Where there is sodium there may be sepsis

Abstract

Hypernatremia affects up to 9% of critically ill patients upon hospital admission, especially in elderly patients with thirst impairment. However, hypernatremia is not entirely explained by fluid imbalance. Recent studies suggest that sodium is an important enhancer of the immune system, raising the question of whether inflammatory states such as sepsis may contribute to hypernatremia. Although sepsis patients with hypernatremia face a greater mortality rate, there is a lack of studies examining a potential association between hypernatremia and sepsis. Motivated by the frequent concurrence of hypernatremia and sepsis observed at an eastern Pennsylvanian community hospital, the current study was conducted to evaluate whether hypernatremia on admission may serve as a potential surrogate marker for sepsis. The medical records of 153 patients with hypernatremia on admission (serum sodium > 145mEq/L) were retrospectively analyzed. The mean age of patients was 81.1. Sepsis was observed in 77.1% of patients, of which 86.2% had dementia. This study demonstrated a positive correlation between hypernatremia on admission and the presence of sepsis. We suggest that the existence of hypernatremia should prompt clinicians to further investigate for sources of infection, especially in the elderly and patients with dementia.

Clinical characteristics and predictors of mortality associated with COVID-19 in elderly patients from a long-term care facility

“…Instead, of note, hypernatremia has been reported as a factor significantly associated with mortality in a small (n = 25) cohort of patients suffering from severe acute respiratory syndrome (SARS) and ARDS 17 . Hypernatremia has been identified as a potential surrogate marker of sepsis, especially in elderly because a severe systemic infection can lead to a significant free water deficit and subsequent hypernatremia 18 . In addition, some evidence also suggests that sodium could represent an important promoter of immune response, improving the function of macrophages and T-lymphocytes 19 .…”

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

“…In some studies, around 50% of patients who present to hospital with community-acquired hypernatremia had dementia [ 9 , 20 ]. One study noted a statistically significant ordinal relationship between the severity of hypernatremia and the proportion of patients with dementia in hospitalized patients, with a mean age of 81 years: mild hypernatremia (76%), moderate hypernatremia (83%), and severe hypernatremia (98%) [ 21 ]. Thus, it was possible that patient selection may have biased both the mortality rate and tests for the association of dementia with hypernatremia progression in our study.…”

Characteristics, outcome and predictors of in-hospital mortality in an elderly population from a SARS-CoV-2 outbreak in a long-term care facility

“…Instead, of note, hypernatremia has been reported as a factor significantly associated with mortality in a small (n=25) cohort of patients suffering from severe acute respiratory syndrome (SARS) and ARDS [21]. Hypernatremia has been identified as a potential surrogate marker of sepsis, especially in elderly because a severe systemic infection can lead to a significant free water deficit and subsequent hypernatremia [22]. In addition, some evidence also suggests that sodium could represent an important promoter of immune response, improving the function of macrophages and T-lymphocytes [23].…”