Acquired hypernatremia in a general surgical Intensive Care Unit: Incidence and prognosis.
OBJECTIVE
Intensive Care Unit (ICU)-acquired hypernatremia (IAH) is a serious electrolyte disturbance that recently was shown to present an independent risk factor for mortality in critically ill patients. IAH has not been widely investigated in Surgical ICU (SICU) patients. No study has specifically investigated IAH epidemiology in the Kingdome of Saudi Arabia (KSA) in general SICU. The objectives of this study are to assess the epidemiological characteristics and prognostic impact of IAH on SICU mortality and outcome in KSA and compare it with international figures.


METHODS
A retrospective observational study on a prospectively collected data of patients (14 years of age or older) admitted to SICU over 2 years, with normal serum sodium on admission and who developed IAH (serum sodium above 145 mmol/L) from day two of admission. Traumatic brain injury patients with therapeutic target sodium level above 145 mmol/L were excluded.


RESULTS
Over 2 years study period, 864 patients were admitted to SICU. A total of 50 (5.8%) developed IAH and were included in the study. Twenty-eight (56%) patients were male. The median age was 47 (14-84) years. The mean (± standard deviation) Acute Physiology and Chronic Health Evaluation II score was 17 ± 6.5. The incident density (the rate of occurrence of IAH per 100 days care for SICU admission for the first episode) was 0.71. Risk factors include mechanical ventilation, male sex, age ≥50 years, postgastrointestinal surgeries, weekend and night admission. SICU mortality was 40%. The SICU and hospital median (range) length of stay was 8.3 (2-53) and 28.8 (3-95), respectively.


CONCLUSIONS
IAH is not uncommon in SICU patients and is associated with increased risk of SICU as well as hospital mortality.
Department of Adult Critical Care Medicine, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.
Mariam A
MA
Alansari
Department of Critical Care, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.
Ahmed
A
Abdulmomen
Department of Quality Management, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.
Mohammed
M
Hussein
Department of Surgical, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.
Ahmad Mohmmad
AM
Zubaidi
Department of Nursing, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.
Jalal T
JT
Alswaiti
Fluid replacement; Intensive Care Unit; hypernatremia; quality of care