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Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 7/2010

01-07-2010 | Reports of Original Investigations

Characterization of intensive care unit acquired hyponatremia and hypernatremia following cardiac surgery

Authors: Henry Thomas Stelfox, MD, PhD, Sofia B. Ahmed, MD, David Zygun, MD, Farah Khandwala, MSc, Kevin Laupland, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 7/2010

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Abstract

Purpose

Although intensive care unit (ICU) acquired sodium disturbances are common in critically ill patients, few studies have examined sodium disturbances in patients following cardiac surgery. The objective of this study was to describe the epidemiology of ICU-acquired hyponatremia and hypernatremia in patients following cardiac surgery.

Methods

We identified 6,727 adults (≥18 yr) who were admitted consecutively to a regional cardiovascular intensive care unit (CVICU) from January 1, 2000 to December 31, 2006 and were documented as having normal serum sodium levels (133 to 145 mmol·L−1) during the first day of ICU admission. ICU-acquired hyponatremia and hypernatremia were defined as a change in serum sodium concentration to <133 mmol·L−1 or >145 mmol·L−1, respectively, following ICU day one.

Results

A first episode of ICU-acquired hyponatremia and hypernatremia developed in 785 (12%) and 242 (4%) patients, respectively, (95% confidence interval [CI] 11-12% and 95% CI 3-4%, respectively), with a respective incidence density of 4.2 and 1.3 patients per 100 days of ICU admission (95% CI 4.0-4.5 and 95% CI 1.2-1.5). The incidence of ICU-acquired sodium disturbances varied according to the patients’ demographic and clinical variables for both hyponatremia (age, diabetes, Acute Physiology and Chronic Health Evaluation [APACHE II] score, mechanical ventilation, length of ICU stay, serum glucose level, and serum potassium level) and hypernatremia (APACHE II score, mechanical ventilation, length of hospital stay prior to ICU admission, length of ICU stay, serum glucose level, and serum potassium level). Compared with patients with normal serum sodium levels, hospital mortality was increased in patients with ICU-acquired hyponatremia (1.6% vs 10%, respectively; P < 0.001) and ICU-acquired hypernatremia (1.6% vs 14%, respectively; P < 0.001).

Conclusion

ICU-acquired hyponatremia and hypernatremia are common complications in critically ill patients following cardiac surgery. They are associated with patient demographic and clinical characteristics and an increased risk of hospital mortality.
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Literature
1.
go back to reference Arieff AI. Acid-base, electrolyte, and metabolic abnormalities. In: Parrillo JE, Dellinger RP (Eds). Critical Care Medicine: Principles of Diagnosis and Management in the Adult, 2nded. St. Louis: Mosby; 2002. Arieff AI. Acid-base, electrolyte, and metabolic abnormalities. In: Parrillo JE, Dellinger RP (Eds). Critical Care Medicine: Principles of Diagnosis and Management in the Adult, 2nded. St. Louis: Mosby; 2002.
2.
go back to reference Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818-29.CrossRefPubMed Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818-29.CrossRefPubMed
3.
go back to reference Polderman KH, Schreuder WO, Strack van Schijndel RJ, Thijs LG. Hypernatremia in the intensive care unit: an indicator of quality of care? Crit Care Med 1999; 27: 1105-8.CrossRefPubMed Polderman KH, Schreuder WO, Strack van Schijndel RJ, Thijs LG. Hypernatremia in the intensive care unit: an indicator of quality of care? Crit Care Med 1999; 27: 1105-8.CrossRefPubMed
4.
go back to reference Stelfox HT, Ahmed SB, Khandwala F, Zygun D, Shahpori R, Laupland K. The epidemiology of intensive care unit-acquired hyponatraemia and hypernatraemia in medical-surgical intensive care units. Crit Care 2008; 12: R162.CrossRefPubMed Stelfox HT, Ahmed SB, Khandwala F, Zygun D, Shahpori R, Laupland K. The epidemiology of intensive care unit-acquired hyponatraemia and hypernatraemia in medical-surgical intensive care units. Crit Care 2008; 12: R162.CrossRefPubMed
5.
go back to reference Lindner G, Funk GC, Schwarz C, et al. Hypernatremia in the critically ill is an independent risk factor for mortality. Am J Kidney Dis 2007; 50: 952-7.CrossRefPubMed Lindner G, Funk GC, Schwarz C, et al. Hypernatremia in the critically ill is an independent risk factor for mortality. Am J Kidney Dis 2007; 50: 952-7.CrossRefPubMed
6.
go back to reference Bennani SL, Abouqal R, Zeggwagh AA, et al. Incidence, causes and prognostic factors of hyponatremia in intensive care (French). Rev Med Interne 2003; 24: 224-9.CrossRefPubMed Bennani SL, Abouqal R, Zeggwagh AA, et al. Incidence, causes and prognostic factors of hyponatremia in intensive care (French). Rev Med Interne 2003; 24: 224-9.CrossRefPubMed
7.
go back to reference Fitzsimons MG, Agnihotri AK. Hyponatremia and cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2007; 21: 273-5.CrossRefPubMed Fitzsimons MG, Agnihotri AK. Hyponatremia and cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2007; 21: 273-5.CrossRefPubMed
8.
go back to reference Chung HM, Kluge R, Schrier RW, Anderson RJ. Postoperative hyponatremia, A prospective study. Arch Intern Med 1986; 146: 333-6.CrossRefPubMed Chung HM, Kluge R, Schrier RW, Anderson RJ. Postoperative hyponatremia, A prospective study. Arch Intern Med 1986; 146: 333-6.CrossRefPubMed
9.
go back to reference Polderman KH, Girbes AR. Severe electrolyte disorders following cardiac surgery: a prospective controlled observational study. Crit Care 2004; 8: R459-66.CrossRefPubMed Polderman KH, Girbes AR. Severe electrolyte disorders following cardiac surgery: a prospective controlled observational study. Crit Care 2004; 8: R459-66.CrossRefPubMed
12.
go back to reference Cullen DJ, Civetta JM, Briggs BA, Ferrara LC. Therapeutic intervention scoring system: a method for quantitative comparison of patient care. Crit Care Med 1974; 2: 57-60.CrossRefPubMed Cullen DJ, Civetta JM, Briggs BA, Ferrara LC. Therapeutic intervention scoring system: a method for quantitative comparison of patient care. Crit Care Med 1974; 2: 57-60.CrossRefPubMed
13.
go back to reference Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Canadian Journal of Diabetes 2008; 32 (Suppl 1): iv-S201. Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Canadian Journal of Diabetes 2008; 32 (Suppl 1): iv-S201.
14.
go back to reference Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics 1986; 42: 121-30.CrossRefPubMed Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics 1986; 42: 121-30.CrossRefPubMed
15.
go back to reference Lipsitz SR, Fitzmaurice GM, Orav EJ, Laird NM. Performance of generalized estimating equations in practical situations. Biometrics 1994; 50: 270-8.CrossRefPubMed Lipsitz SR, Fitzmaurice GM, Orav EJ, Laird NM. Performance of generalized estimating equations in practical situations. Biometrics 1994; 50: 270-8.CrossRefPubMed
16.
go back to reference Pan W. Akaike’s information criterion in generalized estimating equations. Biometrics 2001; 57: 120-5.CrossRefPubMed Pan W. Akaike’s information criterion in generalized estimating equations. Biometrics 2001; 57: 120-5.CrossRefPubMed
17.
go back to reference Polderman KH, Peerdeman SM, Girbes AR. Hypophosphatemia and hypomagnesemia induced by cooling in patients with severe head injury. J Neurosurg 2001; 94: 697-705.CrossRefPubMed Polderman KH, Peerdeman SM, Girbes AR. Hypophosphatemia and hypomagnesemia induced by cooling in patients with severe head injury. J Neurosurg 2001; 94: 697-705.CrossRefPubMed
18.
go back to reference Gheorghiade M, Abraham WT, Albert NM, et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J 2007; 28: 980-8.CrossRefPubMed Gheorghiade M, Abraham WT, Albert NM, et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J 2007; 28: 980-8.CrossRefPubMed
19.
go back to reference Gheorghiade M, Rossi JS, Cotts W, et al. Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE Trial. Arch Intern Med 2007; 167: 1998-2005.CrossRefPubMed Gheorghiade M, Rossi JS, Cotts W, et al. Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE Trial. Arch Intern Med 2007; 167: 1998-2005.CrossRefPubMed
20.
go back to reference Klein L, O’Connor CM, Leimberger JD, et al. Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure: results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study. Circulation 2005; 111: 2454-60.CrossRefPubMed Klein L, O’Connor CM, Leimberger JD, et al. Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure: results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study. Circulation 2005; 111: 2454-60.CrossRefPubMed
Metadata
Title
Characterization of intensive care unit acquired hyponatremia and hypernatremia following cardiac surgery
Authors
Henry Thomas Stelfox, MD, PhD
Sofia B. Ahmed, MD
David Zygun, MD
Farah Khandwala, MSc
Kevin Laupland, MD
Publication date
01-07-2010
Publisher
Springer-Verlag
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 7/2010
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-010-9309-1

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