Sodium Correction Practice and Clinical Outcomes in Profound Hyponatremia.

Authors:
Pierce Geoghegan
Pierce Geoghegan
University College Hospital Galway
Ireland
Dr Andrew M Harrison, MD, PhD
Dr Andrew M Harrison, MD, PhD
Mayo Clinic
Postdoctoral researcher
Clinical Informatics
Rochester, MN | United States
Charat Thongprayoon
Charat Thongprayoon
Mayo Clinic
Phoenix | United States
Rahul Kashyap
Rahul Kashyap
Mayo Clinic
United States
Adil Ahmed
Adil Ahmed
Mayo Clinic
Phoenix | United States
Yue Dong
Yue Dong
Mayo Clinic
United States
Alejandro A Rabinstein
Alejandro A Rabinstein
Mayo Clinic
Phoenix | United States
Kianoush B Kashani
Kianoush B Kashani
Mayo Clinic
United States

Mayo Clin Proc 2015 Oct;90(10):1348-55

Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.

Objectives: To assess the epidemiology of nonoptimal hyponatremia correction and to identify associated morbidity and in-hospital mortality.

Patients And Methods: An electronic medical record search identified all patients admitted with profound hyponatremia (sodium <120 mmol/L) from January 1, 2008, through December 31, 2012. Patients were classified as having optimally or nonoptimally corrected hyponatremia at 24 hours after admission. Optimal correction was defined as sodium correction in 24 hours of 6 through 10 mmol/L. We investigated the association between sodium correction and demographic and outcome variables, including occurrence of osmotic demyelination syndrome (ODS). Baseline characteristics by correction outcome categories were compared using the Kruskal-Wallis test for continuous variables and the χ(2) test for categorical variables. Odds ratios for in-hospital mortality between groups were assessed using logistic regression. Adjusted differences in hospital length of stay (LOS) and intensive care unit (ICU) LOS were assessed using the Dunnett 2-tailed t test.

Results: A total of 412 patients satisfied inclusion criteria of whom 174 (42.2%) were admitted to the ICU. A total of 211 (51.2%) had optimal correction of their hyponatremia at 24 hours, 87 (21.1%) had undercorrected hyponatremia, and 114 (27.9%) had overcorrected hyponatremia. Both patient factors and treatment factors were associated with nonoptimal correction. There was a single case of ODS. Overcorrection was not associated with in-hospital mortality or ICU LOS. When adjusted for patient factors, undercorrection of profound hyponatremia was associated with an increase in hospital LOS (9.3 days; 95% CI, 1.9-16.7 days).

Conclusion: Nonoptimal correction of profound hyponatremia is common. Fortunately, nonoptimal correction is associated with serious morbidity only infrequently.

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http://dx.doi.org/10.1016/j.mayocp.2015.07.014DOI Listing

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October 2015
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