Dysnatremia in the ICU

Pokaharel, Milap; Block, Clay A.

doi:10.1097/mcc.0b013e32834cd388

Cited by 64 publications

(52 citation statements)

References 57 publications

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“…As serum sodium concentration is finely maintained by renal salt and water regulation [9][10][11][12], it is plausible that critically ill patients presenting with AKI or acute-on-chronic AKI (AoCKI) may have an inadequate sodium and water control, presenting higher prevalence of dysnatremia [2][3][4][13][14][15][16][17][18][19][20][21][22][23]. However, the prevalence of dysnatremia in critically ill patients with AKI in need of dialysis and its possible association with outcomes in this population have not been completely elucidated.…”

Section: Introductionmentioning

confidence: 99%

Predialysis hypernatremia is a prognostic marker in acute kidney injury in need of renal replacement therapy

Mendes

Soares

Valente

et al. 2015

Journal of Critical Care

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Section: Introductionmentioning

confidence: 99%

Predialysis hypernatremia is a prognostic marker in acute kidney injury in need of renal replacement therapy

Mendes

Soares

Valente

et al. 2015

Journal of Critical Care

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“…Dysnatremia, a disorder of sodium concentration, is common not only in critically ill patients but also hospitalized patients, and it confers increased risk for adverse outcomes [1]. The prevalence of dysnatremia in the intensive care unit (ICU) ranges from 6.9 to 17.7%, and varies according to the time of onset, the threshold for diagnosis, and the population being assessed [2].…”

Section: Introductionmentioning

confidence: 99%

Dysnatremia is an Independent Indicator of Mortality in Hospitalized Patients

Wang

Geng

et al. 2017

Med Sci Monit

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BackgroundDysnatremia is a risk factor for poor outcomes. We aimed to describe the prevalence and outcomes of various dysnatremia in hospitalized patients. High-risk patients must be identified to improve the prognosis of dysnatremia.Material/MethodsThis prospective study included all adult patients admitted consecutively to a university hospital between October 1, 2014 and September 30, 2015.ResultAll 90 889 patients were included in this study. According to the serum sodium levels during hospitalization, the incidence of hyponatremia and hypernatremia was 16.8% and 1.9%, respectively. Mixed dysnatremia, which was defined when both hyponatremia and hypernatremia happened in the same patient during hospitalization, took place in 0.3% of patients. The incidence of dysnatremia was different in various underlying diseases. Multiple logistic regression analyses showed that all kinds of dysnatremia were independently associated with hospital mortality. The following dysnatremias were strong predictors of hospital mortality: mixed dysnatremia (OR 22.344, 95% CI 15.709–31.783, P=0.000), hypernatremia (OR 13.387, 95% CI 10.642–16.840, P=0.000), and especially hospital-acquired (OR 16.216, 95% CI 12.588–20.888, P=0.000) and persistent (OR 22.983, 95% CI 17.554–30.092, P=0.000) hypernatremia. Hyponatremia was also a risk factor for hospital mortality (OR 2.225, 95% CI 1.857–2.667). However, the OR increased to 56.884 (95% CI 35.098–92.193) if hyponatremia was over-corrected to hypernatremia.ConclusionsDysnatremia was independently associated with poor outcomes. Hospital-acquired and persistent hypernatremia were strong risk factors for hospital mortality. Effective prevention and proper correction of dysnatremia in high-risk patients may reduce the hospital mortality.

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“…CVVH with a gradient of sodium replacement fluid may be advantageous in this setting and may achieve the desired rate of correction (33). However, one-third of the patients had an RRSeNa > 1 mEq/L/h.…”

Section: Discussionmentioning

confidence: 93%