Recommendations for active correction of hypernatremia in volume-resuscitated shock or sepsis patients should be taken with a grain of salt: A systematic review

Quinn, Joseph W.; Sewell, Kerry; Simmons, Dell E.

doi:10.1177/2050312118762043

Cited by 12 publications

(12 citation statements)

References 43 publications

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“…However, there is an inadequate literature to guide an approach to water replacement in this setting. 67 The effectiveness of free water-deficit formulas has been challenged. 68 The development of ICU-acquired hypernatremia has been proposed to be a marker of severity of illness and not related to sodium-containing fluid resuscitation and water balance.…”

Section: Hypernatremiamentioning

confidence: 99%

Management of Endocrine Emergencies in the ICU

Jacobi

2019

Journal of Pharmacy Practice

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Endocrine emergencies are frequent in critically ill patients and may be the cause of admission or can be secondary to other critical illness. The ability to anticipate endocrine abnormalities such as adrenal excess or , hypothyroidism, can mitigate their duration and severity. Hyperglycemic crisis may trigger hospital and intensive care unit (ICU) admission and may be life threatening. Recognition and safe treatment of severe conditions such as acute adrenal insufficiency, thyroid crisis, and hypoglycemia and hyperglycemic crisis may be lifesaving. Electrolyte abnormalities such as hypercalcemia and hypocalcemia may have underlying endocrine causes, and may be treated differently with recognition of those disorders- electrolyte replacement alone may not be adequate for efficient resolution. Sodium disorders are common in the ICU and are generally related to altered water balance however may be related to pituitary abnormalities in selected patients, and recognition may improve treatment effectiveness and safety.

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Section: Hypernatremiamentioning

confidence: 99%

Management of Endocrine Emergencies in the ICU

Jacobi

2019

Journal of Pharmacy Practice

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“…We demonstrate that the change in urinary sodium excretion due to a large volume and salt load corresponded to a pattern that could be in line with the natriuretic ureotelic concept and that this response could be impaired in the pathogenesis of hypernatremia. Regarding therapy of hypernatremia, for which hardly any data exists [18], the lower tonicity of the infusion volume seen in our normonatremic patients could be an interesting factor.…”

mentioning

confidence: 77%

Intensive Care Unit Acquired Hypernatremia after Major Surgery is Associated with Urine Concentrating Defect: An Observational Study

Deetjen

Jaschinski

Heller

2020

Preprint

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Background: Although intensive care acquired hypernatremia is a common event, limited knowledge exists about the pathogenesis of this disorder. The present study attempts to show that patients undergoing major surgery develop hypernatremia in the presence of both high salt and volume load and concentration disorder of the kidney with insufficient sodium excretion.Methods: In a retrospective study, all patients who were admitted to a 40-bed tertiary surgical intensive care unit of a university hospital from July 2019 to December 2019 with major surgery were examined. Hypernatremia was defined as a sodium value exceeding 145 mmol/l. In addition to the analysis of all patients, complete water and salt balances were performed in a smaller subgroup with 142 patients.Results: 23.9% of patients undergoing major surgery developed hypernatremia, whereby hypernatremia was associated with increased mortality. Patients with hypernatremia showed a renal concentration defect with decreased urine sodium concentration (65 (IQR: 44.8-90) mmol/l vs 78 (IQR: 46-107) mmol/l, p = 0.007) and decreased urine osmolality (514 (IQR: 465-605) mmol/l vs 602 (IQR: 467-740) mmol/l, p < 0.001). In the subgroup of patients with complete sodium and water balance, a positive salt and water balance was observed. After propensity score matching, we found a significantly increased electrolyte free water clearance (1020 ±1740 ml vs -560 ±1620 ml, p <0.001) in the hypernatremia group, together with an inadequately lower total sodium urine excretion (401 ±303 mmol vs 593 ±400 mmol, p = 0.02). Conclusion: The present study shows that postoperative hypernatremia is associated with an imbalance between perioperative salt and water load and renal sodium and water handling with inadequately low renal sodium excretion and inadequately high renal water excretion. The underlying renal concentration disorder may be explained by a defect in a natriuretic-ureotelic response a recently described renal urea-mediated water conservation mechanism after salt exposure.

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“…Sodium acts by enhancing the function of macrophages and T-lymphocytes [23]. In fact, a hypernatremic environment may serve as an immunological defense mechanism in inflammatory states such as infection [15]. During skin infections, the concentration of sodium in the skin increases.…”

Section: Discussionmentioning

confidence: 99%

“…Recent evidence shows that serum sodium levels may not be completely explained by fluid balance or sodium intake [14]. Some studies suggest that sodium is intimately tied to the immune system, thus raising the question of whether inflammatory states such as sepsis can play a role in the development of hypernatremia [15]. Although sepsis patients with hypernatremia face a greater mortality rate, there is currently a lack of studies examining the exact relationship between hypernatremia and sepsis [16].…”

Section: Introductionmentioning

confidence: 99%

Where there is sodium there may be sepsis

Freitas

Gudur

Vela-Ortiz

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

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Hypernatremia affects up to 9% of critically ill patients upon hospital admission, especially in elderly patients with thirst impairment. However, hypernatremia is not entirely explained by fluid imbalance. Recent studies suggest that sodium is an important enhancer of the immune system, raising the question of whether inflammatory states such as sepsis may contribute to hypernatremia. Although sepsis patients with hypernatremia face a greater mortality rate, there is a lack of studies examining a potential association between hypernatremia and sepsis. Motivated by the frequent concurrence of hypernatremia and sepsis observed at an eastern Pennsylvanian community hospital, the current study was conducted to evaluate whether hypernatremia on admission may serve as a potential surrogate marker for sepsis. The medical records of 153 patients with hypernatremia on admission (serum sodium > 145mEq/L) were retrospectively analyzed. The mean age of patients was 81.1. Sepsis was observed in 77.1% of patients, of which 86.2% had dementia. This study demonstrated a positive correlation between hypernatremia on admission and the presence of sepsis. We suggest that the existence of hypernatremia should prompt clinicians to further investigate for sources of infection, especially in the elderly and patients with dementia.

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Recommendations for active correction of hypernatremia in volume-resuscitated shock or sepsis patients should be taken with a grain of salt: A systematic review

Cited by 12 publications

References 43 publications

Management of Endocrine Emergencies in the ICU

Management of Endocrine Emergencies in the ICU

Intensive Care Unit Acquired Hypernatremia after Major Surgery is Associated with Urine Concentrating Defect: An Observational Study

Where there is sodium there may be sepsis

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