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

Abstract

Background and objectivesHypernatremia is common in hospitalized, critically ill patients. Although there are no clear guidelines on sodium correction rate for hypernatremia, some studies suggest a reduction rate not to exceed 0.5 mmol/L per hour. However, the data supporting this recommendation and the optimal rate of hypernatremia correction in hospitalized adults are unclear.Design, setting, participants, & measurementsWe assessed the association of hypernatremia correction rates with neurologic outcomes and mortality in critically ill patients with hypernatremia at admission and those that developed hypernatremia during hospitalization. We used data from the Medical Information Mart for Intensive Care-III and identified patients with hypernatremia (serum sodium level >155 mmol/L) on admission (n=122) and hospital-acquired (n=327). We calculated different ranges of rapid correction rates (>0.5 mmol/L per hour overall and >8, >10, and >12 mmol/L per 24 hours) and utilized logistic regression to generate adjusted odds ratios (aOR) with 95% confidence intervals (95% CIs) to examine association with outcomes.ResultsWe had complete data on 122 patients with severe hypernatremia on admission and 327 patients who developed hospital-acquired hypernatremia. The difference in in-hospital 30-day mortality proportion between rapid (>0.5 mmol/L per hour) and slower (≤0.5 mmol/L per hour) correction rates were not significant either in patients with hypernatremia at admission with rapid versus slow correction (25% versus 28%; P=0.80) or in patients with hospital-acquired hypernatremia with rapid versus slow correction (44% versus 40%; P=0.50). There was no difference in aOR of mortality for rapid versus slow correction in either admission (aOR, 1.3; 95% CI, 0.5 to 3.7) or hospital-acquired hypernatremia (aOR, 1.3; 95% CI, 0.8 to 2.3). Manual chart review of all suspected chronic hypernatremia patients, which included all 122 with hypernatremia at admission, 128 of the 327 hospital-acquired hypernatremia, and an additional 28 patients with ICD-9 codes for cerebral edema, seizures and/or alteration of consciousness, did not reveal a single case of cerebral edema attributable to rapid hyprnatremia correction.ConclusionsWe did not find any evidence that rapid correction of hypernatremia is associated with a higher risk for mortality, seizure, alteration of consciousness, and/or cerebral edema in critically ill adult patients with either admission or hospital-acquired hypernatremia.

Progression to Severe Hypernatremia in Hospitalized General Medicine Inpatients: An Observational Study of Hospital-Acquired Hypernatremia

“…It is also possible that a fear of overly rapid correction of hypernatremia may explain why normal saline comprised 40% of the volume of fluids in patients with moderate hypernatremia in our study. The rate of correction is still debated but could have been quicker when there was an acute onset [ 19 ].…”

Extremely Severe Hypernatremia Caused by Wrong Belief in a Patient with Cervical Cancer

“…Second, the generally accepted treatment principle of hypernatremia may not be applicable to adults. In a recent study of more than 100 adult patients, although hypernatremia was corrected at a rate of 0.5 mEq/ L per hour or more (0.6-1.4 mEq/L per hour), no neurological complication such as seizure or brain edema occurred regardless of chronicity of the onset 13) . This study suggests that the reason why significant neurological complications do not occur even though hypernatremia is rapidly corrected in adult patients may be due to differences in brain capacity between adults and children.…”

Predictive Factors and Microbial Spectrum for Infectious Complications after Hepatectomy with Cholangiojejunostomy in Perihilar Cholangiocarcinoma

“…Hypernatremia creates cellular dehydration and promotes peripheral insulin resistance, aggravating metabolic and immune disturbances, which might be the mechanism of development and exacerbation of infection [42,43]. Although the rate of hypernatremia relief still is controversial [44,45], it is suggested that patients can benefit from early identification and correction of post-operative hypernatremia as described in previous papers.…”