Rate of Correction of Hypernatremia and Health Outcomes in Critically Ill Patients

高钠血症 医学 优势比 病危 逻辑回归 置信区间 儿科 重症监护医学 死亡率 重症监护 内科学 急诊医学 有机化学 化学
作者
Kinsuk Chauhan,Pattharawin Pattharanitima,Niralee Patel,Áine Duffy,Aparna Saha,Kumardeep Chaudhary,Neha Debnath,Tielman Van Vleck,Lili Chan,Girish N. Nadkarni,Steven G. Coca
出处
期刊:Clinical Journal of The American Society of Nephrology [American Society of Nephrology]
卷期号:14 (5): 656-663 被引量:69
标识
DOI:10.2215/cjn.10640918
摘要

Background and objectives Hypernatremia is common in hospitalized, critically ill patients. Although there are no clear guidelines on sodium correction rate for hypernatremia, some studies suggest a reduction rate not to exceed 0.5 mmol/L per hour. However, the data supporting this recommendation and the optimal rate of hypernatremia correction in hospitalized adults are unclear. Design, setting, participants, & measurements We assessed the association of hypernatremia correction rates with neurologic outcomes and mortality in critically ill patients with hypernatremia at admission and those that developed hypernatremia during hospitalization. We used data from the Medical Information Mart for Intensive Care-III and identified patients with hypernatremia (serum sodium level >155 mmol/L) on admission ( n =122) and hospital-acquired ( n =327). We calculated different ranges of rapid correction rates (>0.5 mmol/L per hour overall and >8, >10, and >12 mmol/L per 24 hours) and utilized logistic regression to generate adjusted odds ratios (aOR) with 95% confidence intervals (95% CIs) to examine association with outcomes. Results We had complete data on 122 patients with severe hypernatremia on admission and 327 patients who developed hospital-acquired hypernatremia. The difference in in-hospital 30-day mortality proportion between rapid (>0.5 mmol/L per hour) and slower (≤0.5 mmol/L per hour) correction rates were not significant either in patients with hypernatremia at admission with rapid versus slow correction (25% versus 28%; P =0.80) or in patients with hospital-acquired hypernatremia with rapid versus slow correction (44% versus 40%; P =0.50). There was no difference in aOR of mortality for rapid versus slow correction in either admission (aOR, 1.3; 95% CI, 0.5 to 3.7) or hospital-acquired hypernatremia (aOR, 1.3; 95% CI, 0.8 to 2.3). Manual chart review of all suspected chronic hypernatremia patients, which included all 122 with hypernatremia at admission, 128 of the 327 hospital-acquired hypernatremia, and an additional 28 patients with ICD-9 codes for cerebral edema, seizures and/or alteration of consciousness, did not reveal a single case of cerebral edema attributable to rapid hyprnatremia correction. Conclusions We did not find any evidence that rapid correction of hypernatremia is associated with a higher risk for mortality, seizure, alteration of consciousness, and/or cerebral edema in critically ill adult patients with either admission or hospital-acquired hypernatremia.
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