The Development of Intensive Care Unit Acquired Hypernatremia Is Not Explained by Sodium Overload or Water Deficit: A Retrospective Cohort Study on Water Balance and Sodium Handling
Background. ICU acquired hypernatremia (IAH, serum sodium concentration (sNa) ≥ 143 mmol/L) is mainly considered iatrogenic, induced by sodium overload and water deficit. Main goal of the current paper was to answer the following questions: Can the development of IAH indeed be explained by sodium in...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2016-01-01
|
| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2016/9571583 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849401134022656000 |
|---|---|
| author | M. C. O. van IJzendoorn H. Buter W. P. Kingma G. J. Navis E. C. Boerma |
| author_facet | M. C. O. van IJzendoorn H. Buter W. P. Kingma G. J. Navis E. C. Boerma |
| author_sort | M. C. O. van IJzendoorn |
| collection | DOAJ |
| description | Background. ICU acquired hypernatremia (IAH, serum sodium concentration (sNa) ≥ 143 mmol/L) is mainly considered iatrogenic, induced by sodium overload and water deficit. Main goal of the current paper was to answer the following questions: Can the development of IAH indeed be explained by sodium intake and water balance? Or can it be explained by renal cation excretion? Methods. Two retrospective studies were conducted: a balance study in 97 ICU patients with and without IAH and a survey on renal cation excretion in 115 patients with IAH. Results. Sodium intake within the first 48 hours of ICU admission was 12.5 [9.3–17.5] g in patients without IAH (n=50) and 15.8 [9–21.9] g in patients with IAH (n=47), p=0.13. Fluid balance was 2.3 [1–3.7] L and 2.5 [0.8–4.2] L, respectively, p=0.77. Urine cation excretion (urine Na + K) was < sNa in 99 out of 115 patients with IAH. Severity of illness was the only independent variable predicting development of IAH and low cation excretion, respectively. Conclusion. IAH is not explained by sodium intake or fluid balance. Patients with IAH are characterized by low urine cation excretion, despite positive fluid balances. The current paradigm does not seem to explain IAH to the full extent and warrants further studies on sodium handling in ICU patients. |
| format | Article |
| id | doaj-art-8a616b3126b34c7abd7f1092fc40bf86 |
| institution | Kabale University |
| issn | 2090-1305 2090-1313 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Critical Care Research and Practice |
| spelling | doaj-art-8a616b3126b34c7abd7f1092fc40bf862025-08-20T03:37:50ZengWileyCritical Care Research and Practice2090-13052090-13132016-01-01201610.1155/2016/95715839571583The Development of Intensive Care Unit Acquired Hypernatremia Is Not Explained by Sodium Overload or Water Deficit: A Retrospective Cohort Study on Water Balance and Sodium HandlingM. C. O. van IJzendoorn0H. Buter1W. P. Kingma2G. J. Navis3E. C. Boerma4Department of Intensive Care, Medical Centre Leeuwarden, P.O. Box 888, 8901 BK Leeuwarden, NetherlandsDepartment of Intensive Care, Medical Centre Leeuwarden, P.O. Box 888, 8901 BK Leeuwarden, NetherlandsDepartment of Intensive Care, Medical Centre Leeuwarden, P.O. Box 888, 8901 BK Leeuwarden, NetherlandsDepartment of Internal Medicine, University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, NetherlandsDepartment of Intensive Care, Medical Centre Leeuwarden, P.O. Box 888, 8901 BK Leeuwarden, NetherlandsBackground. ICU acquired hypernatremia (IAH, serum sodium concentration (sNa) ≥ 143 mmol/L) is mainly considered iatrogenic, induced by sodium overload and water deficit. Main goal of the current paper was to answer the following questions: Can the development of IAH indeed be explained by sodium intake and water balance? Or can it be explained by renal cation excretion? Methods. Two retrospective studies were conducted: a balance study in 97 ICU patients with and without IAH and a survey on renal cation excretion in 115 patients with IAH. Results. Sodium intake within the first 48 hours of ICU admission was 12.5 [9.3–17.5] g in patients without IAH (n=50) and 15.8 [9–21.9] g in patients with IAH (n=47), p=0.13. Fluid balance was 2.3 [1–3.7] L and 2.5 [0.8–4.2] L, respectively, p=0.77. Urine cation excretion (urine Na + K) was < sNa in 99 out of 115 patients with IAH. Severity of illness was the only independent variable predicting development of IAH and low cation excretion, respectively. Conclusion. IAH is not explained by sodium intake or fluid balance. Patients with IAH are characterized by low urine cation excretion, despite positive fluid balances. The current paradigm does not seem to explain IAH to the full extent and warrants further studies on sodium handling in ICU patients.http://dx.doi.org/10.1155/2016/9571583 |
| spellingShingle | M. C. O. van IJzendoorn H. Buter W. P. Kingma G. J. Navis E. C. Boerma The Development of Intensive Care Unit Acquired Hypernatremia Is Not Explained by Sodium Overload or Water Deficit: A Retrospective Cohort Study on Water Balance and Sodium Handling Critical Care Research and Practice |
| title | The Development of Intensive Care Unit Acquired Hypernatremia Is Not Explained by Sodium Overload or Water Deficit: A Retrospective Cohort Study on Water Balance and Sodium Handling |
| title_full | The Development of Intensive Care Unit Acquired Hypernatremia Is Not Explained by Sodium Overload or Water Deficit: A Retrospective Cohort Study on Water Balance and Sodium Handling |
| title_fullStr | The Development of Intensive Care Unit Acquired Hypernatremia Is Not Explained by Sodium Overload or Water Deficit: A Retrospective Cohort Study on Water Balance and Sodium Handling |
| title_full_unstemmed | The Development of Intensive Care Unit Acquired Hypernatremia Is Not Explained by Sodium Overload or Water Deficit: A Retrospective Cohort Study on Water Balance and Sodium Handling |
| title_short | The Development of Intensive Care Unit Acquired Hypernatremia Is Not Explained by Sodium Overload or Water Deficit: A Retrospective Cohort Study on Water Balance and Sodium Handling |
| title_sort | development of intensive care unit acquired hypernatremia is not explained by sodium overload or water deficit a retrospective cohort study on water balance and sodium handling |
| url | http://dx.doi.org/10.1155/2016/9571583 |
| work_keys_str_mv | AT mcovanijzendoorn thedevelopmentofintensivecareunitacquiredhypernatremiaisnotexplainedbysodiumoverloadorwaterdeficitaretrospectivecohortstudyonwaterbalanceandsodiumhandling AT hbuter thedevelopmentofintensivecareunitacquiredhypernatremiaisnotexplainedbysodiumoverloadorwaterdeficitaretrospectivecohortstudyonwaterbalanceandsodiumhandling AT wpkingma thedevelopmentofintensivecareunitacquiredhypernatremiaisnotexplainedbysodiumoverloadorwaterdeficitaretrospectivecohortstudyonwaterbalanceandsodiumhandling AT gjnavis thedevelopmentofintensivecareunitacquiredhypernatremiaisnotexplainedbysodiumoverloadorwaterdeficitaretrospectivecohortstudyonwaterbalanceandsodiumhandling AT ecboerma thedevelopmentofintensivecareunitacquiredhypernatremiaisnotexplainedbysodiumoverloadorwaterdeficitaretrospectivecohortstudyonwaterbalanceandsodiumhandling AT mcovanijzendoorn developmentofintensivecareunitacquiredhypernatremiaisnotexplainedbysodiumoverloadorwaterdeficitaretrospectivecohortstudyonwaterbalanceandsodiumhandling AT hbuter developmentofintensivecareunitacquiredhypernatremiaisnotexplainedbysodiumoverloadorwaterdeficitaretrospectivecohortstudyonwaterbalanceandsodiumhandling AT wpkingma developmentofintensivecareunitacquiredhypernatremiaisnotexplainedbysodiumoverloadorwaterdeficitaretrospectivecohortstudyonwaterbalanceandsodiumhandling AT gjnavis developmentofintensivecareunitacquiredhypernatremiaisnotexplainedbysodiumoverloadorwaterdeficitaretrospectivecohortstudyonwaterbalanceandsodiumhandling AT ecboerma developmentofintensivecareunitacquiredhypernatremiaisnotexplainedbysodiumoverloadorwaterdeficitaretrospectivecohortstudyonwaterbalanceandsodiumhandling |