PREDICTORS OF OUTCOME IN HOSPITALIZED PATIENTS

Posted by James

Hyponatremia is the most common electrolyte disorder in clinical medicine. Severe hyponatremia, defined as a serum sodium concentration of less than 115 mmol/L, may be associated with substantial morbidity and increased mortality. However, considerable controversy surrounds the optimal therapy for severe hyponatremia, as both an overly rapid correction rate and slow correction may be associated with neurologic injury and death. Ayus et al. proposed an hourly correction rate of 1.3mmol/L, using 5% saline with generic furosemide, while avoiding correction to normonatremic or hyperna-tremic levels at 48 hours, or a correction of no greater than 25mmol/L in the first 48 hours. Sterns and his coworkers, on the other hand, suggest that patients with severe chronic hyponatremia are more likely to avoid neurologic complications when hyponatremia was corrected slowly. Furthermore, it appears that chronic hyponatremia is not an entirely benign condition, as a recent report has shown that chronic symptomatic hyponatremia in post-menopausal women can be associated with major morbidity and mortality.

Unresolved at this time is whether the patients die of hyponatremia, the effects of therapy, or co-morbid disease. In this report, we describe the etiologic factors, incidence, therapy, and outcome of severe hyponatremia in hospitalized patients and characterize the factors affecting mortality in this patient population.
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