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Predictive factors for high mortality in hypernatremic patients

A K Mandal1, M G Saklayen, N M Hillman

  • 1Department of Medicine, Veterans Affairs Medical Center, Dayton, OH, USA.

The American Journal of Emergency Medicine
|March 1, 1997
PubMed
Summary

High mortality is linked to hypernatremia (serum sodium > 145 mEq/L). Persistently high sodium levels and low blood pressure during hospitalization predict a poor prognosis in these patients.

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Area of Science:

  • Internal Medicine
  • Nephrology
  • Critical Care Medicine

Background:

  • Hypernatremia, defined as a serum sodium level exceeding 145 mEq/L, is a critical electrolyte imbalance associated with significant mortality.
  • Effective management strategies require a thorough understanding of factors contributing to adverse outcomes in hypernatremic patients.

Purpose of the Study:

  • To identify clinical factors predictive of high mortality in hospitalized patients diagnosed with hypernatremia.
  • To analyze the association between serum sodium levels, blood pressure, cognitive status, fluid administration, and patient outcomes.

Main Methods:

  • Retrospective analysis of medical records from 116 hypernatremic patients across two university-affiliated teaching hospitals.
  • Data collected included serum sodium (Na+) levels (early, peak, late), systolic and diastolic blood pressure (SBP, DBP), cognitive function status, and type of intravenous fluid administered.

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  • Patients were categorized into two groups: expired and survived.

    • Main Results:

    • A high mortality rate of 66% (77 out of 116 patients) was observed.
    • Significantly higher late-phase serum sodium levels (151.2 ± 9.2 mEq/L vs. 143.1 ± 8.0 mEq/L) were found in the expired group compared to the survived group (P < .001).
    • Patients who died exhibited significantly lower SBP and DBP throughout their hospital course (P < .001) and more frequent cognitive abnormalities (P < .05).
    • Prolonged infusion of normal (isotonic) saline was significantly more common in patients who expired (P < .00001).

    Conclusions:

    • Persistently elevated serum sodium levels, particularly in the later stages of hospitalization, are strongly associated with increased mortality in hypernatremic patients.
    • Protracted hypotension and cognitive dysfunction are significant indicators of a poor prognosis.
    • The findings suggest that prolonged administration of normal saline may contribute to adverse outcomes by exacerbating hypernatremia and potentially masking underlying issues.