Examining evidence for osmotically inactive sodium storage in critically ill patients.

Baardman, F. (Flip) (2014) Examining evidence for osmotically inactive sodium storage in critically ill patients. thesis, Medicine.

Text BaardmanF.pdf Restricted to Registered users only Download (633kB)

Abstract

Background: Changes in the therapy of patients in the intensive care unit (ICU) have led to an increasing incidence of hypernatremia ([Na] >145 mmol/L). Hypernatremia is associated with increased mortality and takes relatively very long to correct. The cause for the persistence of hypernatremia is not well understood. Animal studies indicate that sodium might be stored in an osmotically inactive form. In ICU patients such a form of storage might contribute to the difficulty in correcting hypernatremia. Conventional physiology implies that changes in circulating sodium ∆[Na], sodium balance ∆Na and the ∆ECV are directly related. If non-osmotic storage of sodium exists, the ∆F thus predicted ( p∆ECV ) should differ from the observed change (o∆ECV). We therefore compared p∆ECV with o∆ECV in patients with pronounced hypernatremia. Objective: To examine evidence for osmotically inactive sodium storage in hypernatremic ICU-patients through balance studies. Patients and methods: We analyzed patients with a [Na]>155 mmol/L and sufficient balance data who were treated in the ICU of the University Medical Center in Groningen between 2009 and 2012. For each patient the p∆ECV and o∆ECV were compared for two phases: phase 1 during which [Na] increased and phase 2 during which [Na] decreased. Results: 38 patients with 1148 ICU days were analyzed. During the first phase mean ±SD [Na] rose from 139.2±6.7 to 159.7± 3.8 mmol/L (p<0.001) over a median of 12 days. During the second phase [Na] decreased 142.1±6.3 mmol/L (p<0001) over a median of 10 days. During phase 1 the difference between the p∆ECV and o∆ECV was –7.2±6.2 L (p<0.001) and during phase 2 this difference was +2.7±8.9 L (p=0.07). During progressive hypernatremia the patients received more sodium than reflected by their rise in serum sodium, whereas during the phase of recovery from hypernatremia, Conclusion: In this retrospective study we found evidence of an osmotic inactive sodium storage in patients admitted to the ICU. The results of our study may have consequences for the therapy and treatment of ICU patients.

Item Type:	Thesis (Thesis)
Supervisor name:	Nijsten, Maarten en and Oude Lansink, Annemieke and Department of Critical Care, UMC Groningen
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:59
Last Modified:	25 Jun 2020 10:59
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1955

Actions (login required)

View Item