title: Increased mortality in hypernatremic burned patients.
abstract: BACKGROUND
  In-hospital hypernatremia develops usually iatrogenically from inadequate or inappropriate fluid prescription. In severely burned patient an extensive initial fluid resuscitation is necessary for burn shock survival. After recovering of cellular integrity the circulating volume has to be normalized. Hereby extensive water and electrolyte shifts can provoke hypernatremia.
  
  
  OBJECTIVE
  Is a hypernatremic state associated with increased mortality?
  
  
  METHODS
  Retrospective study for the incidence of hypernatremia and survival in 40 patients with a totally burned surface area (TBSA) >10%. Age, sex, TBSA, ABSI-Score and fluid resuscitation within the first 24 hours were analyzed. Patients were separated in two groups without (Group A) or with (Group B) hypernatremia.
  
  
  RESULTS
  Hypernatremia occurred on day 5+/-1.4. No significant difference for age, sex, TBSA, ABSI-Score and fluid resuscitation within the first 24 hours were calculated. In Group A all patients survived, while 3 of the hypernatremic patient in Group B died during ICU-stay (Odds-ratio = 1.25; 95% CI 0.971-1.61; p=0.046).
  
  
  CONCLUSIONS
  Burned patients with an in-hospital acquired hypernatremia have an increased mortality risk. In case of a hypernatremic state early intervention is obligatory. There is a need of a fluid removal strategy in severely burned patient to avoid water imbalance.
authors.affiliation: Department of Plastic and Hand Surgery, Burn Unit, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany. thomas.namdar@uk-sh.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Namdar
authors.forename: Frank
authors.initials: F
authors.lastname: Siemers
authors.forename: Peter L
authors.initials: PL
authors.lastname: Stollwerck
authors.forename: Felix H
authors.initials: FH
authors.lastname: Stang
authors.forename: Peter
authors.initials: P
authors.lastname: Mailänder
authors.forename: Thomas
authors.initials: T
authors.lastname: Lange
mesh_terms: D000328:Adult; D000368:Aged; D002056:Burns / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D006955:Hypernatremia / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D014883:Water-Electrolyte Imbalance / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy