Progression to Severe Hypernatremia in Hospitalized General Medicine Inpatients: An Observational Study of Hospital-Acquired Hypernatremia

Abstract

Background and objectives: Hypernatremia can be community or hospital-acquired, and there may be specific factors unique to the hospital environment, such as intravenous fluid treatment, which contribute to hypernatremia. The aim of this study was to determine the factors associated with the progression from moderate to severe hospital-acquired hypernatremia among patients admitted under general medicine. Materials and Methods: In this retrospective, single-center cohort study (2012 to 2017), we used ICD-10 coding and medical records to identify adult patients who developed moderate hypernatremia and followed them for progression to severe hypernatremia. We profiled the serum biochemistry and the volume and composition of prescribed intravenous fluids. We applied logistic regression to determine the factors associated with the progression to severe hypernatremia, using the patients with moderate hypernatremia as reference. Results: Of the 180 medical inpatients (median age of 81 years) with moderate hospital-acquired hypernatremia, 9.4% progressed to severe hypernatremia. Normal saline comprised 76% of intravenous fluid volume administered prior to onset of moderate hypernatremia. After the onset, 38% of fluid volume prescribed remained normal saline. The factors independently associated with progression to severe hypernatremia included chronic kidney disease stage (odds ratio 2.38, 95% CI: 1.26–4.50, P = 0.008) and serum creatinine increase (per 10 µmol/L, OR 1.29, 95% CI: 1.07–1.57, P = 0.009). Conclusions: Patients with chronic kidney disease and acute kidney injury may have an increased risk of severe hospital-acquired hypernatremia.

Outcomes of Hospital-Acquired Hypernatremia

“…This report confirms previous observations relating hospital-acquired hypernatremia and its severity to mortality in hospitalized patients 1,4,7,10,11 and extends previous research by examining discharge dispositions. Our findings for increment of in-hospital mortality along with the increase in the severity of hypernatremia are similar to other studies.…”

“…4–7 Outcomes of hypernatremia have also been less studied, and most studies examined selected patient populations. 1,4,8–10 In addition, there are limited studies regarding hospital-acquired hypernatremia 11 and patients' kidney function at admission.…”

Nomogram Prediction Model of Hypernatremia on Mortality in Critically Ill Patients

“… 47 Studies have found that the increase of serum creatinine was closely related to the progression of severe hypernatremia. 35 At the time of hypernatremia, patients are usually still being treated with normal saline, which may worsen the hypernatremia. 12 However, we also recognized that there were many reasons for elevated serum creatinine that might not be explained.…”

“…10,[30][31][32][33][34] A study found that the hospital mortality rate of patients with hospital-acquired hypernatremia was 29%. 35 However, it is unclear whether hypernatremia directly reduces survival or whether it is a surrogate marker for more severe disease states.…”

Hipernatremija Intensyviojoje Terapijoje

“…Padidėjęs laisvo vandens netekimas sukelia hipernatremiją. Karščiavimas yra dažnas veiksnys, kuris paskatina hipovoleminės hipernatremijos atsiradimą [2,3,6]. Viduriavimas -kita priežastis, dėl kurios prarandamas hipotoninis vanduo.…”