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Open Access Research article

Undercorrection of hypernatremia is frequent and associated with mortality

Stanislas Bataille1*, Camille Baralla2, Dominique Torro2, Christophe Buffat3, Yvon Berland1, Marc Alazia2, Anderson Loundou4, Pierre Michelet2 and Henri Vacher-Coponat1

Author Affiliations

1 Aix-Marseille University, APHM, Hôpital de la Conception, Centre de néphrologie et transplantation rénale, Marseille 13005, France

2 Aix-Marseille University, APHM, Hôpital de la Conception, Service d’accueil des urgences, Marseille 13005, France

3 Aix-Marseille University, APHM, Hôpital de la Conception, Laboratoire de Biochimie, Marseille 13005, France

4 Aix-Marseille University, Laboratoire de Santé Publique EA3279, Marseille 13284, France

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BMC Nephrology 2014, 15:37  doi:10.1186/1471-2369-15-37

Published: 21 February 2014

Abstract

Background

About 1% of patients admitted to the Emergency Department (ED) have hypernatremia, a condition associated with a mortality rate of 20 to 60%. Management recommendations originate from intensive care unit studies, in which patients and medical diseases differ from those in ED.

Methods

We retrospectively studied clinical characteristics, treatments, and outcomes of severely hypernatremic patients in the ED and risk factors associated with death occurrence during hospitalization.

Results

During 2010, 85 cases of severe hypernatremia ≥150 mmol/l were admitted to ED. Hypernatremia occurred in frail patients: mean age 79.7 years, 55% institutionalized, 28% with dementia.

Twenty four percent of patients died during hospitalization. Male gender and low mean blood pressure (MBP) were independently associated with death, as well as slow natremia correction speed, but not the severity of hyperosmolarity at admission. Infusion solute was inappropriate for 45% of patients with MBP <70 mmHg who received hypotonic solutes and 22% of patients with MBP ≥70 mmHg who received isotonic solutes or were not perfused.

Conclusions

This is the first study assessing outcome of hypernatremic patients in the ED according to the treatment provided. It appears that not only a too quick, but also a too slow correction speed is associated with an increased risk of death regardless of initial natremia. Medical management of hypernatremic patients must be improved regarding evaluation and treatment.

Keywords:
Intracellular dehydration; Dysnatremia; Hypernatremia; Renal failure; Emergency; Mortality