Dysnatraemias in the emergency room: Undetected, untreated, unknown?

Abstract

Dysnatraemias are present in almost 1 in 5 patients who presented to the emergency department. Contrarily to patients who are already hospitalized, hypernatraemia was by far more common than hyponatraemia in patients at the emergency department. Surprisingly, patients with hyponatraemia were significantly older than normonatraemic patients while there was no age difference in hypernatraemic patients. Dysnatraemias are common in the emergency room and further studies are indicated to evaluate the causes and the impact on outcome of patients.

Undercorrection of hypernatremia is frequent and associated with mortality

“…However, unlike in-hospital acquired hypernatremia, most patients with hypernatremia at hospital admission receive initial treatment in the ED. To our knowledge, very few studies have reported on presentation, management and outcome of severely hypernatremic patients upon their arrival to the hospital (Table 5) [1,2,18]. Arampatzis et al reported hypernatremia >145 mmol/L in 0.9% of patients admitted toED and 1.5% of patients with natremia dosing, and severe hypernatremia ≥150 mmol/L in 0.1% of admissions and 0.2% of patients with natremia dosing, which is similar to our results.…”

“…Such patients often have various underlying pathologies implicated in hypernatremia occurrence [1]. In most cases, treatment of hypernatremia is started at ED, but there have been only two reports on the characteristics, symptoms, treatments, and outcomes of severely hypernatremic patients at ED [1,2]. …”

Factors Affecting Mortality in Elderly Patients Hospitalized for Nonmalignant Reasons

“…Hyponatremia and hypernatremia are among the most frequently encountered electrolyte disorders in hospitalized patients and are associated with increased mortality [23]. In a study in which sodium concentration was measured in 3182 patients (mean age, 53 ± 21 years) admitted to the emergency room, hyponatremia and hypernatremia were determined at the rates of 4% and 13%, respectively, and the patients with hyponatremia were reported to be older [24]. In another study, hyponatremia was determined in 14.5% of 98411 adult hospitalized patients, hyponatremic patients were reported to be older and to have more comorbidity, and hyponatremia was found to be associated with increased in-hospital mortality [25].…”

Addition of sodium criterion to SOAR stroke score

“…10 Indeed, both hypoand hypernatraemia have been shown to increase inpatient mortality in various settings including intensive care units and emergency departments. 10 Indeed, both hypoand hypernatraemia have been shown to increase inpatient mortality in various settings including intensive care units and emergency departments.…”

“…Dysnatremia, either hypo-or hypernatraemia, is the commonest electrolyte abnormality in hospitalized patients. 10 Indeed, both hypoand hypernatraemia have been shown to increase inpatient mortality in various settings including intensive care units and emergency departments. [10][11][12] Recently, studies have established that hyponatremia increases both short-and long-term mortality in stroke patients.…”