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Glucocorticoid treatment is associated with ICU-acquired hypernatremia: a nested case-control study
Takahiro Imaizumi1, Masahiro Nakatochi2, Yoshiro Fujita3
1Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Clinical and Experimental Nephrology
|September 22, 2020
Summary
High-dose glucocorticoid use is linked to intensive care unit-acquired hypernatremia (IAH) in critically ill patients. Prolonged use shows a duration-response effect, necessitating careful serum sodium monitoring.
Area of Science:
- Critical Care Medicine
- Nephrology
- Endocrinology
Background:
- Hypernatremia is a critical electrolyte disorder linked to mortality in ICU patients.
- Glucocorticoid therapy's role in intensive care unit-acquired hypernatremia (IAH) requires clarification.
Purpose of the Study:
- To investigate the association between glucocorticoid administration and IAH.
- To determine risk factors for IAH in critically ill patients.
Main Methods:
- A nested case-control study involving 1756 ICU patients.
- 121 IAH cases were identified and matched with controls.
- Patients admitted with normal serum sodium (130-149 mEq/L) and ICU stays ≥2 days were included.
Main Results:
- High-dose glucocorticoids (OR, 4.15) were significantly associated with IAH.
- Acute kidney injury (OR, 2.72) and osmotic diuretics (OR, 3.44) were also associated with IAH.
- Prolonged glucocorticoid use demonstrated a duration-response effect, but pulse therapy did not.
Conclusions:
- High-dose glucocorticoid use is a significant risk factor for IAH.
- Prolonged glucocorticoid administration requires careful monitoring of serum sodium levels in ICU patients.
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