Mandal A K, Saklayen M G, Hillman N M, Markert R J
Department of Medicine, Veterans Affairs Medical Center, Dayton, OH, USA.
Am J Emerg Med. 1997 Mar;15(2):130-2. doi: 10.1016/s0735-6757(97)90082-6.
Hypernatremia (serum sodium level of > 145 mEq/L) is associated with high mortality. This study reports an analysis of mortality in 116 patients with hypernatremia from two large university-affiliated teaching hospitals. The purpose was to identify factors predictive of high mortality in hypernatremic patients. Medical records were reviewed to obtain the following data: serum sodium (Na+) levels; systolic (S) and diastolic (D) blood pressure (BP) at the time of admission and throughout the hospital course; status of cognitive function; and type of fluid administered. The patients were divided into two groups: expired and survived. Seventy-seven of 116 patients (66%) expired, while 39 patients (34%) survived and were discharged from the hospital. The mean age and gender for patients who died (70.9 +/- 15.4 years, 90% men) were not different from those who survived (66.4 +/- 17.3 years, 87% men). For the serum Na+ levels recorded at three different times (early, peak, and late), mean late serum Na+ level during hospital course was significantly higher in patients who died than in those who survived (151.2 +/- 9.2 v 143.1 +/- 8.0 mEq/L, respectively; P < .001). Mean admission serum Na+ level (154.9 +/- 5.5 v 155.1 +/- 7.7 mEq/L, respectively) and mean peak serum Na+ level (157.5 +/- 6.5 v 156.8 +/- 9.4 mEq/L, respectively) were not different between the two groups. Both SBP and DBP at the time of admission (P < .05) and throughout the hospital course (P < .001) were significantly lower in the patients who died than in those who survived. The cognitive abnormalities consisting of confusion, obtundation, and speech abnormality were significantly (P < .05) higher in the expired patients than in those who survived. Normal (isotonic) saline was used significantly more frequently (P < .00001) in patients who expired than in those who survived. Thus, this study suggests that a persistently elevated serum Na+ level (possibly caused by prolonged infusion of normal saline) in association with protracted hypotension portends a dismal prognosis in hospitalized hypernatremic patients.
高钠血症（血清钠水平>145 mEq/L）与高死亡率相关。本研究报告了对来自两家大型大学附属医院的116例高钠血症患者死亡率的分析。目的是确定高钠血症患者高死亡率的预测因素。查阅病历以获取以下数据：血清钠（Na+）水平；入院时及整个住院过程中的收缩压（S）和舒张压（D）；认知功能状态；以及所输注液体的类型。患者分为两组：死亡组和存活组。116例患者中有77例（66%）死亡，39例（34%）存活并出院。死亡患者的平均年龄和性别（70.9±15.4岁，90%为男性）与存活患者（66.4±17.3岁，87%为男性）无差异。在三个不同时间点（早期、峰值和晚期）记录的血清Na+水平中，死亡患者住院期间的平均晚期血清Na+水平显著高于存活患者（分别为151.2±9.2 vs 143.1±8.0 mEq/L；P<.001）。两组的平均入院血清Na+水平（分别为154.9±5.5 vs 155.1±7.7 mEq/L）和平均峰值血清Na+水平（分别为157.5±6.5 vs 156.8±9.4 mEq/L）无差异。死亡患者入院时（P<.05）及整个住院过程中的收缩压和舒张压（P<.001）均显著低于存活患者。死亡患者中由意识模糊、迟钝和言语异常组成的认知异常显著高于存活患者（P<.05）。死亡患者比存活患者更频繁地使用生理盐水（P<.00001）。因此，本研究表明，持续升高的血清Na+水平（可能由长期输注生理盐水引起）与持续性低血压相关，预示着住院高钠血症患者预后不良。
