Article ; Online: Hypernatremia in the intensive care unit.
Current opinion in nephrology and hypertension
2021 Volume 31, Issue 2, Page(s) 199–204
Abstract: Purpose of review: Hypernatremia is a relatively frequent electrolyte disorder seen in critically ill patients. As many as 27% of patients in intensive care units (ICUs) develop hypernatremia of variable severity during an ICU stay. Debate among ... ...
| Abstract | Purpose of review: Hypernatremia is a relatively frequent electrolyte disorder seen in critically ill patients. As many as 27% of patients in intensive care units (ICUs) develop hypernatremia of variable severity during an ICU stay. Debate among specialists often ensues as to whether to correct hypernatremia or not. Some practitioners, particularly intensivists, believe that correction of hypernatremia with fluids may cause expansion of the extracellular fluid volume (ECFV) thereby worsening ventilation and impeding extubation. Other practitioners, including many nephrologists, do not expect correction of hypernatremia to lead to clinically apparent ECFV expansion, and fear other deleterious effects of hypernatremia. In this review we address the controversy regarding appropriate practice. Recent findings: There are no randomized, clinical trials (RCTs) to guide the administration of electrolyte-free fluid administration in hypernatremic patients. However, there are associations, demonstrated in the literature, suggesting that hypernatremia of any severity will increase the mortality and length of stay in these patients. These associations generally support the practice of correction of hypernatremia. In addition, our knowledge of the distribution of total body water influences us towards correcting hypernatremia as an appropriate therapy. We do not expect that adequate RCTs addressing this question will be performed. Summary: Allowing persistence of any degree of hypernatremia is associated with increased mortality, length of stay (LOS) and postdischarge mortality. We expect that proper use of electrolyte-free water intake will avoid adverse outcomes. |
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| MeSH term(s) | Critical Illness ; Humans ; Hypernatremia/complications ; Hypernatremia/therapy ; Intensive Care Units ; Length of Stay ; Water-Electrolyte Imbalance/complications ; Water-Electrolyte Imbalance/therapy |
| Language | English |
| Publishing date | 2021-12-23 |
| Publishing country | England |
| Document type | Journal Article ; Review |
| ZDB-ID | 1151092-4 |
| ISSN | 1473-6543 ; 1535-3842 ; 1062-4813 ; 1062-4821 |
| ISSN (online) | 1473-6543 ; 1535-3842 |
| ISSN | 1062-4813 ; 1062-4821 |
| DOI | 10.1097/MNH.0000000000000773 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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