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Anaesthesia


Title:Acquired hypernatraemia is an independent predictor of mortality in critically ill patients
Author(s):O'Donoghue, S. D. Dulhunty, J. M. Bandeshe, H. K. Senthuran, S. Gowardman, J. R.
Address:Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. Steve_O'Donoghue@health.qld.gov.au
Year:2009 May
Journal Title:Anaesthesia
Page Number:514-20
Language:eng
Volume:64
Issue:5
ISSN/ISBN:1365-2044 (Electronic). 0003-2409 (Linking)
Abstract:This study reports the incidence and associated mortality of acquired hypernatraemia (Na > 150 mmol x l(-1)) in a general medical/surgical intensive care unit. Patients admitted over a 5-year period with normal sodium values were eligible for inclusion; exclusions were made for burn/neurosurgical diagnoses and for hypertonic saline therapy. From 3475 admissions (3317 patients), 266 (7.7%) episodes of hypernatraemia were observed. Hospital mortality was 33.5% in the hypernatraemic group and 7.7% in the normonatraemic group (p < 0.001). Acquired hypernatraemia was an independent risk factor for in-hospital mortality (OR 1.97, 95% CI 1.37-2.82, p < 0.001). Intermediate sodium levels (145-150 mmol x l(-1)) were associated with increased mortality (OR 1.42, 95% CI 1.02-1.98). Uncorrected sodium at discharge (p = 0.001) and peak sodium (p = 0.001) were better predictors of mortality than time to onset (p = 0.71) and duration of hypernatraemia (p = 1.0). Hypernatraemia avoidance is justified, but determinants of hypernatraemia and benefits of targeted treatment strategies require further elucidation.

 
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