfKeeh1-'2_`gg .2'#,21 130 _bf_g #, =2=K fK`bh 1-'2 _^fg .2'#,21 130 _a`_a #, 32-+,# #2 gK_`h 1-'2deb.2'#,21130eaff#,&'4#0W'%30#d#2 *#3aXM .

(151) `b. (%G8%1)!;,#""& "'1!"!'"!&&&"!&. (D8%1)!;,#""& "'1!"!'"!&&&"!&9 Tableau “résum é” pour Osm ol basse, Saison Manquants 227 DDL. 3. Chi 2. 5,334. p (Chi 2). ,1489. G-carré. 5,323. p (G-carré). ,1496. Coef. de contingence. ,011. V de Cramer. ,011. Fréquences observ. pour Osm ol basse, Saison automne été hiver printemps Osmol eff < 275. 1089. Totaux. 1299. 674. 632. 3694. Osmol eff > 275. 12124 13520. 6714. 6813. 39171. Totaux. 13213 14819. 7388. 7445. 42865. .

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(156) `f. (%J8 ",!!"!'"!( 1!& ;,#"!'%1 100. Age moyen (années). 90. 80. 70. 60. 50. 40 DEPLETION ND / AUTRE POTOMANIE. SIADH. SURCHARGE. (E8&' &%#"(%;.!"!'"!( 1!& ;,#"!'%1 Test PLSD de Fisher pour Age Effet : Mécanism e Niveau de significativité : 5 % Critère d’inclusion : Vrai hypo de Données sans titre #1 Diff. moy. Diff. crit. Valeur p DEPLETION, ND / AUTRE. 7,057. 6,346. ,0294 S. DEPLETION, POTOMANIE. 14,797. 6,129. <,0001 S. DEPLETION, SIADH. 5,312. 4,164. ,0126 S. DEPLETION, SURCHARGE. 6,265. 4,764. ,0101 S. ND / AUTRE, POTOMANIE. 7,740. 8,222. ,0649. ND / AUTRE, SIADH. -1,745. 6,884. ,6184. -,792. 7,262. ,8303. POTOMANIE, SIADH. -9,485. 6,684. ,0056 S. POTOMANIE, SURCHARGE. -8,532. 7,073. ,0182 S. ,953. 5,460. ,7315. ND / AUTRE, SURCHARGE. SIADH, SURCHARGE. . . .

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(160) a^. . Tableau “résum é” pour Mécanism e, Niveau Age Critère d’inclusion : Vrai hypo de Stats finales2.svd Manquants 0 DDL. 4. Chi 2. 26,748. p (Chi 2). <,0001. G-carré. 27,328. p (G-carré). <,0001. Coef. de contingence. ,273. V de Cramer. ,284. Fréquences observ. pour Mécanism e, Niveau Age Critère d’inclusion : Vrai hypo de Stats finales2.svd Age<75 Age>=75 Totaux DEPLETION. 50. 115. 165. ND / AUTRE. 11. 13. 24. POTOMANIE. 21. 5. 26. SIADH. 32. 37. 69. SURCHARGE Totaux. 23. 25. 48. 137. 195. 332. . 9E9. ,#"!'%1 &&1)0%&&, #'" '$(&8. -31 4-,1 0#!&#0!&= ",1 *#1 - 1#042'-,1 +="'!*#1 * .0=1#,!#K "# 17+.2B+#1 .-34,2>20#0#*'=193,#&7.-,20=+'#K#24-,1',1'!2=%-0'1=*#1.2'#,21"#*Q=23"# #, 17+.2-+2'/3# -3 ,-,M Q,*71# 3,'40'=# "# * .0=1#,!# "# 17+.2B+#1 #, $-,!2'-,"#1+=!,'1+#1+-,20=3,#"'$$=0#,!#1'%,'$'!2'4#W.j^K^^^bX4#!edKf_h "#1 .0=1#,2,2 "#1 17+.2B+#1 "Q&7.-,20=+'# #2 f_Kbfh "#1 "=.*=2'-,1M #1 &7.-,20=+'#11#!-,"'0#193,#130!&0%#1#+ *#,2*#1+-',117+.2-+2'/3#14#! 1#3*#+#,2 c^h "#1 .2'#,21 .0=1#,2,2 "#1 17+.2B+#1 !-+.2' *#1 W'%30# __ #2 *#3dXM .

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(163) aa. *#3eL!&!$(&%)'1"(; &&"!!%1! '"!"(!&"!&!'!&& !"!'"!& 1!& &;,#"!'%1 Tableau “résum é” pour S cliniqiues de gravité ou réa, Mécanism e Critère d’inclusion : Vrai hypo de Stats finales2.svd Manquants 0 DDL. 4. Chi 2. 12,159. p (Chi 2). ,0162. G-carré. 12,352. p (G-carré). ,0149. Coef. de contingence. ,188. V de Cramer. ,191. Fréquences observ. pour S cliniqiues de gravité ou réa, Mécanism e Critère d’inclusion : Vrai hypo de Stats finales2.svd DEPLETION ND / AUTRE POTOMANIE SIADH SURCHARGE. Totaux. 0. 84. 17. 14. 49. 33. 1. 81. 7. 12. 20. 15. 135. 165. 24. 26. 69. 48. 332. Totaux. 9E9. 197. . ,#"!'%1 ' "%''1"&#'0%8. , ,*71# 3,'40'=#K * +-02*'2= &-1.'2*'<0# "#1 .2'#,21 !*11=1 ",1 *# %0-3.# 130!&0%#=2'21'%,'$'!2'4#+#,2.*31=*#4=#/3#!#**#"#1.2'#,21"3%0-3.#"=.*=2'-, W`gKegh41_cK_ghK.j^K^^^`XW'%30#_a#2 *#3fXM .

(164) ab. (%BD8 "%''1"&#'0%&"! 1!& ;,#"!'%1 . (I8 "%''1"&#'0%&"! 1!& ;,#"!'%1 Tableau “résum é” pour Décès, Mécanism e Critère d’inclusion : Vrai hypo de Stats finales2.svd Manquants 12 DDL. 4. Chi 2. 22,264. p (Chi 2). ,0002. G-carré. •. p (G-carré). •. Coef. de contingence. ,255. V de Cramer. ,264. Fréquences observ. pour Décès, Mécanism e Critère d’inclusion : Vrai hypo de Stats finales2.svd DEPLETION ND / AUTRE POTOMANIE SIADH. SURCHARGE. Totaux. 0. 134. 21. 26. 64. 33. 278. 1. 24. 0. 0. 4. 14. 42. 158. 21. 26. 68. 47. 320. Totaux. 9E9. . !,& (')%18'(%&!(!/!'&. ,#"!'%1 &&, #'" '$(&8 $',"#"=2#0+',#0*#140' *#1',"=.#,",2#111-!'=#19*.0=1#,!#"#17+.2B+#1 !*','/3#1 "Q&7.-,20=+'#K ,-31 4-,1 0=*'1= 3,# ,*71# +3*2'40'=# .0 0=%0#11'-,.

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(168) (!)(!'%1 - B!"!'"!& 1!& & 140. 120. Na cor. 100. 80. 60. 40. 20. 0. DEPLETION. ND / AUTRE. POTOMANIE. SIADH. SURCHARGE. . (J8&'

(169) (!)(!'%1 - B!"!'"!& 1!& & Mécanisme Résidu. ddl. Somme des carrés. Carré moyen. Valeur de F. Valeur de p. Lambda. Puissance. 4. 106,589. 26,647. 1,401. ,2340. 5,605. ,425. 253. 4810,835. 19,015. . 40'2'-,"#*,20=+'##,20#*Q"+'11'-,#2*#_#0(-30.3>20#!*!3*=#!&#8`ca .2'#,21 130 aa` ',!*31K d .2'#,21 =2'#,2 0#2-30,=1 9 "-+'!'*# *# _#0 (-30K b =2'#,2 "=!="=1#2dg,Q-,2.1 =,=$'!'="Q3,"-1%#"#*,20=+'#M.

(170) af. #**#O!' #12 1'%,'$'!2'4#+#,2 "'$$=0#,2# 1#*-, *# +=!,'1+# =2'-*-%'/3# 9 *Q-0'%',# "# *Q&7.-,20=+'#W.k^M^^^_XM ,20=+'# 3%+#,2# .*31 0.'"#+#,2 *# .0#+'#0 (-30 *-01/3# *Q&7.-,20=+'# #12 1#!-,"'0# 9 3,# .-2-+,'# W"'$$=0#,!# +-7#,,# "# OcKb ++-*T* .-30 "=.*=2'-, 41M .-2-+,'#W.k^K^^^_XK"#dKe++-*T*.-30.-2-+,'#41M130!&0%#W.k^K^^^_X#2"#d ++-*T*.-30.-2-+,'#41M K.k^K^^_XW'%30#_e#2 *#3_^XM (%BH8" #%&"!&)%'"!&!'%1 !'%; &&"!'B%"(%&"! & 1!& & 18 16. Delta Na cor. 14 12 10 8 6 4 2 0. . DEPLETION. ND / AUTRE. POTOMANIE. SIADH. SURCHARGE. .

(171) ag. (BA8#12"#40',!#WX"3'!'%1 !'%; &&"!'B% "(%&"!& 1!& & C tè e d. Mécanisme Résidu. c us o ddl. aJ de Stats a es s d Somme des carrés Carré moyen. 4. 750,062. 187,516. 253. 5304,341. 20,966. . Lambda. Puissance. <,0001. 35,776. 1,000. Diff. crit.. DEPLETION, ND / AUTRE. -1,661. 2,457. DEPLETION, POTOMANIE. -5,409. 2,077. Valeur p ,1844 <,0001 S. ,650. 1,466. ,3834. DEPLETION, SURCHARGE. 1,273. 1,696. ,1406. ND / AUTRE, POTOMANIE. -3,748. 3,019. ,0152 S. ND / AUTRE, SIADH. 2,311. 2,637. ,0857. ND / AUTRE, SURCHARGE. 2,933. 2,771. ,0381 S. POTOMANIE, SIADH. 6,059. 2,287. <,0001 S. POTOMANIE, SURCHARGE. 6,682. 2,440. <,0001 S. ,623. 1,948. SIADH, SURCHARGE. . Valeur de p. 8,944. Diff. moy.. DEPLETION, SIADH. . Valeur de F. ,5295. .

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