Hypernatraemia in critically ill patients: too little water and too much salt

Hoorn, Ewout J.; Betjes, Michiel G. H.; Weigel, Joachim; Zietse, Robert

doi:10.1093/ndt/gfm831

Cited by 171 publications

(200 citation statements)

References 30 publications

Supporting

Mentioning

173

Contrasting

Unclassified

Order By: Relevance

“…En la literatura se ha descrito que esta asociación se debe a que en las etapas tardías de la sepsis se provoca un déficit de la hormona antidiurética mientras que en la IRA existe una mala capacidad de concentrar la orina (3)(4)(5). Sin embargo, al analizar estos datos mediante regresión logística binaria, las variables no tuvieron significancia estadística en el modelo final sostenible de asociación con hipernatremia y una de ellas, la IRA, mostró ser una variable de confusión con el uso de diuréticos, que sí mostró valor significativo por sí misma.…”

Section: Discussionunclassified

“…En el 2007, Lidner et al, describieron en una Unidad de Cuidados Intensivos, que la presencia de la hipernatremia se asoció con una mayor mortalidad (entre el 39 y 43%) en relación a los pacientes que no la tuvieron (24%) (2), observación totalmente coincidente con otros estudios anteriores y posteriores que describen igualmente letalidad alrededor del 33,5% en pacientes con hipernatremia contra 7,7% de pacientes con valores normales de sodio sérico, concluyendo que la hipernatremia es un factor de independiente de riesgo de muerte intrahospitalaria (OR 1,97, p<0,001) (3)(4)(5).…”

Section: Introductionunclassified

See 1 more Smart Citation

Factores asociados a la incidencia de hipernatremia intrahospitalaria en pacientes adultos de un servicio de Medicina de Lima, Perú

Zevallos¹,

Barbat²,

Soriano³

2017

Rev Med Hered

View full text Add to dashboard Cite

RESUMENObjetivos: Identificar las variables asociadas con la hipernatremia en pacientes adultos hospitalizados en el servicio de Medicina de un hospital general de Lima, Perú. Material y métodos: Estudio modelo de casos y controles de pacientes hospitalizados en el servicio de Medicina del Hospital Cayetano Heredia en el año 2013. Se calculó un tamaño de muestra de 65 casos y 65 controles para obtener un OR de 3 con una potencia del 80% y una confianza del 95%, apareados por época de hospitalización y Score Glasgow. Resultados: El análisis final de regresión logística binaria mostró que la hipernatremia estuvo asociada a la fiebre (p=0,013), la taquipnea (p=0,030), el nivel de conciencia (p=0,032), el uso de diuréticos (p=0,017), la presencia de diarrea (p=0,045) y el uso de soluciones hipertónicas (p=0,000). La falla aguda renal y la sepsis mostraron asociación en el análisis univariado pero no en el análisis de regresión logística binaria. Conclusiones: Este estudio mostró que la fiebre, la taquipnea, el nivel de conciencia, uso de diuréticos, diarrea y uso de soluciones hipertónicas fueron las relevantes para el desarrollo de hipernatremia adquirida en el hospital.PALABRAS CLAVE: Hipernatremia, hospitalización, soluciones hipertónicas, diuréticos. (Fuente: DeCS BIREME). SUMMARY Objectives:To identify variables associated with hypernatremia in adult patients admitted in an internal medicine service in a general hospital in Lima, Peru. Methods: Case-control study of patients admitted in the Internal Medicine service of Hospital Cayetano Heredia during 2013. A sample size of 65 cases and controls, matched by date of admission and Glasgow coma scale, to obtain an OR of 3 with 80% power and 95% confidence was estimated. Results: Hypernatremia was associated with fever (p=0.013); tachypnea (p=0.030); level of consciousness (p=0.032); use of diuretics (p=0.017); presence of diarrhea (p=0.045) and use of hypertonic solutions (p<0.0001). Acute renal failure and sepsis showed association in the univariate analysis but not in the logistic regression analysis. Conclusions: This study showed that fever, tachypnea, level of consciousness, use of diuretics, diarrhea and use of hypertonic solutions were relevant to develop hospital-acquired hypernatremia.

show abstract

Section: Discussionunclassified

Section: Introductionunclassified

Factores asociados a la incidencia de hipernatremia intrahospitalaria en pacientes adultos de un servicio de Medicina de Lima, Perú

Zevallos¹,

Barbat²,

Soriano³

2017

Rev Med Hered

View full text Add to dashboard Cite

show abstract

“…Niedobór wazopresyny występuje u ⅓ pacjentów w późnych fazach sepsy oraz wstrząsu septycznego i stanowi niezależny czynnik prognostyczny zwiększonej śmiertelności na OIT [32]. Niewykluczone, że SAE może prowadzić do zaburzeń funkcjonowania regionalnego w mózgowiu, zwłaszcza w podwzgórzu i przysadce, które regulują równo-wagę wodną i elektrolitową.…”

Section: Zaburzenia Metaboliczne I Elektrolitoweunclassified

Encefalopatia septyczna a majaczenie stanu ciężkiego

Kotfis

2018

Pomeranian J Life Sci

View full text Add to dashboard Cite

Introduction: Sepsis-associated encephalopathy is an acute dysfunction of the central nervous system (CNS) that arises as a consequence of generalized systemic infection, yet without brain infection. The aim of this review is to introduce septic encephalopathy as a disease, with all of the epidemiology data, diagnostic opportunities, pathophysiology and possible treatment. Sepsis-associated encephalopathy is a medical condition characterized by a broad spectrum of disturbances of consciousness, from delirium to coma, with possible seizures or focal neurological signs. Many pathophysiological mechanisms lie at the basis of septic encephalopathy, including inflammation or dysfunction of cerebral perfusion. Another important mechanism includes interactions between inflammatory cytokines and acetylcholine that lead to abnormal cholinergic transmission and neuronal death. Moreover, interaction between acetylcholine and inflammatory cytokines may induce immunosuppression. Sepsis-associated encephalopathy diagnosis is strictly clinical, based on neurological examination and the exclusion of other causes, because there are no definite biochemical tests or radiological studies specific for this disease. The use of ICU delirium screening tools, such as CAM-ICU (Confusion Assessment Method for the Intensive Care Unit) enables earlier detection of brain dysfunction. Neuroimaging studies (computed tomography, magnetic resonance imaging), as well as electroencephalograhy may be helpful in the assessment of the severity of dysfunction. The most important element is early diagnosis of sepsis, especially with the use of the QuickSOFA scale, and early initiation of multidirectional treatment according to Surviving Sepsis Campaign guidelines: early source identification and source control, initiation of optimal antibiotic therapy, adequate fluid therapy and supportive treatment for major organs. In order to prevent CNS dysfunction in the ICU, deep sedation and benzodiazepines should be avoided and dexmedetomidine and propofol introduced instead. Pharmacological treatment of ICU delirium is based on the use of typical (haloperidol) and atypical (i.e. quetiapine) antipsychotics. Non-pharmacological methods include early mobilization, ensuring day and night cycles, the minimalization of noctural factors (light, sounds, interventions), and family engagement. Conclusion: Sepsis-associated encephalopathy is a serious illness associated with severe consequences, including increased mortality, long-term cognitive dysfunction, and immunosuppression. The co-dependence between septic encephalopathy and the immune system should be underlined in the approach towards sepsis treatment. Keywords: sepsis associated encephalopathy; sepsis; ICU delirium; CAM-ICU; cognitive dysfunction. ABSTRAKT Wstęp:Encefalopatia septyczna (sepsis-associated encephalopathy -SAE) jest ostrym zaburzeniem funkcjonowania ośrodko-wego układu nerwowego (OUN), które pojawia się w następstwie infekcji ogólnoustrojowej, jednak bez infekcji samego mózgu. Celem ninie...

show abstract

“…65 Similar to hyponatremia, a diagnosis of hypernatremia has been associated with an increased risk for hospital death. 64,65,[67][68][69] However, it may be difficult to separate the contribution to mortality of hypernatremia alone from that of the underlying disease process and overall illness severity. Nonetheless, mortality has been shown higher for critically ill patients with hypernatremia (serum [Na ? ]…”

Section: Hypernatremiamentioning

confidence: 99%

“…64 In addition, Polderman et al 66 showed that the risk of hospital death was higher for patients with hospital-acquired hypernatremia than for patients with hypernatremia present at the time of admission to the intensive care unit (32% vs. 20%, respectively, P \ 0.001). Recently, Hoorn et al 68 showed hypernatremia (serum [Na ? ] C 150 mmol l -1 ) was independently associated with higher mortality (48% vs. 10%, P \ 0.001).…”

Section: Hypernatremiamentioning

confidence: 99%

Les troubles de l’équilibre hydrosodé chez les patients hospitalisés

Bagshaw

Townsend

McDermid

2008

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose To review and discuss the epidemiology, contributing factors, and approach to clinical management of disorders of sodium and water balance in hospitalized patients. Source An electronic search of the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases and a search of the bibliographies of all relevant studies and review articles for recent reports on hyponatremia and hypernatremia with a focus on critically ill patients. Principal findings Disorders of sodium and water balance are exceedingly common in hospitalized patients, particularly those with critical illness and are often iatrogenic. These disorders are broadly categorized as hypo-osmolar or hyper-osmolar, depending on the balance (i.e., excess or deficit) of total body water relative to total body sodium content and are classically recognized as either hyponatremia or hypernatremia. These disorders may represent a surrogate for increased neurohormonal activation, organ dysfunction, worsening severity of illness, or progression of underlying chronic disease. Hyponatremic disorders may be caused by appropriately elevated (volume depletion) or inappropriately elevated (SIADH) arginine vasopressin levels, appropriately suppressed arginine vasopressin levels (kidney dysfunction), or alterations in plasma osmolality (drugs or body cavity irrigation with hypotonic solutions). Hypernatremia is most commonly due to unreplaced hypotonic water depletion (impaired mental status and/or access to free water), but it may also be caused by transient water shift into cells (from convulsive seizures) and iatrogenic sodium loading (from salt intake or administration of hypertonic solutions). Conclusion In hospitalized patients, hyponatremia and hypernatremia are often iatrogenic and may contribute to serious morbidity and increased risk of death. These disorders require timely recognition and can often be reversed with appropriate intervention and treatment of underlying predisposing factors.

show abstract

Hypernatraemia in critically ill patients: too little water and too much salt

Cited by 171 publications

References 30 publications

Factores asociados a la incidencia de hipernatremia intrahospitalaria en pacientes adultos de un servicio de Medicina de Lima, Perú

Factores asociados a la incidencia de hipernatremia intrahospitalaria en pacientes adultos de un servicio de Medicina de Lima, Perú

Encefalopatia septyczna a majaczenie stanu ciężkiego

Les troubles de l’équilibre hydrosodé chez les patients hospitalisés

Contact Info

Product

Resources

About