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Intensive care unit-acquired hyponatremia in critically ill medical patients

BACKGROUND: Previous research has focused on intensive care unit (ICU)-acquired hypernatremia; however, ICU-acquired hyponatremia has frequently been overlooked and has rarely been studied in surgical or mixed ICUs. The aim of this study is to investigate the incidence of ICU-acquired hyponatremia,...

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Autores principales: Sim, Jae Kyeom, Ko, Ryoung-Eun, Na, Soo Jin, Suh, Gee Young, Jeon, Kyeongman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333267/
https://www.ncbi.nlm.nih.gov/pubmed/32616002
http://dx.doi.org/10.1186/s12967-020-02443-4
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author Sim, Jae Kyeom
Ko, Ryoung-Eun
Na, Soo Jin
Suh, Gee Young
Jeon, Kyeongman
author_facet Sim, Jae Kyeom
Ko, Ryoung-Eun
Na, Soo Jin
Suh, Gee Young
Jeon, Kyeongman
author_sort Sim, Jae Kyeom
collection PubMed
description BACKGROUND: Previous research has focused on intensive care unit (ICU)-acquired hypernatremia; however, ICU-acquired hyponatremia has frequently been overlooked and has rarely been studied in surgical or mixed ICUs. The aim of this study is to investigate the incidence of ICU-acquired hyponatremia, the risk factors associated with its development, and its impact on outcomes in critically ill medical patients. METHODS: We conducted a retrospective cohort study based on the prospective registry of all critically ill patients admitted to the medical ICU from January 2015 to December 2018. Baseline characteristics and management variables were compared between ICU-acquired hyponatremia and normonatremia patients. RESULTS: Of 1342 patients with initial normonatremia, ICU-acquired hyponatremia developed in 217 (16.2%) patients and ICU-acquired hypernatremia developed in 117 (8.7%) patients. The Sequential Organ Failure Assessment (8.0 vs 7.0, P = 0.009) and Simplified Acute Physiology Score 3 scores (55.0 vs 51.0, P = 0.005) were higher in ICU-acquired hyponatremia patients compared with normonatremia patients. Baseline sodium (137.0 mmol/L vs 139.0 mmol/L, P < 0.001), potassium (4.2 mmol/L vs 4.0 mmol/L, P = 0.001), and creatinine (0.98 mg/dL vs 0.88 mg/dL, P = 0.034) levels were different between the two groups. Net volume balance over first 3 days was higher in ICU-acquired hyponatremia patients (19.4 mL/kg vs 11.5 mL/kg, P = 0.004) and was associated with the development of ICU-acquired hyponatremia (adjusted odds ratio, 1.004; 95% confidence interval, 1.002–1.007; P = 0.001). ICU mortality was similar in both groups (15.2% vs. 14.4%, P = 0.751), but renal replacement therapy was more commonly required in ICU-acquired hyponatremia patients (13.4% vs 7.4%, P = 0.007). CONCLUSIONS: ICU-acquired hyponatremia is not uncommon in critically ill medical patients. Increased volume balance is associated with its development. ICU-acquired hyponatremia is related to increased use of renal replacement therapy but not to mortality.
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spelling pubmed-73332672020-07-06 Intensive care unit-acquired hyponatremia in critically ill medical patients Sim, Jae Kyeom Ko, Ryoung-Eun Na, Soo Jin Suh, Gee Young Jeon, Kyeongman J Transl Med Research BACKGROUND: Previous research has focused on intensive care unit (ICU)-acquired hypernatremia; however, ICU-acquired hyponatremia has frequently been overlooked and has rarely been studied in surgical or mixed ICUs. The aim of this study is to investigate the incidence of ICU-acquired hyponatremia, the risk factors associated with its development, and its impact on outcomes in critically ill medical patients. METHODS: We conducted a retrospective cohort study based on the prospective registry of all critically ill patients admitted to the medical ICU from January 2015 to December 2018. Baseline characteristics and management variables were compared between ICU-acquired hyponatremia and normonatremia patients. RESULTS: Of 1342 patients with initial normonatremia, ICU-acquired hyponatremia developed in 217 (16.2%) patients and ICU-acquired hypernatremia developed in 117 (8.7%) patients. The Sequential Organ Failure Assessment (8.0 vs 7.0, P = 0.009) and Simplified Acute Physiology Score 3 scores (55.0 vs 51.0, P = 0.005) were higher in ICU-acquired hyponatremia patients compared with normonatremia patients. Baseline sodium (137.0 mmol/L vs 139.0 mmol/L, P < 0.001), potassium (4.2 mmol/L vs 4.0 mmol/L, P = 0.001), and creatinine (0.98 mg/dL vs 0.88 mg/dL, P = 0.034) levels were different between the two groups. Net volume balance over first 3 days was higher in ICU-acquired hyponatremia patients (19.4 mL/kg vs 11.5 mL/kg, P = 0.004) and was associated with the development of ICU-acquired hyponatremia (adjusted odds ratio, 1.004; 95% confidence interval, 1.002–1.007; P = 0.001). ICU mortality was similar in both groups (15.2% vs. 14.4%, P = 0.751), but renal replacement therapy was more commonly required in ICU-acquired hyponatremia patients (13.4% vs 7.4%, P = 0.007). CONCLUSIONS: ICU-acquired hyponatremia is not uncommon in critically ill medical patients. Increased volume balance is associated with its development. ICU-acquired hyponatremia is related to increased use of renal replacement therapy but not to mortality. BioMed Central 2020-07-02 /pmc/articles/PMC7333267/ /pubmed/32616002 http://dx.doi.org/10.1186/s12967-020-02443-4 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Sim, Jae Kyeom
Ko, Ryoung-Eun
Na, Soo Jin
Suh, Gee Young
Jeon, Kyeongman
Intensive care unit-acquired hyponatremia in critically ill medical patients
title Intensive care unit-acquired hyponatremia in critically ill medical patients
title_full Intensive care unit-acquired hyponatremia in critically ill medical patients
title_fullStr Intensive care unit-acquired hyponatremia in critically ill medical patients
title_full_unstemmed Intensive care unit-acquired hyponatremia in critically ill medical patients
title_short Intensive care unit-acquired hyponatremia in critically ill medical patients
title_sort intensive care unit-acquired hyponatremia in critically ill medical patients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333267/
https://www.ncbi.nlm.nih.gov/pubmed/32616002
http://dx.doi.org/10.1186/s12967-020-02443-4
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