Choo Wai-Ping, Groeneveld A B Johan, Driessen Ronald H, Swart Eleonora L
Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands.
Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands.
J Crit Care. 2014 Jun;29(3):390-4. doi: 10.1016/j.jcrc.2014.01.025. Epub 2014 Feb 3.
We wanted to identify modifiable risk factors for intensive care unit (ICU)-acquired hypernatremia.
We retrospectively studied sodium and fluid loads and balances up to 7 days prior to the development of hypernatremia (first serum sodium concentration, [Na+], >150 mmol/L; H) vs control (maximum [Na+] ≤150 mmol/L; N), in consecutive patients admitted into the ICU with a normal serum sodium (<145 mmol/L) and without cerebral disease, within a period of 8 months.
There were 57 H and 150 N patients. Severity of disease and organ failure was greater, and length of stay and mechanical ventilation in the ICU were longer in H (P<.001), with a mortality rate of 28% vs 16% in N (P=.002). Sodium input was higher in H than in N, particularly from 0.9% saline to dissolve drugs for infusion and to keep catheters open during the week prior to the first day of hypernatremia (P<.001). Fluid balances were positive and did not differ from N on most days in the presence of slightly higher plasma creatinine and more frequent administration of furosemide, at higher doses, in H than in N.
High sodium input by 0.9% saline used to dilute drugs and keep catheters open is a modifiable risk factor for ICU-acquired H. Dissolving drugs in dextrose 5% may partially prevent potentially harmful sodium overloading and H.
我们希望确定重症监护病房（ICU）获得性高钠血症的可改变危险因素。
我们回顾性研究了连续8个月内入住ICU且血清钠正常（<145 mmol/L）且无脑部疾病的患者，在高钠血症发生前（首次血清钠浓度，[Na+]，>150 mmol/L；H组）与对照组（最大[Na+]≤150 mmol/L；N组）直至7天的钠和液体输入量及平衡情况。
有57例H组患者和150例N组患者。H组患者的疾病严重程度和器官衰竭程度更高，ICU住院时间和机械通气时间更长（P<0.001），死亡率为28%，而N组为16%（P=0.002）。H组的钠输入量高于N组，尤其是在高钠血症第一天前一周内用于溶解输注药物和保持导管通畅的0.9%生理盐水（P<0.001）。在大多数日子里，H组的液体平衡为正，与N组无差异，只是H组的血浆肌酐略高，且更频繁地给予更高剂量的呋塞米。
用于稀释药物和保持导管通畅的0.9%生理盐水导致的高钠输入是ICU获得性高钠血症的一个可改变危险因素。将药物溶解在5%葡萄糖中可能部分预防潜在有害的钠超载和高钠血症。
