Hypernatremia at presentation to the emergency department: a case series

Abstract

Disorders of serum sodium are common findings in patients presenting to the emergency department (ED). The aim of this study was to systematically investigate the prevalence, symptoms, etiology, treatment as well as the course of hypernatremia present on admission to the ED. All adult patients with measurements of serum sodium presenting to the ED between 01 January 2017 and 31 December 2020 were included in this retrospective cohort study. Chart reviews were performed for all patients with hypernatremia defined as serum sodium > 147 mmol/L. 376 patients (0.7%) had a serum sodium > 145 mmol/L on admission and 109 patients (0.2%) had clinically relevant hypernatremia > 147 mmol/L. Main symptoms included somnolence (42%) followed by disorientation (30%) and recent falls (17%). An impaired sense of thirst was the main cause of hypernatremia as present in 76 patients (70%), followed by a lack of free access to water in 50 patients (46%). Regarding treatment, only one patient received targeted oral hydration and 38 patients (35%) experienced inadequate correction of hypernatremia as defined as either a correction of < 2 mmol/L or further increasing sodium during the first 24 h. 25% of patients with hypernatremia died during the course of their hospital stay. Patients who died had significantly lower correction rates of serum sodium (0 mmol/L (−3 − 1.5) versus − 6 mmol/L (−10 − 0), p < 0.001). Hypernatremia is regularly encountered in the ED and patients present with unspecific neurologic symptoms. Initial treatment and correction of hypernatremia are frequently inadequate with no decrease or even increase in serum sodium during the first 24 h.

Studi Kasus: Pertolongan Pertama Kegawatdaruratan pada Suspek Hipernatremia di Rumah

“…Partisipan ternyata diketahui juga memiliki hipersensitivitas terhadap celery sebab 15 menit setelah konsumsi 300 ml jus celery, partisipan menunjukkan tanda sesak napas, dada berdebar, takikardia dan merasa lelah. Adanya keluhan ini menjadi kewaspadaan bahwa partisipan dicurigai mengalami hipernatremia (Ravioli et al, 2022).…”

Diagnostic and prognostic efficacy of optic nerve sheath diameter in patients with dysnatremia

“…Therefore, it is commonly seen in older patients and in those with mental or physical disorders. Risk factors for hypernatremia include diseases that disrupt thermoregulation, increased fluid loss, excessive salt intake, and disorders such as diabetes insipidus [4,5]. Previous studies have reported that dysnatremia is an indicator of mortality and morbidity in critically ill patients [6,7].…”

Systemic and iatrogenic factors contribute to the development of severe hypernatraemia in vulnerable inpatients

“…Delayed recognition and treatment of hypernatraemia is reported to be associated with increased mortality 15,16 . Even when recognised, inadequate correction of hypernatraemia has also been reported 17 . Concerningly, while hypernatraemia is present in approximately 0.2% of patients on presentation to hospital, it has been documented in up to 1% of hospitalised patients at any point during admission suggesting that a significant proportion of patients develop hypernatraemia while under medical care 13,15,16 …”

“…15,16 Even when recognised, inadequate correction of hypernatraemia has also been reported. 17 Concerningly, while hypernatraemia is present in approximately 0.2% of patients on presentation to hospital, it has been documented in up to 1% of hospitalised patients at any point during admission suggesting that a significant proportion of patients develop hypernatraemia while under medical care. 13,15,16 We have defined severe hypernatraemia as a sodium concentration ≥ 155 mmol/L, in line with previously published studies.…”