Zurnuq Sultan, Aljurfi Mahmoud, Albekery Mohamed, Shawaqfeh Mohammad S, Elmubark Ahmed, Vasudevan Senthilvel, Alharbi Shmeylan, Alkatheri Mohammed, Albekairy Abdulkareem M, Al Katheri Abdulmalik A
College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
King Fahd Military Medical Complex, Dhahran, Saudi Arabia.
SAGE Open Med. 2022 Apr 28;10:20503121221095333. doi: 10.1177/20503121221095333. eCollection 2022.
The aim of this study is to compare the adherence to the guidelines in patients presenting with hyponatremia defined as a sodium (Na) level ⩽120 mEq/L, treated with 3% hypertonic saline or normal saline. The comparison included 3% hypertonic saline use, safe serum sodium increases within 24 and 48 h, frequency of hyponatremia-related complications, and length of stay.
This retrospective observational study enrolled 122 patients with serum sodium ⩽120 mEq/L admitted to the Internal Medicine Department, King Abdulaziz Medical City, National Guard-Health Affairs (NGHA), Riyadh, Saudi Arabia, from January 2016 to December 2017. The patients were treated with either 3% hypertonic saline or normal saline.
Of the 122 patients, 105 (83.3%) received normal saline, and 17 (13.5%) received hypertonic saline. In the normal saline group, the mean serum sodium increase at 24 h was lower (6.60 ± 4.75) compared to the hypertonic saline group (9.24 ± 5.04). The length of stay was longer in the normal saline group (10.35 ± 13.90) compared to the hypertonic saline group (4.35 ± 3.39). A small proportion (8.7%) of the normal saline group had a serum sodium increase >12 mg/dL at 24 h compared to 29.4% for the hypertonic saline group, and the difference was statistically significant (p value = 0.013). Almost one-third of the sample (36%) presented with complications, the majority (77.3%, n = 34) had a serum sodium of ⩽115 mg/dL, and 22.7% (n = 10) with a serum sodium of 116-120 mg/dL (p value = 0.041).
Despite the strong recommendation for 3% hypertonic saline use in severe hyponatremia, many practitioners still use normal saline, even in patients with serum sodium ⩽120 mEq/L. Normal saline showed some efficacy in managing hyponatremia in asymptomatic cases; however, severe cases may have a delayed correction, hyponatremia-related complications, and an extended length of stay.
本研究旨在比较血清钠水平≤120 mEq/L的低钠血症患者使用3%高渗盐水或生理盐水治疗时对指南的遵循情况。比较内容包括3%高渗盐水的使用情况、24小时和48小时内血清钠安全升高幅度、低钠血症相关并发症的发生率以及住院时间。
这项回顾性观察性研究纳入了2016年1月至2017年12月在沙特阿拉伯利雅得国民警卫队卫生事务部阿卜杜勒阿齐兹国王医疗城内科住院的122例血清钠≤120 mEq/L的患者。这些患者接受了3%高渗盐水或生理盐水治疗。
122例患者中，105例（83.3%）接受了生理盐水治疗，17例（13.5%）接受了高渗盐水治疗。生理盐水组24小时时血清钠平均升高幅度（6.60±4.75）低于高渗盐水组（9.24±5.04）。生理盐水组的住院时间（10.35±13.90）长于高渗盐水组（4.35±3.39）。生理盐水组中一小部分（8.7%）患者24小时时血清钠升高幅度>12 mg/dL，而高渗盐水组为29.4%，差异具有统计学意义（p值=0.013）。近三分之一的样本（36%）出现了并发症，大多数（77.3%，n=34）血清钠≤115 mg/dL，22.7%（n=10）血清钠为116 - 120 mg/dL（p值=0.041）。
尽管强烈推荐在严重低钠血症中使用3%高渗盐水，但许多从业者仍使用生理盐水，即使是血清钠≤120 mEq/L的患者。生理盐水在无症状低钠血症病例的管理中显示出一定疗效；然而，严重病例可能会出现纠正延迟、低钠血症相关并发症以及住院时间延长的情况。
