Incidence, étiologies et facteurs pronostiques de l'hyponatrémie en réanimation

Bennani, Souhail; Abouqal, Rédouane; Zeggwagh, A.A.; Madani, N.; Abidi, Kamel; Zekraoui, A.; Kerkeb, O.

doi:10.1016/s0248-8663(02)00811-1

Cited by 107 publications

(34 citation statements)

References 17 publications

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“…Dysnatremia is a common finding at ICU admission [1-3]. Abnormal serum sodium concentrations are known to adversely affect physiologic function and an increasing body of evidence suggests that dysnatremia may be associated with adverse outcome [1-4].…”

Section: Introductionmentioning

confidence: 99%

“…Abnormal serum sodium concentrations are known to adversely affect physiologic function and an increasing body of evidence suggests that dysnatremia may be associated with adverse outcome [1-4]. Critically ill patients are particularly exposed to dysnatremia due to the nature of the disease leading to ICU admission and to lack of free access to water [2,4,5].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, another one-third of critically ill patients will develop an ICU-acquired dysnatremia during ICU stay [4,6]. Prevalence of dysnatremia at ICU admission, however, varies greatly according to the chosen definition [1,2,7,8]. …”

Section: Introductionmentioning

confidence: 99%

“…Serum sodium concentration is closely regulated and physiological serum sodium concentration ranges between 138 and 142 mmol per liter [9] whereas abnormal serum concentration are usually defined as serum sodium lower than 135 or higher than 145 mmol per liter [2]. Most of the studies performed to date chose to focus on severe dysnatremia [1,5,7,10]. Recently, Funk and colleagues demonstrated influence of dysnatremia at ICU admission to be independently associated with outcome [2].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change

Darmon

Diconne

Souweine³

et al. 2013

Crit Care

120

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IntroductionTo assess the prevalence of dysnatremia, including borderline changes in serum sodium concentration, and to estimate the impact of these dysnatremia on mortality after adjustment for confounders.MethodsObservational study on a prospective database fed by 13 intensive care units (ICUs). Unselected patients with ICU stay longer than 48 h were enrolled over a 14-year period were included in this study. Mild to severe hyponatremia were defined as serum sodium concentration < 135, < 130, and < 125 mmol/L respectively. Mild to severe hypernatremia were defined as serum sodium concentration > 145, > 150, and > 155 mmol/L respectively. Borderline hyponatremia and hypernatremia were defined as serum sodium concentration between 135 and 137 mmol/L or 143 and 145 respectively.ResultsA total of 11,125 patients were included in this study. Among these patients, 3,047 (27.4%) had mild to severe hyponatremia at ICU admission, 2,258 (20.3%) had borderline hyponatremia at ICU admission, 1,078 (9.7%) had borderline hypernatremia and 877 (7.9%) had mild to severe hypernatremia. After adjustment for confounder, both moderate and severe hyponatremia (subdistribution hazard ratio (sHR) 1.82, 95% CI 1.002 to 1.395 and 1.27, 95% CI 1.01 to 1.60 respectively) were associated with day-30 mortality. Similarly, mild, moderate and severe hypernatremia (sHR 1.34, 95% CI 1.14 to 1.57; 1.51, 95% CI 1.15 to 1.99; and 2.64, 95% CI 2.00 to 3.81 respectively) were independently associated with day-30 mortality.ConclusionsOne-third of critically ill patients had a mild to moderate dysnatremia at ICU admission. Dysnatremia, including mild changes in serum sodium concentration, is an independent risk factor for hospital mortality and should not be neglected.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change

Darmon

Diconne

Souweine³

et al. 2013

Crit Care

120

View full text Add to dashboard Cite

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“…Hyponatremia and hypernatremia are the most common electrolyte disorders in hospitalized patients [1,2] and have been associated with excess mortality [3,4,5]. Pathophysiology leading to hypo- or hypernatremia is complex which makes it difficult for physicians to identify the mechanisms underlying the development of dysnatremias.…”

Section: Introductionmentioning

confidence: 99%

Electrolyte-Free Water Clearance versus Modified Electrolyte-Free Water Clearance: Do the Results Justify the Effort

Lindner

Schwarz

2012

Nephron Physiol

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Background: Calculation of electrolyte-free water clearance (EFWC) allows for quantification of renal losses of free water and was shown to be helpful in the differential diagnosis of dysnatremias and might help in the correction of the electrolyte disorders. A modified EFWC formula (MEFWC) was described to be more accurate than the conventional one; however, it has never been evaluated clinically. Methods: In order to evaluate the performance of MEFWC compared to EFWC under clinical circumstances, we gathered data from a total of 912 patient days of 138 critically ill patients. EFWC and MEFWC were calculated on the basis of these data. Additionally, from data of critically ill patients, we calculated a prediction of serum sodium based on the Edelman equation using either EFWC or MEFWC and compared results. Results: Altogether, 343 normonatremic, 124 hyponatremic and 445 hypernatremic days were analyzed. Results for EFWC and MEFWC correlated significantly (R = 0.98). In patients with hyponatremia, the absolute difference between EFWC and MEFWC was significantly larger than in patients with normonatremia (437 vs. 256 ml, p < 0.01). The absolute difference between EFWC and MEFWC correlated significantly with the level of serum sodium (R = –0.41). The mean difference in the prediction of serum sodium change as calculated based on the Edelman equation between the formula using EFWC and the formula using MEFWC was 0.7 mmol/l (SD 0.68) and was highest in hyponatremia and lowest in hypernatremia. Conclusion: Results of EFWC and MEFWC were comparable in critically ill patients. Under normal circumstances, the use of the more complicated MEFWC is not justified. In hyponatremia, the difference between EFWC and MEFWC is larger and thus might justify the use of the more complicated formula.

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Managing hyponatremia in patients with syndrome of inappropriate antidiuretic hormone secretion

Verbalis

2010

Journal of Hospital Medicine

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This review will address the management of hyponatremia caused by the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in hospitalized patients. To do so requires an understanding of the pathogenesis and diagnosis of SIADH, as well as currently available treatment options. The review will be structured as responses to a series of questions, followed by a presentation of an algorithm for determining the most appropriate treatments for individual patients with SIADH based on their presenting symptoms. Journal of Hospital Medicine 2010;5:S18-S26. V C 2010 Society of Hospital Medicine. Why is SIADH Important to Hospitalists?Disorders of body fluids, and particularly hyponatremia, are among the most commonly encountered problems in clinical medicine, affecting up to 30% of hospitalized patients. In a study of 303,577 laboratory samples collected from 120,137 patients, the prevalence of hyponatremia (serum [Na þ ] <135 mmol/L) on initial presentation to a healthcare provider was 28.2% among those treated in an acute hospital care setting, 21% among those treated in an ambulatory hospital care setting, and 7.2% in community care centers. 1 Numerous other studies have corroborated a high prevalence of hyponatremia in hospitalized patients, 2 which reflects the increased vulnerability of this patient population to disruptions of body fluid homeostasis. Recognizing the many possible causes of hyponatremia in hospitalized patients and implementing appropriate treatment strategies therefore are critical steps toward optimizing care and improving outcomes in hospitalized patients with hyponatremia.In addition to its frequency, hyponatremia is also important because it has been associated with worse clinical outcomes across the entire range of inpatient care, from the general hospital population to those treated in the intensive care unit (ICU). In a study of 4123 patients age 65 years or older who were admitted to a community hospital, 3.5% had clinically significant hyponatremia (serum [Na þ ] <130 mmol/L) at admission. Compared with nonhyponatremic patients, those with hyponatremia were twice as likely to die during their hospital stay (relative risk [RR], 1.95; P < 0.05). 3 In another study of 2188 patients admitted to a medical ICU over a 5-year period, 13.7% had hyponatremia. The overall rate of in-hospital mortality among all ICU patients was high at 37.7%. However, severe hyponatremia (serum [Na þ ] <125 mmol/L) more than doubled the risk of in-hospital mortality (RR, 2.10; P < 0.001). 4 In addition to the general hospital population, in virtually every disease ever studied, the presence of hyponatremia has been found to be an independent risk factor for increased mortality, from congestive heart failure to tuberculosis to liver failure. 2 What Causes Hyponatremia in Patients with SIADH?Hyponatremia can be caused by 1 of 2 potential disruptions in fluid balance: dilution from retained water, or depletion from electrolyte losses in excess of water. Dilutional hyponatremias are associated with either a ...

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Incidence, étiologies et facteurs pronostiques de l'hyponatrémie en réanimation

Cited by 107 publications

References 17 publications

Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change

Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change

Electrolyte-Free Water Clearance versus Modified Electrolyte-Free Water Clearance: Do the Results Justify the Effort

Managing hyponatremia in patients with syndrome of inappropriate antidiuretic hormone secretion

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