Body salt and water balances in cardiothoracic surgery patients with intensive care unit–acquired hyponatremia

Stieglmair, Sandra; Lindner, Gregor; Lassnigg, Andrea; Mouhieddine, M.; Hiesmayr, Michael; Schwarz, Christoph

doi:10.1016/j.jcrc.2013.05.017

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…Of these, net volume balance was the only variable of significance in multivariate analysis. This result is in agreement with the study by Steiglmair et al showing that positive fluid balance was a single reason of ICU-acquired hyponatremia in 25% of cardiothoracic surgery patients [13]. Interestingly, although not proven in multivariate analysis, use of sodium bicarbonate, which is an established risk factor of hypernatremia, was associated with ICU-acquired hyponatremia [12].…”

Section: Discussionsupporting

confidence: 92%

“…There are diverse criteria to define ICU-acquired hyponatremia in regard to reference sodium concentration, number of hyponatremia events, and timeframe for its onset [10,13,14]. In this study, we defined ICUacquired hyponatremia as new-onset hyponatremia ([Na + ] < 135 mmol/L) in patients whose sodium concentration was within the normal range (135 mmol/L ≤ [Na + ] ≤ 145 mmol/L) at the time of ICU admission.…”

Section: Icu-acquired Hyponatremiamentioning

confidence: 99%

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Intensive care unit-acquired hyponatremia in critically ill medical patients

Sim

et al. 2020

J Transl Med

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Background: Previous research has focused on intensive care unit (ICU)-acquired hypernatremia; however, ICUacquired hyponatremia has frequently been overlooked and has rarely been studied in surgical or mixed ICUs. The aim of this study is to investigate the incidence of ICU-acquired hyponatremia, the risk factors associated with its development, and its impact on outcomes in critically ill medical patients. Methods: We conducted a retrospective cohort study based on the prospective registry of all critically ill patients admitted to the medical ICU from January 2015 to December 2018. Baseline characteristics and management variables were compared between ICU-acquired hyponatremia and normonatremia patients. Results: Of 1342 patients with initial normonatremia, ICU-acquired hyponatremia developed in 217 (16.2%) patients and ICU-acquired hypernatremia developed in 117 (8.7%) patients. The Sequential Organ Failure Assessment (8.0 vs 7.0, P = 0.009) and Simplified Acute Physiology Score 3 scores (55.0 vs 51.0, P = 0.005) were higher in ICU-acquired hyponatremia patients compared with normonatremia patients. Baseline sodium (137.0 mmol/L vs 139.0 mmol/L, P < 0.001), potassium (4.2 mmol/L vs 4.0 mmol/L, P = 0.001), and creatinine (0.98 mg/dL vs 0.88 mg/dL, P = 0.034) levels were different between the two groups. Net volume balance over first 3 days was higher in ICU-acquired hyponatremia patients (19.4 mL/kg vs 11.5 mL/kg, P = 0.004) and was associated with the development of ICU-acquired hyponatremia (adjusted odds ratio, 1.004; 95% confidence interval, 1.002-1.007; P = 0.001). ICU mortality was similar in both groups (15.2% vs. 14.4%, P = 0.751), but renal replacement therapy was more commonly required in ICUacquired hyponatremia patients (13.4% vs 7.4%, P = 0.007). Conclusions: ICU-acquired hyponatremia is not uncommon in critically ill medical patients. Increased volume balance is associated with its development. ICU-acquired hyponatremia is related to increased use of renal replacement therapy but not to mortality.

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Section: Discussionsupporting

confidence: 92%

Section: Icu-acquired Hyponatremiamentioning

confidence: 99%

Intensive care unit-acquired hyponatremia in critically ill medical patients

Sim

et al. 2020

J Transl Med

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“…The key concept derived from the Edelman report states that a change in [Na] S is mathematically the result of a change, in the same direction, of the fraction (TBNa + TBK)/TBW. Clinical reports addressing various aspects of hyponatremia, including specific categories (34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49), general reviews (50-57), and treatment (58)(59)(60)(61), focus their analyses on combinations of losses or gains of TBNa, TBK, and TBW that decrease the fraction (TBNa + TBK)/TBW. Similarly, reports analyzing the pathogenesis and treatment of hypernatremia focus on combinations of losses or gains that increase the fraction (TBNa + TBK)/TBW (62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72).…”

Section: Clinical Reportsmentioning

confidence: 99%

Edelman Revisited: Concepts, Achievements, and Challenges

et al. 2022

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The key message from the 1958 Edelman study states that combinations of external gains or losses of sodium, potassium and water leading to an increase of the fraction (total body sodium plus total body potassium) over total body water will raise the serum sodium concentration ([Na]S), while external gains or losses leading to a decrease in this fraction will lower [Na]S. A variety of studies have supported this concept and current quantitative methods for correcting dysnatremias, including formulas calculating the volume of saline needed for a change in [Na]S are based on it. Not accounting for external losses of sodium, potassium and water during treatment and faulty values for body water inserted in the formulas predicting the change in [Na]S affect the accuracy of these formulas. Newly described factors potentially affecting the change in [Na]S during treatment of dysnatremias include the following: (a) exchanges during development or correction of dysnatremias between osmotically inactive sodium stored in tissues and osmotically active sodium in solution in body fluids; (b) chemical binding of part of body water to macromolecules which would decrease the amount of body water available for osmotic exchanges; and (c) genetic influences on the determination of sodium concentration in body fluids. The effects of these newer developments on the methods of treatment of dysnatremias are not well-established and will need extensive studying. Currently, monitoring of serum sodium concentration remains a critical step during treatment of dysnatremias.

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“…This is important due to the previously shown fact that dysnatremias are often iatrogenic consequences of inadequate infusion therapy in critically ill patients. [4]…”

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confidence: 99%