Dysnatremia in the ICU.
OBJECTIVE
Dysnatremias, disorders of sodium concentration, are exceedingly common in critically ill patients and confer increased risk for adverse outcomes including mortality. The physiology that underpins the diagnosis and management of these disorders is complex. This review seeks to discuss current literature regarding the pathophysiology, diagnosis, epidemiology, and management of these disorders.


RESULTS
The role of arginine vasopressin in the maintenance of normal and pathologic plasma osmolality increasingly is refined, improving our ability to diagnose and understand dysnatremia. Identified recent epidemiologic studies highlight the frequent hospital acquisition or exacerbation of dysnatremia, confirm the recognized adverse consequences and explore the potential causality. Despite the complex nature of these disorders, simple consensus treatment strategies have emerged.


CONCLUSIONS
Dysnatremia remains a common disorder across the spectrum of critically ill patients. It is frequently hospital acquired. Simplified treatment regimens are proposed and the potential for prevention or earlier recognition and intervention is emphasized. Future directions of interest include further exploration of how dysnatremia contributes to adverse outcomes and new treatment strategies.
Section of Nephrology and Hypertension, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Milap
M
Pokaharel
Clay A
CA
Block
D003422:Critical Care; D016638:Critical Illness; D006801:Humans; D006955:Hypernatremia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D007010:Hyponatremia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D011379:Prognosis; D012306:Risk; D014481:United States / Q000453:epidemiology; D014667:Vasopressins / Q000037:antagonists & inhibitors
D014667:Vasopressins