Body salt and water balances in cardiothoracic surgery patients with intensive care unit–acquired hyponatremia

Abstract Purpose Hyponatremia is frequently observed in intensive care unit (ICU) patients, but there is still lack information on the physiological mechanisms of development. Materials and Methods In this retrospective analysis we performed tonicity balances in 54 patients with ICU acquired hyponat...

Full description

Saved in:
Bibliographic Details
Published in:Journal of critical care 2013-12, Vol.28 (6), p.1114.e1-1114.e5
Main Authors: Stieglmair, Sandra, MD, Lindner, Gregor, MD, Lassnigg, Andrea, MD, Mouhieddine, Mohamed, MD, Hiesmayr, Michael, MD, Schwarz, Christoph, MD
Format: Article
Language:English
Subjects:
Adult
Cardiac Surgical Procedures
Cardiothoracic surgery
Critical Care
Electrolyte free water clearance
Female
Fluids
Fractional excretion sodium
Heart
Heart surgery
Hospitals
Humans
Hyponatremia
Hyponatremia - physiopathology
Intensive care
Intensive care unit
Intensive Care Units
Male
Middle Aged
Mortality
Nutrition
Potassium
Pulmonary arteries
Retrospective Studies
Risk Factors
Studies
Tonicity balance
Transplants & implants
Water-Electrolyte Imbalance - physiopathology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Purpose Hyponatremia is frequently observed in intensive care unit (ICU) patients, but there is still lack information on the physiological mechanisms of development. Materials and Methods In this retrospective analysis we performed tonicity balances in 54 patients with ICU acquired hyponatremia. We calculated fluid and solute in and outputs during 24 hours in 106 patient days with decreasing serum-sodium levels. Results We could observe a positive fluid balance as a single reason for hyponatremia in 25% of patients and a negative solute balance in 57%. In 18% both factors contributed to the decrease in serum-sodium. Hyponatremic patients had renal water retention, measured by electrolyte free water clearance calculation in 79% and positive input of free water in 67% as reasons for decline of serum-sodium. The theoretical change of serum sodium during 24 hours according to the calculations of measured balances correlated well with the real change of serum sodium ( r = 0.78, P < .01). Conclusions Balance studies showed that renal water retention together with renal sodium loss and high electrolyte free water input are the major contributors to the development of hyponatremia. Control of renal water and sodium handling by urine analysis may contribute to a better fluid management in the ICU population.
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2013.05.017