Clinical Investigation
Severe Hypernatremia Correction RateMortality in Hospitalized Patients

https://doi.org/10.1097/MAJ.0b013e31820a3a90Get rights and content

Abstract

Introduction

Hypernatremia is a common problem in hospitalized patients and is associated with high morbidity and mortality. This study was designed to evaluate whether physicians follow the recommended guidelines for the rate of correction of hypernatremia of ≤ 0.5 mEq/L/hr and to evaluate the effect of the rate of correction of severe hypernatremia on the mortality of hospitalized patients.

Methods

A retrospective chart review of 131 consecutively hospitalized patients with severe hypernatremia (serum sodium ≥ 155 mEq/L) was performed. Primary outcomes were 30-day patient mortality and 72- hour hypernatremia correction. The first 24-hour serum sodium (Na+) correction rate was tested as a categorical variable; slow rate (< 0.25 mEq/L/hr) and fast rate (≥ 0.25 mEq/L/hr).

Results

The mean admission serum Na+ level was 159 ± 3 mEq/L. Ninety percent of patients received the recommended < 0.5 mEq/L/hr serum Na+ correction rate; however, hypernatremia was corrected only in 27% of patients after 72 hours of treatment. Thirty-day patient mortality rate was 37%. In multivariable analysis, do not resuscitate status [hazards ratio (HR), 3.85; P < 0.0001], slower correction rate of hypernatremia (HR, 2.63; P = 0.02) and high heart rate (> 100 beats/min; HR, 1.99; P = 0.03) were the independent predictors of 30-day mortality.

Conclusion

In patients with severe hypernatremia, the rate of correction of hypernatremia was slow and resulted in inadequate correction in majority of the patients. Both slow rate of hypernatremia correction during the first 24 hours and do not resuscitate status were found to be significant predictors of 30-day patient mortality.

Section snippets

METHODS

This retrospective cohort study used computerized medical records of all patients admitted between January 2004 to December 2006 at the Veterans Affairs Medical Center in Memphis, TN, to identify patients with severe hypernatremia, defined as serum Na+ level > 155 mEq/L. Inclusion criterion for the study was serum Na+ level ≥ 155 mEq/L at least once during admission or hospital stay. Exclusion criteria for the study were systolic blood pressure (SBP) < 90 mm Hg and incomplete data. of the 131

RESULTS

Demographic, clinical and laboratory characteristics of the patients are depicted in Table 1, Table 2. In this cohort of 117 hypernatremic patients, 43 patients (37%) died within 30 days of diagnosis of hypernatremia. Ten patients died within 72 hours of diagnosis. Among the 107 patients who survived 72 hours, serum Na+ concentration returned to normal (< 145 mEq/L) in 29 (27%) patients. Patients whose hypernatremia was corrected within 72 hours were more likely to be managed in ICU (89% versus

DISCUSSION

The goal of management of hypernatremia is to correct the water deficit in a reasonable time frame while avoiding untoward adverse effects associated with treatment. In the current study, hypernatremia was corrected within 72 hours of onset in only 36% of patients. The correction rate was higher (47%) in the study by Palevsky et al.1 Patients included in that study had less severe hypernatremia, as serum Na+ concentration cutoff value for inclusion criteria in that study was lower (≥ 150 mEq/L)

CONCLUSION

In conclusion, this study showed that correction of hypernatremia was slow in patients with severe hypernatremia. The majority of the patients’ serum Na+ concentration in the study remained above the normal range even after 72 hours of treatment. This illustrates the importance of early identification and institution of appropriate treatments for hypernatremia in these patients. The association between the slow rate of hypernatremia correction and 30-day mortality in this study emphasizes the

ACKNOWLEDGMENTS

Arif Showkat acknowledges the guidance and suggestions of Fridtjof Thomas, PhD, for data analysis.

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