Profile of Hypernatremia in a Tertiary care hospital: A review of 175 cases over a 5 year period in a South Indian population
Keywords:
Serum sodium, Hypernatremia, Tertiary care hospital, Head injury, Mortality
Abstract
0bjective: The aim of this study was to ascertain the profile of hypernatremia with an emphasis on the prevalence, development, progress and clinical outcomes in hospitalized patients.
Materials and Methods: This study was carried out at a tertiary care centre in south India from March 2011 to march 2016 and included 175 consecutive hospitalized patients who developed hypernatremia during the course of their management.
Results: A total of 5558 patients were admitted as in-patients of which 175 patients developed hypernatremia resulting in a prevalence rate of 3.14%. The majority of patients were males -130 (74.28%) and 57 (32.55%) of the hypernatremic patients were geriatric. The most common disease condition of patients who developed hypernatremia was head injury-37(21.1%) followed by respiratory disease-23(13.1%), sepsis-17(9.7%) and transient hypernatremia-17(9.7%). 21 patients (12%) ended in mortality while the rest 154 (88%) recovered and were discharged from hospital. Patients in the mortality group were found to have higher levels of hypernatremia average- 162 when compared to those that survived 151 (p<0.05).
Conclusion: While there are few reports devoted to hypernatremia in the Indian population, a standardized management protocol needs to be followed and physicians need to focus more on identifying patients who are likely to develop hypernatremia and take step to avoid it by pre-tagging and using preventive measures. This is probably one of the first studies of its kind in a south Indian population and could be an eye opener in the management of hypernatremic patients.
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References
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22. Schwarz C, Leichtle AB, Arampatzis S, Fiedler GM, Zimmermann H, Exadaktylos AK, Lindner G. Thyroid function and serum electrolytes: does an association really exist? Swiss Med Wkly. 2012 Sep 17; 142:w13669. doi: 10.4414/smw.2012.13669.
23. Ma JT, Ho FC, Wang C, Lam KS, Yeung RT. Primary hypothyroidism and essential hypernatremia in a patient with histiocytosis X. Aust N Z J Med. 1985 Feb;15(1):72-4.
24. Sajadi S, Yu C, Sylvestre JD, Looper KJ, Segal M, Rej S. Does lower urine-specific gravity predict decline in renal function and hypernatremia in older adults exposed to psychotropic medications? An exploratory analysis. Clin Kidney J. 2016 Apr;9(2):268-72. doi: 10.1093/ckj/sfv132. Epub 2015 Dec 10.
25. Kovesdy CP. Significance of hypo- and hypernatremia in chronic kidney disease. Nephrol Dial Transplant. 2012 Mar;27(3):891-8. doi: 10.1093/ndt/gfs038.
26. Latcha S, Lubetzky M, Weinstein AM. Severe hyperosmolarity and hypernatremia in an adipsic young woman. Clin Nephrol. 2011 Nov; 76(5):407-11. [PubMed]
27. Varun S, Bhaskar E, Abraham G, Arunkumar AS, Renuka MK. Risk factors for hospital-acquired hypernatremia among critically ill medical patients in a setting utilizing a preventive free water protocol: Do we need to do more? Indian J Crit Care Med. 2013 Jan;17(1):28-33. doi: 10.4103/0972-5229.112157.
28. Palevsky PM, Bhagrath R, Greenberg A. Hypernatremia in hospitalized patients. Ann Intern Med. 1996 Jan 15;124(2):197-203. [PubMed]
29. Leung AA, McAlister FA, Finlayson SR, Bates DW. Preoperative hypernatremia predicts increased perioperative morbidity and mortality. Am J Med. 2013 Oct;126(10):877-86. doi: 10.1016/j.amjmed.2013.02.039. Epub 2013 Aug 1.
30. Polderman KH, Schreuder WO, Strack van Schijndel RJ, Thijs LG. Hypernatremia in the intensive care unit: an indicator of quality of care? Crit Care Med. 1999 Jun;27(6):1105-8.
2. Long CA, Marin P, Bayer AJ, Shetty HG, Pathy MS. Hypernatraemia in an adult in-patient population. Postgrad Med J. 1991 Jul;67(789):643-5.
3. Kumar S, Guleria TC, Nand L, Gupta D, Thakur M. Serum sodium abnormality profile in hospitalized elderly patients in a tertiary care centre from north India: a cross sectional observational study. Int J Res Med Sci 2018; 6(1):321-327.
4. Saroja AO, Naik KR, Mali RV, Kunam SR. 'Wine Glass' sign in recurrent postpartum hypernatremic osmotic cerebral demyelination. Ann Indian Acad Neurol 2013 Jan; 16(1):106-10. doi: 10.4103/0972-2327.107719.
5. Darmon M, Timsit JF, Francais A, Nguile-Makao M, Adrie C, Cohen Y, Garrouste-Orgeas M, Goldgran-Toledano D, Dumenil AS, Jamali S, Cheval C, Allaouchiche B, Souweine B, Azoulay E. Association between hypernatraemia acquired in the ICU and mortality: a cohort study. Nephrol Dial Transplant. 2010 Aug;25(8):2510-5. doi: 10.1093/ndt/gfq067. Epub 2010 Feb 17. [PubMed]
6. Rose BD. Clinical physiology of acid-base and electrolyte disorders 5thed. New York, NY: Mcgraw-Hill; 352:220-228.
7. Soupart A, Penninckx R, Namias B, Stenuit A, Perier O, Decaux G. Brain myelinolysis following hypernatremia in rats. J Neuropathol Exp Neurol. 1996 Jan;55(1):106-13.
8. Beck LH. The aging kidney. Defending a delicate balance of fluid and electrolytes. Geriatrics. 2000 Apr;55(4):26-8, 31-2. [PubMed]
9. Shea AM, Hammill BG, Curtis LH, Szczech LA, Schulman KA. Medical costs of abnormal serum sodium levels. J Am Soc Nephrol. 2008 Apr; 19(4):764-70. doi: 10.1681/ASN.2007070752.
10. Lindner G, Funk GC, Schwarz C, Kneidinger N, Kaider A, Schneeweiss B, Kramer L, Druml W. Hypernatremia in the critically ill is an independent risk factor for mortality. Am J Kidney Dis. 2007 Dec;50(6):952-7. [PubMed]
11. Maitra T, Thakuria R, Basumatary A. Dyselectrolytemia in elderly: A hospital based study. J Evid Based Med Healthc. 2016; 3(30), 1348-51. doi: 10.18410/jebmh/2016/308.
12. Snyder NA, Feigal DW, Arieff AI. Hypernatremia in elderly patients. A heterogeneous, morbid, and iatrogenic entity. Ann Intern Med. 1987 Sep;107(3):309-19. [PubMed]
13. Tisdall M, Crocker M, Watkiss J, Smith M. Disturbances of sodium in critically ill adult neurologic patients: a clinical review. J Neurosurg Anesthesiol. 2006 Jan; 18(1):57-63. [PubMed]
14. Kumar AB, Shi Y, Shotwell MS, Richards J, Ehrenfeld JM. Hypernatremia is a significant risk factor for acute kidney injury after subarachnoid hemorrhage: a retrospective analysis. Neurocrit Care. 2015 Apr;22(2):184-91. doi: 10.1007/s12028-014-0067-8. [PubMed]
15. Li M, Hu YH, Chen G. Hypernatremia severity and the risk of death after traumatic brain injury. Injury. 2013 Sep; 44(9):1213-8. doi: 10.1016/j.injury.2012.05.021.
16. Hadjizacharia P, Beale EO, Inaba K, Chan LS, Demetriades D. Acute diabetes insipidus in severe head injury: a prospective study. J Am CollSurg. 2008Oct; 207(4):477-84.doi: .1016/j.jamcollsurg.2008.04.017. [PubMed]
17. Paiva WS, Bezerra DA, Amorim RL, Figueiredo EG, Tavares WM, De Andrade AF, Teixeira MJ. Serum sodium disorders in patients with traumatic brain injury. Ther Clin Risk Manag. 2011; 7:345-9. doi: 10.2147/TCRM.S17692. Epub 2011 Aug 11.
18. Aiyagari V, Deibert E, Diringer MN. Hypernatremia in the neurologic intensive care unit: how high is too high? J Crit Care. 2006 Jun;21(2):163-72. [PubMed]
19. Mujawar NS, Jaiswal AN. Hypernatremia in the Neonate: Neonatal Hypernatremia and Hypernatremic Dehydration in Neonates Receiving Exclusive Breastfeeding. Indian Journal of Critical Care Medicine : 2017; 21(1):30-33.
20. VAN DE Louw A, Shaffer C, Schaefer E. Early intensive care unit-acquired hypernatremia in severe sepsis patients receiving 0.9% saline fluid resuscitation. Acta Anaesthesiol Scand. 2014 Sep;58(8):1007-14. doi: 10.1111/aas.12368. Epub 2014 Jul 15. [PubMed]
21. Ebrahim MK, George A, Bang RL. Only some septicaemic patients develop hypernatremia in the burn intensive care unit: why? Burns. 2002 Sep;28(6):543-7.
22. Schwarz C, Leichtle AB, Arampatzis S, Fiedler GM, Zimmermann H, Exadaktylos AK, Lindner G. Thyroid function and serum electrolytes: does an association really exist? Swiss Med Wkly. 2012 Sep 17; 142:w13669. doi: 10.4414/smw.2012.13669.
23. Ma JT, Ho FC, Wang C, Lam KS, Yeung RT. Primary hypothyroidism and essential hypernatremia in a patient with histiocytosis X. Aust N Z J Med. 1985 Feb;15(1):72-4.
24. Sajadi S, Yu C, Sylvestre JD, Looper KJ, Segal M, Rej S. Does lower urine-specific gravity predict decline in renal function and hypernatremia in older adults exposed to psychotropic medications? An exploratory analysis. Clin Kidney J. 2016 Apr;9(2):268-72. doi: 10.1093/ckj/sfv132. Epub 2015 Dec 10.
25. Kovesdy CP. Significance of hypo- and hypernatremia in chronic kidney disease. Nephrol Dial Transplant. 2012 Mar;27(3):891-8. doi: 10.1093/ndt/gfs038.
26. Latcha S, Lubetzky M, Weinstein AM. Severe hyperosmolarity and hypernatremia in an adipsic young woman. Clin Nephrol. 2011 Nov; 76(5):407-11. [PubMed]
27. Varun S, Bhaskar E, Abraham G, Arunkumar AS, Renuka MK. Risk factors for hospital-acquired hypernatremia among critically ill medical patients in a setting utilizing a preventive free water protocol: Do we need to do more? Indian J Crit Care Med. 2013 Jan;17(1):28-33. doi: 10.4103/0972-5229.112157.
28. Palevsky PM, Bhagrath R, Greenberg A. Hypernatremia in hospitalized patients. Ann Intern Med. 1996 Jan 15;124(2):197-203. [PubMed]
29. Leung AA, McAlister FA, Finlayson SR, Bates DW. Preoperative hypernatremia predicts increased perioperative morbidity and mortality. Am J Med. 2013 Oct;126(10):877-86. doi: 10.1016/j.amjmed.2013.02.039. Epub 2013 Aug 1.
30. Polderman KH, Schreuder WO, Strack van Schijndel RJ, Thijs LG. Hypernatremia in the intensive care unit: an indicator of quality of care? Crit Care Med. 1999 Jun;27(6):1105-8.
CITATION
DOI: 10.17511/ijmrr.2018.i03.05
Published: 2018-03-31
How to Cite
1.
George A, Alexander R, T Abraham S, Venugopal E V. R. Profile of Hypernatremia in a Tertiary care hospital: A review of 175 cases over a 5 year period in a South Indian population. Int J Med Res Rev [Internet]. 2018Mar.31 [cited 2024Apr.25];6(3):159-65. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/972
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