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Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices

Background: Hyponatraemia is associated with increased morbidity, increased mortality and is frequently hospital-acquired due to inappropriate administration of hypotonic fluids. Despite several attempts to minimise the risk, knowledge is lacking as to whether inappropriate prescribing practice cont...

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Autores principales: Sindahl, Per, Overgaard-Steensen, Christian, Wallach-Kildemoes, Helle, De Bruin, Marie Louise, Leufkens, Hubert GM, Kemp, Kaare, Gardarsdottir, Helga
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565867/
https://www.ncbi.nlm.nih.gov/pubmed/32872460
http://dx.doi.org/10.3390/jcm9092790
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author Sindahl, Per
Overgaard-Steensen, Christian
Wallach-Kildemoes, Helle
De Bruin, Marie Louise
Leufkens, Hubert GM
Kemp, Kaare
Gardarsdottir, Helga
author_facet Sindahl, Per
Overgaard-Steensen, Christian
Wallach-Kildemoes, Helle
De Bruin, Marie Louise
Leufkens, Hubert GM
Kemp, Kaare
Gardarsdottir, Helga
author_sort Sindahl, Per
collection PubMed
description Background: Hyponatraemia is associated with increased morbidity, increased mortality and is frequently hospital-acquired due to inappropriate administration of hypotonic fluids. Despite several attempts to minimise the risk, knowledge is lacking as to whether inappropriate prescribing practice continues to be a concern. Methods: A cross-sectional survey was performed in Danish emergency department physicians in spring 2019. Prescribing practices were assessed by means of four clinical scenarios commonly encountered in the emergency department. Thirteen multiple-choice questions were used to measure knowledge. Results: 201 physicians responded corresponding to 55.4% of the total population of physicians working at emergency departments in Denmark. About a quarter reported that they would use hypotonic fluids in patients with increased intracranial pressure and 29.4% would use hypotonic maintenance fluids in children, both of which are against guideline recommendations. Also, 29.4% selected the correct fluid, a 3% hypertonic saline solution, for a patient with hyponatraemia and severe neurological symptoms, which is a medical emergency. Most physicians were unaware of the impact of hypotonic fluids on plasma sodium in acutely ill patients. Conclusion: Inappropriate prescribing practices and limited knowledge of a large number of physicians calls for further interventions to minimise the risk of hospital-acquired hyponatraemia.
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spelling pubmed-75658672020-10-26 Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices Sindahl, Per Overgaard-Steensen, Christian Wallach-Kildemoes, Helle De Bruin, Marie Louise Leufkens, Hubert GM Kemp, Kaare Gardarsdottir, Helga J Clin Med Article Background: Hyponatraemia is associated with increased morbidity, increased mortality and is frequently hospital-acquired due to inappropriate administration of hypotonic fluids. Despite several attempts to minimise the risk, knowledge is lacking as to whether inappropriate prescribing practice continues to be a concern. Methods: A cross-sectional survey was performed in Danish emergency department physicians in spring 2019. Prescribing practices were assessed by means of four clinical scenarios commonly encountered in the emergency department. Thirteen multiple-choice questions were used to measure knowledge. Results: 201 physicians responded corresponding to 55.4% of the total population of physicians working at emergency departments in Denmark. About a quarter reported that they would use hypotonic fluids in patients with increased intracranial pressure and 29.4% would use hypotonic maintenance fluids in children, both of which are against guideline recommendations. Also, 29.4% selected the correct fluid, a 3% hypertonic saline solution, for a patient with hyponatraemia and severe neurological symptoms, which is a medical emergency. Most physicians were unaware of the impact of hypotonic fluids on plasma sodium in acutely ill patients. Conclusion: Inappropriate prescribing practices and limited knowledge of a large number of physicians calls for further interventions to minimise the risk of hospital-acquired hyponatraemia. MDPI 2020-08-29 /pmc/articles/PMC7565867/ /pubmed/32872460 http://dx.doi.org/10.3390/jcm9092790 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sindahl, Per
Overgaard-Steensen, Christian
Wallach-Kildemoes, Helle
De Bruin, Marie Louise
Leufkens, Hubert GM
Kemp, Kaare
Gardarsdottir, Helga
Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices
title Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices
title_full Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices
title_fullStr Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices
title_full_unstemmed Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices
title_short Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices
title_sort are further interventions needed to prevent and manage hospital-acquired hyponatraemia? a nationwide cross-sectional survey of iv fluid prescribing practices
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565867/
https://www.ncbi.nlm.nih.gov/pubmed/32872460
http://dx.doi.org/10.3390/jcm9092790
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