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. 2024 Nov 22;26(4):311-318.
doi: 10.1016/j.ccrj.2024.09.004. eCollection 2024 Dec.

Severe intensive care unit-acquired hypernatraemia: Prevalence, risk factors, trajectory, management, and outcome

Anis Chaba  1   2 , Atthaphong Phongphithakchai  1 , Oscar Pope  1 , Sam Rajapaksha  1 , Pratibha Ranjan  1 , Akinori Maeda  1 , Sofia Spano  1 , Yukiko Hikasa  1 , Glenn Eastwood  1 , Nuttapol Pattamin  1 , Nuanprae Kitisin  1   3 , Ahmad Nasser  4   5 , Kyle C White  4   5   6   7   8 , Rinaldo Bellomo  1   2   9   10   11 ; Severe Hypernatremia Assessment, Resolution, and Eradication (SHARE) Investigators
Affiliations

Severe intensive care unit-acquired hypernatraemia: Prevalence, risk factors, trajectory, management, and outcome

Anis Chaba et al. Crit Care Resusc. .

Abstract

Background: Severe intensive care unit-acquired hypernatraemia (ICU-AH) is a serious complication of critical illness. However, there is no detailed information on how this condition develops.

Objectives: The objective of this study was to study the prevalence, risk factors, trajectory, management, and outcome of severe ICU-AH (≥155 mmol·L-1).

Methods: A retrospective study was conducted in a 40-bed ICU in a university-affiliated hospital. Assessment of sodium levels, factors associated with severe ICU-AH, urinary electrolyte measurements, water therapy, fluid balance, correction rate, and delirium was made.

Results: We screened 11,642 ICU admissions and identified 109 patients with severe ICU-AH. The median age was 57 years, 63% were male, and the median Acute Physiology and Chronic Health Evaluation III score was 64 (52; 80). On the day of ICU admission, 64% of patients were ventilated; 71% received vasopressors, and 22% had acute kidney injury. The median peak sodium level was 158 (156; 161) mmolL-1 at a median of 4 (1; 11) days after ICU admission. Only eight patients (7%) had urine sodium measurement (median concentration: 17 mmol·L-1). On the day of peak hypernatraemia, 80% of patients were unable to drink due to invasive ventilation; 34% were on diuretics; 25% had fever, and 50% did not receive hypotonic fluids. When available, the median electrolyte-free water clearance was -1.1 L (-1.7; -0.5), representing half of the urine output. After peak hypernatraemia, the correction rate was -2.8 mmol·L-1 per day (95% confidence interval: [-2.9 to -2.6]) during the first 3 d.

Conclusions: Severe hypernatraemia occurred in the setting of inability to drink, near-absent measurement of urinary free water losses, diuretic therapy, fever, renal impairment, and near-absent or limited or delayed water administration. Correction was slow.

Keywords: Correction rate; Electrolyte-free water clearance; Hypernatraemia; ICU-acquired hypernatraemia.

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Conflict of interest statement

Rinaldo Bellomo is the Editor-in-Chief of Critical Care and Resuscitation Journal. The other authors do not have any conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Time course of serum sodium and serum chloride with respect to A: time since ICU-AH onset and B: time since peak hypernatraemia. Points represent the daily geometric mean, and shaded areas represent the associated 95% confidence interval (CI). Correction rates were computed using a linear mixed model, with patients treated as a random effect. The correction rate during the 7 days following the first day of hypernatraemia was −0.41 mmol/L per day (95% CI: [-0.48 to −0.34]) mmol·L−1 per day. The correction rate during the 3 days following the peak of hypernatraemia was −2.8 mmol/L per day (95% CI: [-2.9 to −2.6]) mmol·L−1 per day. Abbreviations: ICU-AH, intensive care unit–acquired hypernatraemia.
Fig. 2
Fig. 2
Free water deficit, hypotonic fluid volume, and urine output from the day when hypernatraemia first developed.
Fig. 3
Fig. 3
Free water deficit, hypotonic fluid volume, and urine output with respect to the day when peak hypernatraemia occurred.
Fig. 4
Fig. 4
Urinary sodium and urinary osmolarity when measured.
See this image and copyright information in PMC

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