Hypernatremia in the Critically Ill Is an Independent Risk Factor for Mortality

Lindner, Gregor; Funk, Georg‐Christian; Schwarz, Christoph; Kneidinger, Nikolaus; Kaider, Alexandra; Schneeweiß, Bruno; Kramer, Ludwig; Druml, Wilfred

doi:10.1053/j.ajkd.2007.08.016

Cited by 255 publications

(246 citation statements)

References 16 publications

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“…14,15 Nevertheless, sustained hypernatremia may be deleterious by exacerbating cerebral edema, particularly in areas where the blood-brain barrier is disrupted. 16 Furthermore, hypernatremia itself is a known risk factor for mortality in critically ill patients, 17,18 including those with TBI. 12,19,20 Commentators have expressed concerns regarding the use of HTS as a continuous infusion citing the lack of clinical evidence and the potential for harm.…”

Section: Résumémentioning

confidence: 99%

The effect of continuous hypertonic saline infusion and hypernatremia on mortality in patients with severe traumatic brain injury: a retrospective cohort study

Tan

Kolmodin

Sekhon

et al. 2016

Can J Anesth/J Can Anesth

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Purpose Hypertonic saline (HTS) is used to control intracranial pressure (ICP) in patients with traumatic brain injury (TBI); however, in prior studies, the resultant hypernatremia has been associated with increased mortality. We aimed to study the effect of HTS on ICP and mortality in patients with severe TBI. Methods We performed a retrospective cohort study of 231 patients with severe TBI ( [CI], 0.56 to 2.05; P = 0.84) nor hypernatremia (HR, 1.31; 95% CI, 0.68 to 2.55; P = 0.42) was associated with hospital mortality. There was no effect modification by either HTS or hypernatremia on each another. Patients who received HTS observed a significant decrease in ICP during their ICU stay compared with those who did not receive HTS (4 mmHg; 95% CI, 2 to 6; P \ 0.001 vs 2 mmHg; 95% CI, -1 to 5; P = 0.14). Conclusions Hypertonic saline and hypernatremia are not associated with hospital mortality in patients with severe TBI. RésuméObjectif Une solution saline hypertonique (HTS) est utilisée pour contrô ler la pression intracrânienne (PIC) chez les patients ayant subi un traumatisme cérébral (TC); toutefois, dans des études précédentes, l'hypernatrémie

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Section: Résumémentioning

confidence: 99%

The effect of continuous hypertonic saline infusion and hypernatremia on mortality in patients with severe traumatic brain injury: a retrospective cohort study

Tan

Kolmodin

Sekhon

et al. 2016

Can J Anesth/J Can Anesth

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“…Hipernatremia factor de riesgo independiente de mortalidad, empeora el pronóstico 17,[27][28][29][30][31] .…”

Section: Tercer Paso: Clasificación De Los Estados Poliúricosunclassified

Enfoque práctico para el diagnóstico y tratamiento de los estados poliúricos en pacientes con injuria cerebral aguda

et al. 2013

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com.ar L a prevalencia de los estados poliúricos en sujetos con injuria cerebral aguda es desconocida, pudiendo presentarse como consecuencia del daño neurológico per se o por la terapéutica adoptada 1-4 . Poliurias pueden tener impacto negativo sobre el cerebro injuriado, a través de hipovolemia, hipotensión arterial y cambios en la osmolaridad. Implica un verdadero reto diagnóstico-terapéutico 5,6 ; por ello, un rápido reconocimiento y adecuado análisis, permitirá instaurar la conducta más apropiada. Los estados poliúricos están relacionados con desequilibrios hidroelectrolíticos, (principalmente del contenido de sodio) y trastornos de la osmolaridad 7-10 , situaciones que contribuyen a agravar y perpetuar el daño inicial 11 . Este trabajo pretende en forma práctica y sencilla aportar un enfoque que nos permita reconocer los estados poliúricos, identificar sus causas y analizar la manera más adecuada de tratarlos. Primer paso: ¿cómo definimos poliuria?Poliuria deriva del griego "poly" (mucho); ouro (orina) 12 . Se define de diferentes maneras: a) > 3.000 cc diarios; b) > 150 ml/h; c) > 3 ml/kg/h, o d) diuresis mayor a 10 ml/min [5][6][7][8][9][10] . Sus causas son variadas al igual que su duración, pudiendo estar ocasionadas por la injuria cerebral o por intervenciones terapéuticas: reposiciones de volumen, utilización de agentes osmóticos (manitol, salino hipertónico), diuréticos, nutrición parenteral.

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“…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%

Les troubles de l’équilibre hydrosodé chez les patients hospitalisés

Bagshaw

Townsend

McDermid

2008

Can J Anesth/J Can Anesth

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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.

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Hypernatremia in the Critically Ill Is an Independent Risk Factor for Mortality

Cited by 255 publications

References 16 publications

The effect of continuous hypertonic saline infusion and hypernatremia on mortality in patients with severe traumatic brain injury: a retrospective cohort study

The effect of continuous hypertonic saline infusion and hypernatremia on mortality in patients with severe traumatic brain injury: a retrospective cohort study

Enfoque práctico para el diagnóstico y tratamiento de los estados poliúricos en pacientes con injuria cerebral aguda

Les troubles de l’équilibre hydrosodé chez les patients hospitalisés

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