Evaluation of efficiency of various treatment modalities and outcome in patients with hyponatremia admitted to ICU

Abstract

Background:Hyponatremia is the most common dyselectrolytemia in ICU patients and is an independent predictor of mortality. Its etiology, presentation and response to therapy and outcomes are highly unpredictable and rapid correction can lead to myelinolysis.Objectives: To Observe outcome of therapy in patients with hyponatremia and to compare efficacy of various treatment modalities.Methods:Observational study of patients admitted and managed by primary consultants. Sample of 50 consecutive adult patients admitted to Medical ICU from 01/10/2013 to 01/04/2014 with serum Sodium < 130 meq/L were prospectively studied after informed consent. Measures of Efficacy were taken as improvement in symptoms, adequate correction and length of ICU stay.Measures of safety were taken as mortality, rapid correction and over correction.Result:Hypertension was the most common comorbidity (48%). The commonest symptom was altered sensorium (52%). 14 % patients were receiving hydrochlorothiazide for HT. The mean sodium level was 116.96 ± 10.6 and the lowest value was 94 meq/l. 16% patients developed hyponatremia (Sodium level <130 meq/l) during ICU stay.Overcorrection of sodium level appears to be associated with increased mortality [3/5 vs 6/45] (Fishers exact test, p = 0.035). Conclusion:The volume of hypertonic saline calculated based on bodyweight and serum sodium levels consistently produces overcorrection of sodium levels in South Indian patients. The usage of hypertonic saline was restricted to the more severely hyponatremic patients and in general, less than 50% of the daily calculated volume of hypertonic saline only was administered.

Keywords: Hyponatremia,serum,sodium,nursing