title: Increased incidence of diuretic use in critically ill obese patients.
abstract: OBJECTIVE
  Sodium retention occurs commonly in cardiac and liver disease, requiring the administration of diuretics to restore fluid balance. Whether obesity is associated with sodium retention has not been fully evaluated.
  
  
  METHODS
  In a large single-center cohort of critically ill patients, we evaluated whether admission body mass index was associated with the administration of either oral or intravenous diuretics during the intensive care unit (ICU) stay.
  
  
  RESULTS
  Of 7724 critically ill patients, 3946 (51.1%) were prescribed diuretics during the ICU stay. Overweight, class I obesity, and class II/III obesity were associated with a 1.35 (95% confidence interval [CI], 1.20-1.53; P < .001), 1.56 (95% CI, 1.35-1.80; P < .001), and 1.91 (95% CI, 1.61-2.26; P < .001) adjusted risk of receiving diuretics within the ICU, respectively. In adjusted analysis, a 5-kg/m(2) increment of body mass index was associated with a 1.19 (95% CI, 1.14-1.23; P < .001) increased adjusted risk of within-ICU diuretics. Among those patients receiving loop diuretics, obese patients received significantly larger daily diuretic doses.
  
  
  CONCLUSIONS
  Critically ill obese patients are more likely to receive diuretics during their stay in the ICU and to receive higher dosages of diuretics. Our data suggest that obesity is an independent risk factor for sodium retention.
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Medicine.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: de Louw
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Medicine.
authors.forename: Pepijn O
authors.initials: PO
authors.lastname: Sun
authors.affiliation: Harvard-MIT Division of Health Sciences and Technology; School of Public Health and Health Systems, University of Waterloo.
authors.forename: Joon
authors.initials: J
authors.lastname: Lee
authors.affiliation: Harvard-MIT Division of Health Sciences and Technology; Institute for Infocomm Research, A*STAR, Singapore.
authors.forename: Mengling
authors.initials: M
authors.lastname: Feng
authors.affiliation: Harvard-MIT Division of Health Sciences and Technology.
authors.forename: Roger G
authors.initials: RG
authors.lastname: Mark
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Medicine; Harvard-MIT Division of Health Sciences and Technology.
authors.forename: Leo Anthony
authors.initials: LA
authors.lastname: Celi
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Medicine.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Medicine. Electronic address: jdanzige@bidmc.harvard.edu.
authors.forename: John
authors.initials: J
authors.lastname: Danziger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D016638:Critical Illness / Q000453:epidemiology*; D016208:Databases, Factual; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology; D012307:Risk Factors; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D014882:Water-Electrolyte Balance; D014883:Water-Electrolyte Imbalance / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D004232:Diuretics; D049994:Sodium Potassium Chloride Symporter Inhibitors
keywords: BMI; Fluid balance; Loop diuretics; Sodium retention