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. 2014 Feb 21:15:37.
doi: 10.1186/1471-2369-15-37.

Undercorrection of hypernatremia is frequent and associated with mortality

Stanislas Bataille  1 , Camille Baralla, Dominique Torro, Christophe Buffat, Yvon Berland, Marc Alazia, Anderson Loundou, Pierre Michelet, Henri Vacher-Coponat
Affiliations

Undercorrection of hypernatremia is frequent and associated with mortality

Stanislas Bataille et al. BMC Nephrol. .

Abstract

Background: About 1% of patients admitted to the Emergency Department (ED) have hypernatremia, a condition associated with a mortality rate of 20 to 60%. Management recommendations originate from intensive care unit studies, in which patients and medical diseases differ from those in ED.

Methods: We retrospectively studied clinical characteristics, treatments, and outcomes of severely hypernatremic patients in the ED and risk factors associated with death occurrence during hospitalization.

Results: During 2010, 85 cases of severe hypernatremia ≥ 150 mmol/l were admitted to ED. Hypernatremia occurred in frail patients: mean age 79.7 years, 55% institutionalized, 28% with dementia.Twenty four percent of patients died during hospitalization. Male gender and low mean blood pressure (MBP) were independently associated with death, as well as slow natremia correction speed, but not the severity of hyperosmolarity at admission. Infusion solute was inappropriate for 45% of patients with MBP <70 mmHg who received hypotonic solutes and 22% of patients with MBP ≥ 70 mmHg who received isotonic solutes or were not perfused.

Conclusions: This is the first study assessing outcome of hypernatremic patients in the ED according to the treatment provided. It appears that not only a too quick, but also a too slow correction speed is associated with an increased risk of death regardless of initial natremia. Medical management of hypernatremic patients must be improved regarding evaluation and treatment.

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Figures

Figure 1
Figure 1
Clinical and biological features of hypernatremic patients. A. Natremia at admission and outcomes of hypernatremic patients. B. Renal function at admission. Renal function at admission was measured using estimated glomerular filtration rate (eGFR) estimated by Modification of Diet in Renal Disease formula (23). C. Month of occurrence of hypernatremia.
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