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. 2021 Jan 12;6(1):63-78.
doi: 10.1093/jalm/jfaa127.

Serum Sodium and Potassium Distribution and Characteristics in the US Population, National Health and Nutrition Examination Survey 2009-2016

Katherine J Overwyk  1   2 , Christine M Pfeiffer  3 , Renee J Storandt  4 , Lixia Zhao  5 , Zefeng Zhang  1 , Norm R C Campbell  6 , Jennifer L Wiltz  1   7 , Robert K Merritt  1 , Mary E Cogswell  1
Affiliations

Serum Sodium and Potassium Distribution and Characteristics in the US Population, National Health and Nutrition Examination Survey 2009-2016

Katherine J Overwyk et al. J Appl Lab Med. .

Abstract

Background: Concern has been expressed by some that sodium reduction could lead to increased prevalence of hyponatremia and hyperkalemia for specific population subgroups. Current concentrations of serum sodium and potassium in the US population can help address this concern.

Methods: We used data from the National Health and Nutrition Examination Survey 2009-2016 to examine mean and selected percentiles of serum sodium and potassium by sex and age group among 25 520 US participants aged 12 years or older. Logistic regression models with predicted residuals were used to examine the age-adjusted prevalence of low serum sodium and high serum potassium among adults aged 20 or older by selected sociodemographic characteristics and by health conditions or medication use.

Results: The distributions of serum sodium and potassium concentrations were within normal reference intervals overall and across Dietary Reference Intake life-stage groups, with a few exceptions. Overall, 2% of US adults had low serum sodium (<135 mmol/L) and 0.6% had high serum potassium (>5 mmol/L). Prevalence of low serum sodium and high serum potassium was higher among adults aged 71 or older (4.7 and 2.0%, respectively) and among adults with chronic kidney disease (3.4 and 1.9%), diabetes (5.0 and 1.1%), or using certain medications (which varied by condition), adjusted for age; whereas, prevalence was <1% among adults without these conditions or medications.

Conclusions: Most of the US population has normal serum sodium and potassium concentrations; these data describe population subgroups at higher risk of low serum sodium and high serum potassium and can inform clinical care.

Keywords: chronic conditions; hyperkalemia; hyponatremia; medication; serum levels.

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Conflict of interest statement

Authors’ Disclosures or Potential Conflicts of Interest: No authors declared any potential conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Boxplot of serum sodium (mmol/L) by sex and age group.
Fig. 2.
Fig. 2.
Boxplot of serum potassium (mmol/L) by sex and age group.
See this image and copyright information in PMC

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