. 2024 Nov 22;26(4):303-310.

doi: 10.1016/j.ccrj.2024.09.003. eCollection 2024 Dec.

ICU-acquired hypernatremia: Prevalence, patient characteristics, trajectory, risk factors, and outcomes

Ahmad Nasser^{1

2}, Anis Chaba^{3

4}, Kevin B Laupland^{5

6}, Mahesh Ramanan^{2

6

7}, Alexis Tabah^{2

8}, Antony G Attokaran^{2

9}, Aashish Kumar¹⁰, James McCullough^{11

12}, Kiran Shekar^{2

13}, Peter Garrett^{12

14}, Philippa McIlroy¹⁵, Stephen Luke^{16

17}, Siva Senthuran^{17

18}, Rinaldo Bellomo^{3

4

19

20}, Kyle C White^{1

2

21}; Queensland Critical Care Research Network (QCCRN)

Collaborators, Affiliations

Collaborators

Queensland Critical Care Research Network (QCCRN):
Mahesh Ramanan, Prashanti Marella, Patrick Young, Philippa McIlroy, Ben Nash, James McCullough, Kerina J Denny, Mandy Tallott, Andrea Marshall, David Moore, Sunil Sane, Aashish Kumar, Lynette Morrison, Pam Dipplesman, Jennifer Taylor, Stephen Luke, Anni Paasilahti, Ray Asimus, Jennifer Taylor, Kyle White, Jason Meyer, Rod Hurford, Meg Harward, James Walsham, Neeraj Bhadange, Wayne Stevens, Kevin Plumpton, Sainath Raman, Andrew Barlow, Alexis Tabah, Hamish Pollock, Stuart Baker, Kylie Jacobs, Antony G Attokaran, David Austin, Jacobus Poggenpoel, Josephine Reoch, Kevin B Laupland, Felicity Edwards, Tess Evans, Jayesh Dhanani, Marianne Kirrane, Pierre Clement, Nermin Karamujic, Paula Lister, Vikram Masurkar, Lauren Murray, Jane Brailsford, Todd Erbacher, Kiran Shekar, Jayshree Lavana, George Cornmell, Siva Senthuran, Stephen Whebell, Michelle Gatton, Sam Keogh

Affiliations

¹ Intensive Care Unit, Queen Elizabeth II Jubilee Hospital, Coopers Plains, QLD, Australia.
² Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia.
³ Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia.
⁴ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁵ Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
⁶ School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
⁷ Intensive Care Unit, Caboolture Hospital, Caboolture, QLD, Australia.
⁸ Intensive Care Unit, Redcliffe Hospital, Redcliffe, QLD, Australia.
⁹ Intensive Care Unit, Rockhampton Hospital, The Range, QLD, Australia.
¹⁰ Intensive Care Unit, Logan Hospital, Logan, QLD, Australia.
¹¹ Intensive Care Unit, Gold Coast University Hospital, Southport, QLD, Australia.
¹² School of Medicine and Dentistry, Griffith University, Mount Gravatt, QLD, Australia.
¹³ Adult Intensive Care Services, The Prince Charles Hospital, Chermside, QLD, Australia.
¹⁴ Intensive Care Unit, Sunshine Coast University Hospital, Birtinya, QLD, Australia.
¹⁵ Intensive Care Unit, Cairns Hospital, Cairns, QLD, Australia.
¹⁶ Intensive Care Services, Mackay Base Hospital, Mackay, QLD, Australia.
¹⁷ College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
¹⁸ Intensive Care Unit, Townsville Hospital, Townsville, QLD, Australia.
¹⁹ Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
²⁰ Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.
²¹ Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.

PMID: 39781488
PMCID: PMC11704424
DOI: 10.1016/j.ccrj.2024.09.003

ICU-acquired hypernatremia: Prevalence, patient characteristics, trajectory, risk factors, and outcomes

Ahmad Nasser et al. Crit Care Resusc. 2024.

. 2024 Nov 22;26(4):303-310.

doi: 10.1016/j.ccrj.2024.09.003. eCollection 2024 Dec.

Authors

Collaborators

Queensland Critical Care Research Network (QCCRN):
Mahesh Ramanan, Prashanti Marella, Patrick Young, Philippa McIlroy, Ben Nash, James McCullough, Kerina J Denny, Mandy Tallott, Andrea Marshall, David Moore, Sunil Sane, Aashish Kumar, Lynette Morrison, Pam Dipplesman, Jennifer Taylor, Stephen Luke, Anni Paasilahti, Ray Asimus, Jennifer Taylor, Kyle White, Jason Meyer, Rod Hurford, Meg Harward, James Walsham, Neeraj Bhadange, Wayne Stevens, Kevin Plumpton, Sainath Raman, Andrew Barlow, Alexis Tabah, Hamish Pollock, Stuart Baker, Kylie Jacobs, Antony G Attokaran, David Austin, Jacobus Poggenpoel, Josephine Reoch, Kevin B Laupland, Felicity Edwards, Tess Evans, Jayesh Dhanani, Marianne Kirrane, Pierre Clement, Nermin Karamujic, Paula Lister, Vikram Masurkar, Lauren Murray, Jane Brailsford, Todd Erbacher, Kiran Shekar, Jayshree Lavana, George Cornmell, Siva Senthuran, Stephen Whebell, Michelle Gatton, Sam Keogh

Affiliations

¹ Intensive Care Unit, Queen Elizabeth II Jubilee Hospital, Coopers Plains, QLD, Australia.
² Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia.
³ Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia.
⁴ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁵ Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
⁶ School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
⁷ Intensive Care Unit, Caboolture Hospital, Caboolture, QLD, Australia.
⁸ Intensive Care Unit, Redcliffe Hospital, Redcliffe, QLD, Australia.
⁹ Intensive Care Unit, Rockhampton Hospital, The Range, QLD, Australia.
¹⁰ Intensive Care Unit, Logan Hospital, Logan, QLD, Australia.
¹¹ Intensive Care Unit, Gold Coast University Hospital, Southport, QLD, Australia.
¹² School of Medicine and Dentistry, Griffith University, Mount Gravatt, QLD, Australia.
¹³ Adult Intensive Care Services, The Prince Charles Hospital, Chermside, QLD, Australia.
¹⁴ Intensive Care Unit, Sunshine Coast University Hospital, Birtinya, QLD, Australia.
¹⁵ Intensive Care Unit, Cairns Hospital, Cairns, QLD, Australia.
¹⁶ Intensive Care Services, Mackay Base Hospital, Mackay, QLD, Australia.
¹⁷ College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
¹⁸ Intensive Care Unit, Townsville Hospital, Townsville, QLD, Australia.
¹⁹ Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
²⁰ Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.
²¹ Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.

PMID: 39781488
PMCID: PMC11704424
DOI: 10.1016/j.ccrj.2024.09.003

Abstract

Objective: Knowledge of intensive care unit (ICU) acquired hypernatremia (ICU-AH) has been hampered by the absence of granular data and confounded by variable definitions and inclusion criteria.

Design: Multicentre retrospective cohort study.

Setting: Twelve ICUs in Queensland (QLD), Australia.

Participants: Adult patients admitted to ICU from 2015 to 2021. Only the first ICU admission was considered, and we categorised patients into mild (146-150 mmol·L^-1), moderate (151-155 mmol·L^-1) and severe (>155 mmol·L^-1) ICU-acquired hypernatremia.

Main outcome measure: We aimed to study the prevalence of ICU-AH, patient characteristics, trajectory, risk factors, and outcomes.

Results: Data from 55,255 ICU admissions were included in the analysis, of which 4146 (7.5 %) patients had ICU-AH. These were subcategorised into mild (n = 2,670, 4.8 %), moderate (n = 1,073, 1.9 %) and severe (n = 403, 0.73 %) forms. Median time to diagnosis was 4 (2-6) d after ICU admission, while median time to peak serum sodium level was 5 (3-8) d. The median maximum sodium level across the cohort was 149 (147-152) mmol·L^-1. The sodium correction rate was 1 mmol·L^-1 per day, taking a median of 3 d (1-5) for sodium levels to return below 145 mmol·L^-1. APACHE III score, invasive ventilation, fever, and diuretic use on the day before hypernatremia were independent risk factors for moderate or severe ICU-AH. After adjusting for confounders, all levels of hypernatremia were independently associated with an increased risk of 30-d in-hospital mortality.

Conclusions: In a large multicentric study of critically ill patients, ICU-acquired hypernatremia occurred in one in eight admissions after a median of four days in the ICU and was preceded by identifiable and modifiable risk factors. If severe, its correction was slow, and normalisation was delayed. After adjusting for other factors, all levels of hypernatremia were an independent risk factor for 30-d in-hospital mortality.

Keywords: Critical illness; Diuretics; Electrolyte disturbance; Hypernatremia; Intensive care unit.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Prof Rinaldo Bellomo is on the Critical Care and Resuscitation Editorial Board If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.

Figures

**Fig. 1**
Frequency distribution plot of maximum serum sodium levels in ICU.

**Fig. 2**
Daily maximum serum sodium evolution across time according to severity groups. Points represent the median daily maximum serum sodium level for each ICU-acquired hypernatremia subgroup. The time effect was estimated with a linear mixed model. The model was fitted with time as a fixed effect and a random intercept and slope for each subject to account for multiple measurements per subject. The model included the following specifications: ${s o d i u m_\max}_{i j} = β_{0} + β_{1} + {t i m e}_{i j} + (u_{0 i} + u_{1 i} \cdot {i a h_{g r o u p}}_{i j}) + ϵ_{i j}$ . Where $β_{0}$ and $β_{1}$ are the fixed effect, $u_{0 i}$ and $u_{1 i}$ are random intercept and slope for the subject $i$ , respectively and $ϵ_{i j}$ the residual error. $i a h_{g r o u p}$ is a categorical variable representing the different subgroups of ICU-Acquired hypernatremia and its interaction with the random slope allow for varying effect of time on daily maximum sodium levels across the different groups.

**Fig. 3**
Kaplan Meier survival curve for 30-day hospital mortality according to ICU-acquired hypernatremia severity.

See this image and copyright information in PMC

References

1. Lindner G., Funk G.-C. Hypernatremia in critically ill patients. J Crit Care. 2013;28(2):11–20. 216. - PubMed
1. Chand R., Chand R., Goldfarb D.S. Hypernatremia in the intensive care unit. Curr Opin Nephrol Hypertens. 2022;31(2):199–204. - PubMed
1. Tauseef A., Zafar M., Syed E., Thirumalareddy A., Sood N., Lateef N., et al. Prognostic importance of deranged sodium level in critically ill patients: a systemic literature to review. J Fam Med Prim Care. 2021;10(7):2477. - PMC - PubMed
1. Rugg C., Woyke S., Ronzani M., Markl-Le Levé A., Spraider P., Loveys S., et al. Catabolism highly influences ICU-acquired hypernatremia in a mainly trauma and surgical cohort. J Crit Care. 2023;76 - PubMed
1. Rugg C., Bachler M., Mösenbacher S., Wiewiora E., Schmid S., Kreutziger J., et al. Early ICU-acquired hypernatraemia is associated with injury severity and preceded by reduced renal sodium and chloride excretion in polytrauma patients. J Crit Care. 2021;65:9–17. - PubMed

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ICU-acquired hypernatremia: Prevalence, patient characteristics, trajectory, risk factors, and outcomes

Collaborators

Affiliations

ICU-acquired hypernatremia: Prevalence, patient characteristics, trajectory, risk factors, and outcomes

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources