title: Advanced age, altered level of consciousness and a new diagnosis of diabetes are independently associated with hypernatreamia in hyperglycaemic crisis.
abstract: BACKGROUND
  There is limited literature on hypernatreamia in the setting of hyperglycaemic crisis. This is despite the fact that the presence of hypernatreamia may impact on the classification of hyperglycaemic crisis and its management particularly with regards to the nature of fluid therapy. We determined the prevalence of hypernatreamia and its associated factors at presentation for hyperglycaemic crisis.
  
  
  METHODS
  This was a retrospective review of data for hyperglycaemic crisis admissions in Nelson Mandela Academic Hospital, Mthatha, South Africa. The prevalence of hypernatreamia (uncorrected Serum Sodium at presentation >145 mmol/L) was determined. Hyperosmolality was defined by calculated effective osmolality >320 mosmols/Kg. Multivariate logistic regression was undertaken using variables that were statistically significant in univariate analysis to ascertain those that were independently associated (Odds Ratio (OR) with 95% Confidence Interval (CI)) with hypernatreamia.
  
  
  RESULTS
  The prevalence of hypernatreamia in our admissions for hyperglycaemic crisis was 11.7% (n = 32/273 including 171 females and 102 males). All admissions with hypernatreamia met the criteria for hyperosmolality. Age ≥ 60 years (OR = 3.9 95% CI 1.3-12.3; P = 0.018), Altered level of consciousness (OR = 8.8 95% CI 2.3-32.8; P < 0.001) and a new diagnosis of diabetes (OR = 3.7 95%CI 1.2-11.5; P = 0.025) were independently associated with hypernatreamia.
  
  
  CONCLUSIONS
  The prevalence rate of hypernatreamia in hyperglycaemic admissions was high with all hypernatreamic admissions meeting the criteria for hyperosmolality. Advanced age, altered conscious level and a new diagnosis of diabetes were independently associated with hypernatreamia.
authors.affiliation: Department of Internal Medicine, Faculty of Health Sciences, Walter Sisulu University/Nelson Mandela Academic Hospital, Mthatha, Eastern Cape Province, South Africa. longombenza@yahoo.fr.
authors.forename: Chukwuma O
authors.initials: CO
authors.lastname: Ekpebegh
authors.forename: Benjamin
authors.initials: B
authors.lastname: Longo-Mbenza
authors.forename: Augustin
authors.initials: A
authors.lastname: Nge-Okwe
authors.forename: Anthonia O
authors.initials: AO
authors.lastname: Ogbera
authors.forename: Nomawethu T
authors.initials: NT
authors.lastname: Tonjeni