Clinical InvestigationSevere Hypernatremia Correction RateMortality in Hospitalized Patients
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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2021, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :Hypernatremia is defined31 as serum Na+ concentration >145 mmol/L and is associated with hyperosmolality and cellular dehydration. There is no standardized classification system for severity of hypernatremia,31-36 but as severe symptoms develop at serum Na+ concentrations >160 mmol/L,37 the authors of the present review propose using the classification system in Table 2.31,35,38 Onset, with a duration of <48 hours, is defined as “acute,” and >48 hours is termed “chronic.”31