Lindner Gregor, Schwarz Christoph, Kneidinger Nikolaus, Kramer Ludwig, Oberbauer Rainer, Druml Wilfred
Clinic for Internal Medicine III, Medical University of Vienna, Wien, Austria.
Nephrol Dial Transplant. 2008 Nov;23(11):3501-8. doi: 10.1093/ndt/gfn476. Epub 2008 Aug 22.
Hypernatraemia is common in intensive care patients and may present an independent risk factor of mortality. Several formulae have been proposed to guide infusion therapy for correction of serum sodium. Unfortunately, these formulae have never been validated comparatively. We assessed the predictive potential of four different formulae (Adrogué-Madias, Barsoum-Levine, Kurtz-Nguyen and a simple formula based on electrolyte-free water clearance) in correction and maintenance of serum sodium in 66 hyper- and normonatraemic ICU patients.
With daily measurements of sodium/potassium and fluid/electrolyte balances, a day-to-day prediction of serum sodium levels was calculated using the four formulae. This was compared to the measured changes in serum sodium.
Six hundred and eighty-one patient-days (194 hypernatraemic) in 66 patients were available for calculations. Prediction of serum sodium levels using all four formulae correlated significantly (P < 0.05) with measured changes in serum sodium. Individual variations were extreme, and the mean differences (+/-SD) for predicted versus measured serum sodium were within the range of 3.4-4.5 (+/-4.4-4.7) mmol/l similar for the Adrogué-Madias, Barsoum-Levine and Nguyen-Kurtz formulae. In comparison, our proposed formula underestimated the changes of serum sodium (mean +/- SD -1.5 +/- 5.3). During hypernatraemia, the differences between predicted and measured values were even greater (mean +/- SD 5.0-6.7 +/- 3.9-4.3) using the published formulae compared to our formula (mean +/- SD 0.2 +/- 4.0).
Currently available formulae to guide infusion therapy in hyper- and normonatraemic states do not accurately predict changes of serum sodium in the individual ICU patient. In clinical practice, infusion therapy should be based on the reasons for hypernatraemia and serial measurements of serum sodium to avoid evolution of derangements.
高钠血症在重症监护患者中很常见，可能是死亡率的独立危险因素。已经提出了几种公式来指导输注治疗以纠正血清钠。不幸的是，这些公式从未经过比较验证。我们评估了四种不同公式（阿德罗格 - 马迪亚斯公式、巴尔苏姆 - 莱文公式、库尔茨 - 阮公式以及基于无电解质水清除率的简单公式）对66例高钠血症和正常钠血症ICU患者血清钠的纠正和维持的预测潜力。
通过每日测量钠/钾和液体/电解质平衡，使用这四种公式计算血清钠水平的每日预测值。将其与测量的血清钠变化进行比较。
66例患者中有681个患者日（194个高钠血症患者日）可用于计算。使用所有四种公式预测血清钠水平与测量的血清钠变化显著相关（P < 0.05）。个体差异极大，阿德罗格 - 马迪亚斯公式、巴尔苏姆 - 莱文公式和阮 - 库尔茨公式预测血清钠与测量血清钠的平均差异（±标准差）在3.4 - 4.5（±4.4 - 4.7）mmol/L范围内。相比之下，我们提出的公式低估了血清钠的变化（平均±标准差 -1.5±5.3）。在高钠血症期间，与我们的公式（平均±标准差0.2±4.0）相比，使用已发表的公式时预测值与测量值之间的差异更大（平均±标准差5.0 - 6.7±3.9 - 4.3）。
目前用于指导高钠血症和正常钠血症状态下输注治疗的公式不能准确预测个体ICU患者血清钠的变化。在临床实践中，输注治疗应基于高钠血症的原因和血清钠的系列测量，以避免紊乱的进展。
