title: Undercorrection of hypernatremia is frequent and associated with mortality.
abstract: BACKGROUND
  About 1% of patients admitted to the Emergency Department (ED) have hypernatremia, a condition associated with a mortality rate of 20 to 60%. Management recommendations originate from intensive care unit studies, in which patients and medical diseases differ from those in ED.
  
  
  METHODS
  We retrospectively studied clinical characteristics, treatments, and outcomes of severely hypernatremic patients in the ED and risk factors associated with death occurrence during hospitalization.
  
  
  RESULTS
  During 2010, 85 cases of severe hypernatremia ≥ 150 mmol/l were admitted to ED. Hypernatremia occurred in frail patients: mean age 79.7 years, 55% institutionalized, 28% with dementia.Twenty four percent of patients died during hospitalization. Male gender and low mean blood pressure (MBP) were independently associated with death, as well as slow natremia correction speed, but not the severity of hyperosmolarity at admission. Infusion solute was inappropriate for 45% of patients with MBP <70 mmHg who received hypotonic solutes and 22% of patients with MBP ≥ 70 mmHg who received isotonic solutes or were not perfused.
  
  
  CONCLUSIONS
  This is the first study assessing outcome of hypernatremic patients in the ED according to the treatment provided. It appears that not only a too quick, but also a too slow correction speed is associated with an increased risk of death regardless of initial natremia. Medical management of hypernatremic patients must be improved regarding evaluation and treatment.
authors.affiliation: Aix-Marseille University, APHM, Hôpital de la Conception, Centre de néphrologie et transplantation rénale, Marseille 13005, France. stanislas.bataille@ap-hm.fr.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Bataille
authors.forename: Camille
authors.initials: C
authors.lastname: Baralla
authors.forename: Dominique
authors.initials: D
authors.lastname: Torro
authors.forename: Christophe
authors.initials: C
authors.lastname: Buffat
authors.forename: Yvon
authors.initials: Y
authors.lastname: Berland
authors.forename: Marc
authors.initials: M
authors.lastname: Alazia
authors.forename: Anderson
authors.initials: A
authors.lastname: Loundou
authors.forename: Pierre
authors.initials: P
authors.lastname: Michelet
authors.forename: Henri
authors.initials: H
authors.lastname: Vacher-Coponat
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005440:Fluid Therapy / Q000379:methods* / Q000706:statistics & numerical data*; D005602:France / Q000453:epidemiology; D006801:Humans; D006955:Hypernatremia / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome