Context: Hyponatremia is a common electrolyte disturbance in critically ill hence understanding its implications is important. Aims: This study was carried out to ascertain frequency, predisposing conditions and outcome in critically ill patients with hyponatremia on intensive care unit (ICU) admission. Settings and Design: This was an observational, prospective study of a series of ICU patients during a 12-month period. Materials and Methods: The patients were divided into two groups: Hyponatremic (serum sodium < 135 mmol/L) and Eunatremic groups (135-145 mmol/L). Clinical examination included volume status and drug history, biochemistries, clinical diagnosis and cause of hyponatremia. Statistical Analysis Used: Fisher′s exact test, unpaired t-tests Wilcoxon ranksum tests, profile-likelihood method, log-rank test and Kaplan-Meier curves were used. P < 0.05 were considered to be statistically significant. Results: In the hyponatremic group, the frequency of hyponatremia on ICU admission was 34.3%, most were euvolumic, 58.96%. Females comprised of 36.5%. The mean age was 60.4 ± 17.2. The Syndrome of inappropriate Antidiuretic Hormone (SIADH) criteria was met in ninety-one patients (36.25%), peumonia being the leading cause of SIADH. Patients with severe sepsis, elective surgery patients, renal failure and heart failure, cirrhosis of liver and subarachnoid hemorrhage were other more likely etiologic causes (P < 0.05). The hyponatremic group spent a longer time in the ICU (P = 0.02), had longer mechanical ventilator days (P < 0.05) and had an increased mortality rate (P = 0.01). Conclusions: Hyponatremia present on admission to the ICU is independent risk factors for poor prognosis.
DeVita MV, Gardenswartz MH, Konecky A, Zabetakis PM. Incidence and etiology of hyponatremia in an intensive care unit. Clin Nephrol 1990;34:163-6.
Adrogué HJ, Madias NE. Hyponatremia. N Engl J Med 2000;342:1581-9.
Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: Results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med 1998;26:1793-800.
Bartter FC, Schwartz WB. The syndrome of inappropriate secretion of antidiuretic hormone. Am J Med 1967;42:790-806.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992;101:1644-55.
Moritz ML, Ayus JC. Dysnatremias in the critical care setting. Contrib Nephrol 2004;144:132-57. Ayus JC, Arieff AI. Brain damage and postoperative hyponatremia: The role of gender. Neurology 1996;46:323-8.
Bennani SL, Abouqal R, Zeggwagh AA, Madani N, Abidi K, Zekraoui A, et al. Incidence, causes and prognostic factors of hyponatremia in intensive care. Rev Med Interne 2003;24:224-9.
Berghmans T, Paesmans M, Body JJ. A prospective study on hyponatraemia in medical cancer patients: Epidemiology, aetiology and differential diagnosis. Support Care Cancer 2000;8:192-7.
Coussement J, Danguy C, Zouaoui-Boudjeltia K, Defrance P, Bankir L, Biston P, et al. Treatment of the syndrome of inappropriate secretion of antidiuretic hormone with urea in critically ill patients. Am J Nephrol 2012;35:265-70.
Hannon RJ, Boston VE. Hyponatraemia and intracellular water in sepsis: An experimental comparison of the effect of fluid replacement with either 0.9% saline or 5% dextrose. J Pediatr Surg 1990;25:422-5.
Nair V, Niederman MS, Masani N, Fishbane S. Hyponatremia in community-acquired pneumonia. Am J Nephrol 2007;27:184-90.
Leung AA, McAlister FA, Rogers SO Jr, Pazo V, Wright A, Bates DW. Preoperative hyponatremia and perioperative complications. Arch Intern Med 2012;172:1474-81.
Bissram M, Scott FD, Liu L, Rosner MH. Risk factors for symptomatic hyponatraemia: The role of pre-existing asymptomatic hyponatraemia. Intern Med J 2007;37:149-55.
Shakhe J, Gandhi N, Raghuraman G. Impact of hyponatraemia in critically ill patients. Endocr Abstr 2013;10:31-55.
Funk GC, Lindner G, Druml W, Metnitz B, Schwarz C, Bauer P, et al. Incidence and prognosis of dysnatremias present on ICU admission. Intensive Care Med 2010;36:304-11.
Pai MP, Paloucek FP. The origin of the "ideal" body weight equations. Ann Pharmacother 2000;34:1066-9.