title: Early intensive care unit-acquired hypernatremia in severe sepsis patients receiving 0.9% saline fluid resuscitation.
abstract: BACKGROUND
  Intensive care unit (ICU)-acquired hypernatremia is associated with increased mortality and ascribed to excessive sodium/insufficient free water intakes. We aimed to determine whether the volume of intravenous 0.9% saline fluid resuscitation was associated with hypernatremia in severe sepsis.
  
  
  METHODS
  We retrospectively reviewed the charts of patients admitted to our medical ICU over 1 year with severe sepsis, and recorded all fluid intakes and plasma sodium levels (Nap ) for 5 days along with clinical data. ΔNap was defined as the difference between maximal Nap reached and initial Nap . Hypernatremia was defined as Nap  > 145 mmoles/l.
  
  
  RESULTS
  Among 95 patients with severe sepsis, 29 developed hypernatremia within 5 days (31%), reaching a maximum Nap of 149.1 ± 2.5 mmoles/l on average 3.8 ± 1.5 days after admission. For every 50-ml/kg increase in 0.9% saline intake for the first 48 h, the odds of hypernatremia were 1.61 times larger [confidence interval (CI): 0.98-2.62; P = 0.06] and the mean of ΔNap increased by 1.86 mmoles/l (CI: 0.86-2.86; P < 0.001). Compared with non-hypernatremic patients, hypernatremic patients received more 0.9% saline within the first 48 h (111 ± 50 ml/kg vs. 92 ± 42 ml/kg, P < 0.05) and more other fluids from 48 to 96 h (64 ± 38 ml/kg vs. 42 ± 24 ml/kg, P < 0.05). Patients developing hypernatremia had increased length of mechanical ventilation (12.0 ± 12.6 vs. 9.1 ± 7.2 days, P < 0.05) and ICU mortality (38.5% vs. 13%, P < 0.01).
  
  
  CONCLUSIONS
  Early acquired hypernatremia is a frequent complication in severe sepsis patients and is associated with the volume of 0.9% saline received during the first 48 h of admission.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Penn State University College of Medicine, Hershey, PA, USA.
authors.forename: A
authors.initials: A
authors.lastname: VAN DE Louw
authors.forename: C
authors.initials: C
authors.lastname: Shaffer
authors.forename: E
authors.initials: E
authors.lastname: Schaefer
mesh_terms: D000328:Adult; D000368:Aged; D001835:Body Weight; D005260:Female; D005440:Fluid Therapy; D017052:Hospital Mortality; D006801:Humans; D006955:Hypernatremia / Q000139:chemically induced*; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012151:Resuscitation; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000628:therapy*; D012965:Sodium Chloride / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D012996:Solutions; D013997:Time Factors; D014882:Water-Electrolyte Balance
chemical_list: D012996:Solutions; D012965:Sodium Chloride