title: Severe hypernatremia correction rate and mortality in hospitalized patients.
abstract: BACKGROUND
  Hypernatremia is a common problem in hospitalized patients and is associated with high morbidity and mortality. This study was designed to evaluate whether physicians follow the recommended guidelines for the rate of correction of hypernatremia of ≤0.5 mEq/L/hr and to evaluate the effect of the rate of correction of severe hypernatremia on the mortality of hospitalized patients.
  
  
  METHODS
  A retrospective chart review of 131 consecutively hospitalized patients with severe hypernatremia (serum sodium ≥155 mEq/L) was performed. Primary outcomes were 30-day patient mortality and 72-hour hypernatremia correction. The first 24-hour serum sodium (Na(+)) correction rate was tested as a categorical variable; slow rate (<0.25 mEq/L/hr) and fast rate (≥0.25 mEq/L/hr).
  
  
  RESULTS
  The mean admission serum Na level was 159 ± 3 mEq/L. Ninety percent of patients received the recommended <0.5 mEq/L/hr serum Na(+) correction rate; however, hypernatremia was corrected only in 27% of patients after 72 hours of treatment. Thirty-day patient mortality rate was 37%. In multivariable analysis, do not resuscitate status [hazards ratio (HR), 3.85; P < 0.0001], slower correction rate of hypernatremia (HR, 2.63; P = 0.02) and high heart rate (>100 beats/min; HR, 1.99; P = 0.03) were the independent predictors of 30-day mortality.
  
  
  CONCLUSIONS
  In patients with severe hypernatremia, the rate of correction of hypernatremia was slow and resulted in inadequate correction in majority of the patients. Both slow rate of hypernatremia correction during the first 24 hours and do not resuscitate status were found to be significant predictors of 30-day patient mortality.
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Hala M
authors.initials: HM
authors.lastname: Alshayeb
authors.forename: Arif
authors.initials: A
authors.lastname: Showkat
authors.forename: Fatima
authors.initials: F
authors.lastname: Babar
authors.forename: Therese
authors.initials: T
authors.lastname: Mangold
authors.forename: Barry M
authors.initials: BM
authors.lastname: Wall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005440:Fluid Therapy; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D006955:Hypernatremia / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D012964:Sodium