Undercorrection of hypernatremia is frequent and associated with mortality

Stanislas Bataille, Camille Baralla, Dominique Torro, Christophe Buffat, Yvon Berland, Marc Alazia, Anderson Loundou, Pierre Michelet, Henri Vacher-Coponat, Stanislas Bataille, Camille Baralla, Dominique Torro, Christophe Buffat, Yvon Berland, Marc Alazia, Anderson Loundou, Pierre Michelet, Henri Vacher-Coponat

Abstract

Background: About 1% of patients admitted to the Emergency Department (ED) have hypernatremia, a condition associated with a mortality rate of 20 to 60%. Management recommendations originate from intensive care unit studies, in which patients and medical diseases differ from those in ED.

Methods: We retrospectively studied clinical characteristics, treatments, and outcomes of severely hypernatremic patients in the ED and risk factors associated with death occurrence during hospitalization.

Results: During 2010, 85 cases of severe hypernatremia ≥ 150 mmol/l were admitted to ED. Hypernatremia occurred in frail patients: mean age 79.7 years, 55% institutionalized, 28% with dementia.Twenty four percent of patients died during hospitalization. Male gender and low mean blood pressure (MBP) were independently associated with death, as well as slow natremia correction speed, but not the severity of hyperosmolarity at admission. Infusion solute was inappropriate for 45% of patients with MBP <70 mmHg who received hypotonic solutes and 22% of patients with MBP ≥ 70 mmHg who received isotonic solutes or were not perfused.

Conclusions: This is the first study assessing outcome of hypernatremic patients in the ED according to the treatment provided. It appears that not only a too quick, but also a too slow correction speed is associated with an increased risk of death regardless of initial natremia. Medical management of hypernatremic patients must be improved regarding evaluation and treatment.

Figures

Figure 1
Figure 1
Clinical and biological features of hypernatremic patients. A. Natremia at admission and outcomes of hypernatremic patients. B. Renal function at admission. Renal function at admission was measured using estimated glomerular filtration rate (eGFR) estimated by Modification of Diet in Renal Disease formula (23). C. Month of occurrence of hypernatremia.

References

    1. Arampatzis S, Exadaktylos A, Buhl D, Zimmermann H, Lindner G. Dysnatraemias in the emergency room: Undetected, untreated, unknown? Wien Klin Wochenschr. 2012;124(5–6):181–183.
    1. Arampatzis S, Frauchiger B, Fiedler GM, Leichtle AB, Buhl D, Schwarz C, Funk GC, Zimmermann H, Exadaktylos AK, Lindner G. Characteristics, symptoms, and outcome of severe dysnatremias present on hospital admission. Am J Med. 2012;125(11):1125.
    1. Adrogue HJ, Madias NE. Primary care: hypernatremia. N Engl J Med. 2000;342(20):1493–1499. doi: 10.1056/NEJM200005183422006.
    1. Fall PJ. Hyponatraemia and Hypernatremia (a systemic approach to causes and their correction) Postgrad Med. 2000;107(5):75–82.
    1. Oufella H, Offenstadt G. Troubles de l’équilibre acido-basique et désordres hydro-électrolytiques. La revue du praticien. 2003;53:883–892.
    1. Tareen N, Martins D, Nagami G, Levine B, Norris KC. Sodium disorders in the elderly. J Nat Med Association. 2005;97(2):217–224.
    1. Robertson GL. Thirst and vasopressin function in normal and disordered states of water balance. J Lab Clin Med. 1983;101(3):351–369.
    1. Lindner G, Funk GC. Hypernatremia in critically ill patients. J Crit Care. 2013;28(2):216.e11-20.
    1. Adrogue HJ, Madias NE. Aiding fluids prescription for the dysnatrémies. Intensive Care Med. 1997;23:309–316. doi: 10.1007/s001340050333.
    1. Halperin LM, Cherney DZI, Adrogue HJ, Madias NE. Hypernatremia. N Engl J Med. 2000;343(11):817–818.
    1. Lindner G, Schwarz C, Kneidinger N, Kramer L, Oberbauer R, Druml W. Can we really predict the change in serum sodium levels? An analysis of currently proposed formulae in hypernatraemic patients. Nephrol Dial Transplant. 2008;23(11):3501–3508. doi: 10.1093/ndt/gfn476.
    1. Barsoum NR, Levine BS. Current prescriptions for the correction of hyponatremia and hypernatremia: are they too simple? Nephrol Dial Transplant. 2002;17:1176–1180. doi: 10.1093/ndt/17.7.1176.
    1. Snyder NA, Feigal DW, Arieff AI. Hypernatremia in elderly patients: a heterogeneous, morbid, and iatrogenic entity. Ann Intern Med. 1987;107:309–319. doi: 10.7326/0003-4819-107-2-309.
    1. Palevsky PM, Bhagrath R, Greenberg A. Hypernatremia in hospitalized patients. Ann Inter Med. 1996;124:197–203. doi: 10.7326/0003-4819-124-2-199601150-00002.
    1. Funk GC, Lindner G, Druml W, Metnitz B, Schwarz C, Bauer P, Metnitz PG. Incidence and prognosis of dysnatremias present on ICU admission. Intensive Care Med. 2010;36(2):304–311. doi: 10.1007/s00134-009-1692-0.
    1. Stelfox HT, Ahmed SB, Khandwala F, Zygun D, Shahpori R, Laupland K. The epidemiology of intensive care unit-acquired hyponatraemia and hypernatraemia in medical-surgical intensive care units. Crit Care. 2008;12(6):R162. doi: 10.1186/cc7162. doi:10.1186/cc7162.
    1. Levey AS, Bosch JP, Breyer Lewis J, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med. 1999;130:461–470. doi: 10.7326/0003-4819-130-6-199903160-00002.
    1. Liamis G, Tsimihodimos V, Doumas M, Spyrou A, Bairaktari E, Elisaf M. Clinical and laboratory characteristics of hypernatremia in an internal medicine clinic. Nephro Dial Transplant. 2008;23:136–143.
    1. Chassagne P, Druesne L, Capet C, Ménard JF, Bercoff E. Clinical presentation of hypernatremia in elderly patients: a case control study. J Am Geriatr Soc. 2006;54(8):1225–1230. doi: 10.1111/j.1532-5415.2006.00807.x.
    1. Hausfater P, Mégarbane B, Fabricatore L, Dautheville S, Patzak A, Andronikof M, Santin A, Kierzek G, Doumenc B, Leroy C, Manamani J, Peviriéri F, Riou B. Serum sodium abnormalities during nonexertional heatstroke: incidence and prognostic values. Am J Emerg Med. 2012;30(5):741–748. doi: 10.1016/j.ajem.2011.05.020.
    1. Al-Absi A, Gosmanova EO, Wall BM. A clinical approach to the treatment of chronic hypernatremia. Am J Kidney Dis. 2012;60(6):1032–1038. doi: 10.1053/j.ajkd.2012.06.025.
    1. Himmelstein DU, Jones AA, Woolhandler S. Hypernatremic dehydration in nursing home patients: an indicator of neglect. J Am Geriatr Soc. 1983;31(8):466–471.
    1. Davis RE, Rossier CE, Enfield KB. The impact of weather on influenza and pneumonia mortality in New York City, 1975–2002: a retrospective study. PLoS One. 2012;7(3):e34091. doi: 10.1371/journal.pone.0034091.
    1. Lindner G, Funk GC, Schwarz C, Kneidinger N, Kaider A, Schneeweiss B, Kramer L, Druml W. Hypernatremia in the critically ill is an independent risk factor for mortality. Am J Kidney Dis. 2007;50(6):952–957. doi: 10.1053/j.ajkd.2007.08.016.
    1. Ayus JC, Achinger SG, Arieff A. Brain cell volume regulation in hyponatremia: role of sex, age, vasopressin, and hypoxia. Am J Physiol Renal Physiol. 2008;295(3):F619–F624. doi: 10.1152/ajprenal.00502.2007.

Source: PubMed

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