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

Stieglmair, Sandra; Lindner, Gregor; Lassnigg, Andrea; Mouhieddine, Mohamed; Hiesmayr, Michael; Schwarz, Christoph (2013). Body salt and water balances in cardiothoracic surgery patients with intensive care unit-acquired hyponatremia. Journal of critical care, 28(6), 1114.e1-1114.e5. Elsevier 10.1016/j.jcrc.2013.05.017

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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.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
UniBE Contributor:	Lindner, Gregor
Subjects:	600 Technology > 610 Medicine & health
ISSN:	0883-9441
Publisher:	Elsevier
Language:	English
Submitter:	Patricia Rajaonina
Date Deposited:	04 Jul 2014 09:22
Last Modified:	05 Dec 2022 14:31
Publisher DOI:	10.1016/j.jcrc.2013.05.017
PubMed ID:	23890940
Uncontrolled Keywords:	Hyponatremia, Intensive care unit, Tonicity balance, Electrolyte free water clearance, Cardiothoracic surgery, Fractional excretion sodium
URI:	https://boris.unibe.ch/id/eprint/47367