Amsterdam UMC location University of Amsterdam, Department of Internal Medicine Division of Nephrology, Amsterdam University Medical Centre, Location Academic Medical Centre, University of Amsterdam, Meibergdreef 9 PO Box 22660, 1100 DD, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands.
Department of Emergency Medicine, Kepler Universitätsklinikum GmbH, Linz, Austria; Department of Emergency Medicine, Inselspital, University Hospital Bern, Switzerland.
Eur J Intern Med. 2024 Nov;129:121-124. doi: 10.1016/j.ejim.2024.07.032. Epub 2024 Aug 2.
Rapid correction of dysnatremias can result in neurological complications. Therefore, various formulas are available to predict changes in plasma sodium concentration ([Na]) after treatment, but these have been shown to be inaccurate. This could be explained by sodium acumulation in skin and muscle tissue, which is not explicitly considered in these formulas. We assessed the association between clinical and biochemical factors related to tissue sodium accumulation and the discrepancy between predicted and measured plasma [Na].
We used data from an intensive care unit (ICU) cohort with complete data on sodium, potassium, and water balance. The predicted plasma [Na] was calculated using the Barsoum-Levine (BL) and the Nguyen-Kurtz (NK) formula. We calculated the discrepancy between predicted and measured plasma sodium and fitted a linear mixed-effect model to investigate its association with factors related to tissue sodium accumulation.
We included 594 ICU days of sixty-three patients in our analysis. The mean plasma [Na] at baseline was 147±6 mmol/L. The median (IQR) discrepancy between predicted and measured plasma [Na] was 3.14 mmol/L (1.48, 5.55) and 3.53 mmol/L (1.81, 6.44) for the BL and NK formulas, respectively. For both formulas, estimated total body water (p=0.027), initial plasma [Na] (p<0.001) and plasma [Na] change (p<0.001) were associated with the discrepancy between predicted and measured plasma [Na].
In this ICU cohort, initial plasma [Na], total body water, and plasma [Na] changes, all factors that are related to tissue sodium accumulation, were associated with the inaccurateness of plasma [Na] prediction.
快速纠正电解质紊乱可能导致神经并发症。因此，有多种公式可用于预测治疗后血浆钠浓度 ([Na]) 的变化，但这些公式已被证明不准确。这可能是由于钠在皮肤和肌肉组织中的积累，而这些公式并没有明确考虑到这一点。我们评估了与组织钠积累相关的临床和生化因素与预测和测量的血浆 [Na] 之间的差异之间的相关性。
我们使用了来自重症监护病房 (ICU) 队列的数据，这些数据包含完整的钠、钾和水平衡数据。使用 Barsoum-Levine (BL) 和 Nguyen-Kurtz (NK) 公式计算预测的血浆 [Na]。我们计算了预测和测量的血浆钠之间的差异，并拟合了线性混合效应模型，以研究其与组织钠积累相关因素的相关性。
我们纳入了 63 名患者的 594 个 ICU 日进行分析。基线时的平均血浆 [Na] 为 147±6 mmol/L。BL 和 NK 公式预测和测量的血浆 [Na] 之间的差异中位数 (IQR) 分别为 3.14 mmol/L (1.48, 5.55) 和 3.53 mmol/L (1.81, 6.44)。对于两种公式，估计的总体水量 (p=0.027)、初始血浆 [Na] (p<0.001) 和血浆 [Na] 变化 (p<0.001) 与预测和测量的血浆 [Na] 之间的差异相关。
在这个 ICU 队列中，初始血浆 [Na]、总体水量和血浆 [Na] 变化，所有与组织钠积累相关的因素，都与血浆 [Na] 预测的不准确性相关。
