Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Am J Med Sci. 2011 May;341(5):356-60. doi: 10.1097/MAJ.0b013e31820a3a90.
Hypernatremia is a common problem in hospitalized patients and is associated with high morbidity and mortality. This study was designed to evaluate whether physicians follow the recommended guidelines for the rate of correction of hypernatremia of ≤0.5 mEq/L/hr and to evaluate the effect of the rate of correction of severe hypernatremia on the mortality of hospitalized patients.
A retrospective chart review of 131 consecutively hospitalized patients with severe hypernatremia (serum sodium ≥155 mEq/L) was performed. Primary outcomes were 30-day patient mortality and 72-hour hypernatremia correction. The first 24-hour serum sodium (Na(+)) correction rate was tested as a categorical variable; slow rate (<0.25 mEq/L/hr) and fast rate (≥0.25 mEq/L/hr).
The mean admission serum Na level was 159 ± 3 mEq/L. Ninety percent of patients received the recommended <0.5 mEq/L/hr serum Na(+) correction rate; however, hypernatremia was corrected only in 27% of patients after 72 hours of treatment. Thirty-day patient mortality rate was 37%. In multivariable analysis, do not resuscitate status [hazards ratio (HR), 3.85; P < 0.0001], slower correction rate of hypernatremia (HR, 2.63; P = 0.02) and high heart rate (>100 beats/min; HR, 1.99; P = 0.03) were the independent predictors of 30-day mortality.
In patients with severe hypernatremia, the rate of correction of hypernatremia was slow and resulted in inadequate correction in majority of the patients. Both slow rate of hypernatremia correction during the first 24 hours and do not resuscitate status were found to be significant predictors of 30-day patient mortality.
高钠血症是住院患者中常见的问题，与高发病率和死亡率相关。本研究旨在评估医生是否遵循建议的高钠血症纠正速度≤0.5 mEq/L/hr 的指南，并评估严重高钠血症纠正速度对住院患者死亡率的影响。
对 131 例连续住院的严重高钠血症（血清钠≥155 mEq/L）患者进行回顾性图表审查。主要结局为 30 天患者死亡率和 72 小时高钠血症纠正。将第 24 小时血清钠（Na+）纠正率作为分类变量进行测试；速度较慢（<0.25 mEq/L/hr）和速度较快（≥0.25 mEq/L/hr）。
入院时血清 Na 水平的平均值为 159±3 mEq/L。90%的患者接受了建议的<0.5 mEq/L/hr 的血清 Na+纠正率；然而，72 小时治疗后仅 27%的患者纠正了高钠血症。30 天患者死亡率为 37%。多变量分析显示，不复苏状态[风险比（HR），3.85；P<0.0001]、高钠血症纠正速度较慢（HR，2.63；P=0.02）和高心率（>100 次/分钟；HR，1.99；P=0.03）是 30 天死亡率的独立预测因素。
在严重高钠血症患者中，高钠血症的纠正速度较慢，导致大多数患者纠正不足。在最初 24 小时内高钠血症纠正速度较慢和不复苏状态被发现是 30 天患者死亡率的显著预测因素。
