Increased mortality in hypernatremic burned patients.
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.
Namdar
Thomas
T
Department of Plastic and Hand Surgery, Burn Unit, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany. thomas.namdar@uk-sh.de
Siemers
Frank
F
Stollwerck
Peter L
PL
Stang
Felix H
FH
Mailänder
Peter
P
Lange
Thomas
T
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