Early Sodium Dynamics in Severely Injured Patients with Intestinal Perforations: A Multicenter Analysis

Background: Diagnosis of intestinal perforation in severely injured patients remains challenging. Hyponatremia has been associated with intestinal inflammation in other clinical settings. The aim of this study was to determine whether severely injured patients with an intestinal perforation present lower serum sodium levels compared to severely injured patients without perforation. Methods: A retrospective cohort study was conducted using data from the Swiss Trauma Registry (STR), including 72 severely injured patients with and 61 without intestinal perforation. Serum sodium levels at admission and immediately prior to surgery were retrieved from medical records. Differences in sodium levels were evaluated using linear mixed-effects models to account for repeated measures and group effects (p < 0.05). Results: There was no significant difference in sodium levels between patients with an intestinal perforation compared to controls (mean difference: +0.74 mmol/L, p = 0.204). The time × group interaction indicated a slightly greater decline in sodium from first to last assessment in the perforation group relative to controls (-1.14 mmol/L, p = 0.062); however, these effects were not statistically significant. Conclusions: No significant difference in sodium levels between the patients with and without intestinal perforation undergoing laparotomy in the early phase of hospitalization was found that would have potentially allowed for diagnosis of a hollow viscus organ injury.