Undercorrection of hypernatremia is frequent and associated with mortality.
Undercorrection of hypernatremia is frequent and associated with mortality.
复制标题
高钠血症的不足是频繁的，并且与死亡率有关。
DOI：
10.1186/1471-2369-15-37
复制
发表时间：
2014-02-21
期刊：
影响因子：
2.3
通讯作者：
Vacher-Coponat H
中科院分区：
文献类型：
--
作者：
Bataille S;Baralla C;Torro D;Buffat C;Berland Y;Alazia M;Loundou A;Michelet P;Vacher-Coponat H
大约1%的急诊科（艾德）患者患有高钠血症，这种情况与20 - 60%的死亡率相关。管理建议源于重症监护室的研究，其中患者和内科疾病与ED不同。我们回顾性研究了艾德严重高钠血症患者的临床特征、治疗和结局，以及与住院期间死亡发生相关的危险因素。在2010年期间，85例重度高钠血症≥150 mmol/l的患者被急诊科收治。高钠血症发生在体弱患者中：平均年龄79.7岁，55%住院，28%伴有痴呆。24%的患者在住院期间死亡。男性和低平均血压（MBP）与死亡、血钠纠正速度慢独立相关，但与入院时高渗血症的严重程度无关。45%接受低渗溶质的MBP <70 mmHg患者和22%接受等渗溶质或未灌注的MBP ≥70 mmHg患者不适合输注溶质。这是第一项根据所提供的治疗评估艾德高钠血症患者结局的研究。无论最初是否存在钠血症，纠正速度过快和过慢都与死亡风险增加相关。高钠血症患者的医疗管理，必须改善有关评估和治疗。
About 1% of patients admitted to the Emergency Department (ED) have hypernatremia, a condition associated with a mortality rate of 20 to 60%. Management recommendations originate from intensive care unit studies, in which patients and medical diseases differ from those in ED. We retrospectively studied clinical characteristics, treatments, and outcomes of severely hypernatremic patients in the ED and risk factors associated with death occurrence during hospitalization. During 2010, 85 cases of severe hypernatremia ≥150 mmol/l were admitted to ED. Hypernatremia occurred in frail patients: mean age 79.7 years, 55% institutionalized, 28% with dementia. Twenty four percent of patients died during hospitalization. Male gender and low mean blood pressure (MBP) were independently associated with death, as well as slow natremia correction speed, but not the severity of hyperosmolarity at admission. Infusion solute was inappropriate for 45% of patients with MBP <70 mmHg who received hypotonic solutes and 22% of patients with MBP ≥70 mmHg who received isotonic solutes or were not perfused. This is the first study assessing outcome of hypernatremic patients in the ED according to the treatment provided. It appears that not only a too quick, but also a too slow correction speed is associated with an increased risk of death regardless of initial natremia. Medical management of hypernatremic patients must be improved regarding evaluation and treatment.