Factors associated with mortality in patients presenting to the emergency department with severe hypernatremia

Abstract

Hypernatremia is a common electrolyte disorder associated with prolonged hospitalization and death. Severe hypernatremia is defined as a serum sodium (Na(+)) concentration >160 mmol/L. To the best of our knowledge, there is little information on patients with severe hypernatremia, Na(+) >160 mmol/L. Therefore, in this study, we aimed to determine the frequency, demographic and clinical characteristics, comorbid conditions and treatment strategies in patients presenting to the emergency department with severe hypernatremia, and also to evaluate the effects of these factors on mortality. A retrospective chart review was performed on patients presenting to the emergency department between January 2011 and June 2014. Patients with Na(+) >160 mmol/L were screened retrospectively via the hospital electronic information management system and patient medical record files. During the 3.5 years of screening, 256 patients (0.04 %) with Na(+) >160 mmol/L presented to the emergency department. The mean age of the patients included in the study was 74.4 ± 15.2 years, mean Na(+) level was 168.7 ± 7.4 mmol/L and, mean mortality was 49.5 % during the hospitalization. Multivariable Cox regression analysis showed that low systolic blood pressure, low pH, Na(+) >166 mmol/L, increased plasma osmolarity, mean sodium reduction rate ≤-0.134 mmol/L/h, dehydration, and, pneumonia to be independently associated with mortality. This study describes the demographic and clinical characteristics of patients with Na(+) >160 mmol/L in a large population along with comorbid conditions, incidence, treatment strategies and, its association with mortality.

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

“…In the largest cohort published to date to determine the effect of hypernatremia correction rate in critically ill patients (11)(12)(13), we found that rapid correction of both admission and hospital-acquired hypernatremia occurred in a third of patients, and that rapid correction .0.5 mmol/L per hour or .12 mmol/L per day was not associated with in-hospital mortality or cerebral edema. In fact, there were no cases of cerebral edema in the 78 patients who had serum sodium correction of .12 mmol/L per day.…”

“…However, the data to support this rate of correction is negligible (9). The studies in adults with hypernatremia showed that rapid sodium correction rates associated with less mortality (11,13). Alshayeb et al (12) and Ates et al (13) used .0.134 and $0.25 mmol/L per hour as a rapid hypernatremia correction rates, respectively.…”

“…Although prior literature has documented the association of cerebral edema and rapid hypernatremia correction in children, the literature in adults is scant (9,10). Contrary to the literature in children, two studies in adults demonstrated that excessively slow rates of correction are associated with a higher risk of mortality and those with a greater reduction rate of sodium had less mortality (11)(12)(13). Thus, the outcomes associated with hypernatremia correction rate in hospitalized adults are unclear.…”

Could sodium imbalances predispose to postoperative venous thromboembolism? An analysis of the NSQIP database

“…Similar to hyponatremia, hypernatremia was associated with increased mortality in patients undergoing percutaneous endoscopic gastrostomy [ 39 ], cardiothoracic surgery [ 40 ], or cardiac transplantation; in hip fracture patients [ 31 ]; in patients with chronic kidney disease [ 25 ]; in critically ill patients [ 41 – 43 ]; and in patients with traumatic brain injuries [ 33 , 44 ]. The reported mortality rate varies greatly, ranging from as low as 5.2% to as high as 82% [ 45 – 54 ]. This discrepancy is mainly due to data from elderly patients [ 46 , 47 , 49 , 50 ] and on which cutoff value is used to define hypernatremia [ 51 – 54 ].…”

“…The reported mortality rate varies greatly, ranging from as low as 5.2% to as high as 82% [ 45 – 54 ]. This discrepancy is mainly due to data from elderly patients [ 46 , 47 , 49 , 50 ] and on which cutoff value is used to define hypernatremia [ 51 – 54 ]. However, using a study population similar to ours, Leung et al reported hypernatremia in 2.2% of surgical patients compared with 1% in our population and a mortality rate of 5.2%, which is close to our 9.16% mortality rate [ 12 ].…”