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Hypernatriëmie bij patiënten op de Intensive Care

(2018) Vries, L. de (Linda)

Introduction: ICU-acquired hypernatremia, (IAH, serum sodiumconcentration (s[Na]) ≥ 143
mmol/l) is associated with a higher morbidity and mortality. It is mainly considered
iatrogenic, induced by sodium intake and water deficit. The main goal of the study is to
investigate if there is a difference in sodium intake and fluid balance between the IAH(-) and
IAH(+) groups and to explore other factors.
Methods: Prospective observational cohortstudy in the Intensive Care Unit (ICU) in Medisch
Centrum Leeuwarden. Included patients were admitted in an acute setting, were at least 18
years old and had a ICU length of stay of at least 48 hours.
Results: the sodium intake within the first 24 hours of ICU admission was 8,4 [4,8-12,9]
grams in the IAH(-) group and 7,0 [4,0-13,0] grams in the IAH(+) group, p=0,649. Between
24 and 96 hours this was 12,0 [10,2-14,3] grams in the IAH(-) group versus 15,9 [7,4-19,3]
grams in the IAH(+) group, p=0,377). The median fluid balance within the first 24 hours was
1,2 [0,1-2,4] liters in the IAH(-) group versus 1,2 [0,6-2,0] liters in IAH(+) group. Between
24 and 96 hours this was 0,9 [-0,3-1,9] liters in the IAH(-) group and 1,7 [-0,7-3,3] liters in
the IAH(+) group.
Conclusion: Despite the current opinion, IAH is not explained by sodium intake of fluid
balance. This makes IAH not a primary iatrogenic complication. A renal problem of the third
compartment could play a role in the development of IAH.






 
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