Prevalence of Hyponatremia and Its Associated Morbimortality in Hospitalized Patients Receiving Parenteral Nutrition

Abstract

Background: The objective of the study was to determine the prevalence of hyponatremia (HN) and its associated morbimortality in hospitalized patients receiving parenteral nutrition (PN). Methods: A retrospective study including 222 patients receiving total PN (parenteral nutrition group [PNG]) over a 7-month period in a tertiary hospital and 176 matched to 179 control subjects without PN (control subjects group [CSG]). Demographicdata, Charlson Comorbidity Index (CCI), date of HN detection-(serum sodium or SNa <135 mmol/L)-intrahospital mortality, and hospital length-of-stay (LOS) were registered. In the PNG, body mass index (BMI) and SNa before, during, and after PN were recorded. Results: HN was more prevalent in the PNG: 52.8 vs. 35.8% (p = 0.001), and independent of age, gender, or CCI (OR 1.8 [95% CI 1.1-2.8], p = 0.006). In patients on PN, sustained HN (75% of all intraindividual SNa <135 mmol/L) was associated with a higher mortality rate independent of age, gender, CCI, or BMI (OR 7.38 [95% CI 1.07-50.8], p = 0.042). The absence of HN in PN patients was associated with a shorter hospital LOS (<30 days) and was independent of other comorbidities (OR 3.89 [95% CI 2.11-7.18], p = 0.001). Conclusions: HN is more prevalent in patients on PN. Sustained HN is associated with a higher intrahospital mortality rate. Absence of HN is associated with a shorter hospital LOS.

Prevalence of hyponatremia among older inpatients in a general hospital

“…Early studies confirmed that hyponatremia is the most likely cause of deterioration and increased mortality associated with various internal environmental disorders [ 12 , 13 , 35 , 36 ]. In a study of 53,236 hospitalized patients, Wald et al noted reduced survival rates and prolonged hospitalization times among patients with CAH and HAH [ 35 ].…”

“…Winzeler et al found that serum sodium was positively correlated with mortality, and serum sodium < 125 mmol/L was significantly correlated with 1-year mortality, recurrence rate of hyponatremia, and readmission rate [ 12 ]. Gomez-Hoyos et al found that hyponatremia is associated with increased mortality and morbidity [ 13 ]. However, there is still some debate over how much of the increased risk of death is directly attributable to hyponatraemia, and how much is due to under-lying disease.…”

Hyponatremia: Prevalence and characteristics in internal medicine patients in northeast of China

“…[1] P-Na is also associated with increased mortality and morbidity. [2] It is uncertain however as to whether patients with P-Na tend to be elderly and whether the mortality risk is related to the degree of P-Na. [3,4]…”

Comment on: Sailer C, et al. Primary polydipsia in the medical and psychiatric patient: characteristics, complications and therapy

“…Sailer and colleagues mentioned malnutrition as a known risk factor for hyponatraemia. Generally speaking, hyponatraemia is often found in conditions associated with lower food intake (e.g., in patients with tumours, alcoholism, anorexia nervosa, very advanced age, or in intensive care units) [4], and is more prevalent in patients on parenteral nutrition [5]. It should thus not be surprising that patients with hyponatraemia often exhibit additional electrolyte abnormalities unrelated to the arginine vasopressin secretion (e.g., hypophosphataemia, hypokalaemia, or hypomagnesaemia) [6].…”