• Bruno Riou, Gérald Kierzek, Pierre Hausfater, Laurent Fabricatore, Sandrine Dautheville, Anabela Patzak, Marc Andronikof, Jafar Manamani, and Florence Peviriéri.
• Emergency Department, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris, Paris, and UPMC Univ Paris 06 France. pierre.hausfater@psl.aphp.fr
• Am J Emerg Med. 2012 Jun 1;30(5):741-8.

BackgroundAlthough heatstroke is often associated with dehydration, the clinical significance of serum sodium abnormalities in patients with heat-related illness during heat wave has been poorly documented.MethodWe evaluated 1263 patients (age, 82±15 years; body temperature, 40.1°C+1.2°C) admitted to emergency departments during the August 2003 heat wave in Paris, having a core temperature greater than 38.5°C and measurement of serum sodium concentrations. Patients were classified according to our previously described risk score of death.ResultsHyponatremia (<135 mmol/L) was reported in 409 (32%) and hypernatremia (>145 mmol/L) in 220 patients (17%). One-year survival was significantly decreased in patients with hypernatremia (45%; P=.004) but not in those with hyponatremia (58%; P=.86) as compared with patients with serum sodium concentration in the reference range (57%). Using Cox regression, only hypernatremia was an independent prognostic factor (hazard ratio, 1.35; 95% confidence interval, 1.09-1.36) when risk score was taken into account. Using logistic regression, 2 variables were independently associated with hyponatremia (heatstroke severity score and blood urea nitrogen-creatinine ratio<100). Conversely, 5 variables were independently associated with hypernatremia (living in an institution, dementia, serum creatinine>120 μmol/L, a blood urea nitrogen-creatinine ratio >100, and absence of long-term diuretic intake).ConclusionsSerum sodium abnormalities are frequently observed in patients with a nonexertional heatstroke during heat wave; however, only hypernatremia should be considered as an independent risk factor of death. Rapid measurement of serum sodium concentration is mandatory to appropriately guide electrolyte resuscitation.Copyright © 2012 Elsevier Inc. All rights reserved.

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