• Wai-Ping Choo, A B Johan Groeneveld, Ronald H Driessen, and Eleonora L Swart.
• Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: w.choo@vumc.nl.
• J Crit Care. 2014 Jun 1;29(3):390-4.

PurposeWe wanted to identify modifiable risk factors for intensive care unit (ICU)-acquired hypernatremia.Materials And MethodsWe retrospectively studied sodium and fluid loads and balances up to 7 days prior to the development of hypernatremia (first serum sodium concentration, [Na+], >150 mmol/L; H) vs control (maximum [Na+] ≤150 mmol/L; N), in consecutive patients admitted into the ICU with a normal serum sodium (<145 mmol/L) and without cerebral disease, within a period of 8 months.ResultsThere were 57 H and 150 N patients. Severity of disease and organ failure was greater, and length of stay and mechanical ventilation in the ICU were longer in H (P<.001), with a mortality rate of 28% vs 16% in N (P=.002). Sodium input was higher in H than in N, particularly from 0.9% saline to dissolve drugs for infusion and to keep catheters open during the week prior to the first day of hypernatremia (P<.001). Fluid balances were positive and did not differ from N on most days in the presence of slightly higher plasma creatinine and more frequent administration of furosemide, at higher doses, in H than in N.ConclusionsHigh sodium input by 0.9% saline used to dilute drugs and keep catheters open is a modifiable risk factor for ICU-acquired H. Dissolving drugs in dextrose 5% may partially prevent potentially harmful sodium overloading and H.Copyright © 2014 Elsevier Inc. All rights reserved.

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