Prevalence and Correlates of Hyponatremia in Critically Ill Elderly patients at the time of Admission, its impact on clinical course of ICU in a specialized geriatric facility in northern India
Indian Journal of Surgery - Trang 1-5 - 2023
Tóm tắt
To assess the prevalence of hyponatremia in critically ill elderly patients on admission to acute care facility; its clinic-demographic correlates, impact on clinical course and outcome. The study was done at a centre for geriatric medicine palliative care hospital & hospice at its critical care unit at Lucknow between 2021–2022 for one year. A total of 267 subjects from the hospital records of non-COVID ICU admissions were analysed. Serum sodium levels < 135 mEq/L at admission was considered as hyponatremia. Demographic profile and comorbidity profile of the patients were also noted as per profroma. Severity of hyponatremia was assessed as mild (130–134.9 mEq/L), moderate (125–129.9 mEq/L) and severe (< 125 mEq/L) respectively. Total duration of ICU stay was noted as clinical course of illness and in-ICU mortality was noted as the final outcome. Data was analysed using SPSS 21.0 software. Chi-square, independent samples t-test and ANOVA were calculated. Mean age of the patients was 72.65 ± 7.82 years (range 60–93 years), majority of them were men (56.2%). At admission, hyponatremia was seen in 36.3% (n = 97). Of this majority (n = 50; 51.5%) had mild, followed by moderate (n = 31; 32.0%) and severe (n = 16; 16.5%) hyponatremia. Mean duration of ICU stay was 8.65 ± 5.51 days (range 1–45 days). Mortality was seen in only 10 (3.7%) subjects. History of cardiovascular disease and higher mean number of comorbidities showed a significant association with at-admission hyponatremia. Mortality rate was significantly higher in hyponatremic (8.2%) as compared to non-hyponatremic patients (1.2%). Severity of hyponatremia showed a significant association with hypertension, cardiovascular disease, number of comorbidities, type of hyponatremia, but did not show a significant association with duration of ICU stay and mortality. Hospitalised critically ill elderly had a high prevalence of hyponatremia in just over 1/3rd subjects (36.3%) at the time of admission. Higher mortality and poor overall outcome were seen in those who also had hyponatremia irrespective of the index illness.
Tài liệu tham khảo
Arora SK (2013) Hypernatremic disorders in the intensive care unit. J Intensive Care Med 28(1):37–45
Pokaharel M, Block CA (2011) Dysnatremia in the ICU. Curr Opin Crit Care 17(6):581–593
Hoorn EJ, Betjes MGH, Weigel J, Zietse R (2008) Hypernatraemia in critically ill patients: too little water and too much salt. Nephrol Dial Transplant 23(5):1562–1568
Overgaard-Steensen C, Ring T (2013) Clinical review: practical approach to hyponatraemia and hypernatraemia in critically ill patients. Crit Care 17(1):206
van de Louw A, Shaffer C, Schaefer E (2014) Early intensive care unit-acquired hypernatremia in severe sepsis patients receiving 0.9% saline fluid resuscitation. Acta Anaesthesiologica Scandinavica 58(8):1007–1014
Palmer BF, Alpern RJ, Seldin DW (2008) Physiology and Pathophysiology of Sodium Retention and Wastage. Seldin and Giebisch’s The Kidney. Elsevier, pp 1005–1049
Filippatos TD, Makri A, Elisaf MS, Liamis G (2017) Hyponatremia in the elderly: challenges and solutions. Clin Interv Aging 14(12):1957–1965
Miller M, Morley JE, Rubenstein LZ (1995) Hyponatremia in a nursing home population. J Am Geriatric Soc 43:1410–1413
Rao MY, Sudhir U, Anil Kumar T, Saravanan S, Mahesh E, Punith K (2010) Hospital-Based Descriptive Study of Symptomatic Hyponatremia in Elderly Patients. JAPI 58:667–669
Dash SC, Saundray NK, Rajesh B, Pagad T (2019) Hyponatremia in elderly in-patients. J Clin Diagnostic Res 13(2):OC01–OC04
Zhang X, Li XY (2020) Prevalence of hyponatremia among older inpatients in a general hospital. Eur Geriatr Med 11(4):685–692
Jain AK, Nandy P (2019) Clinico-etiological profile of hyponatremia among elderly age group patients in a tertiary care hospital in Sikkim. J Family Med Prim Care 8(3):988–994
Maloo R, Jain KC (2016) A Study on Hyponatremia in Critically Ill Geriatric Patients. J Ind Acad Geriatrics 12(4):172–178
Kaspa C, Govindu AS (2020) Clinico-etiological profile of hyponatremia among elderly patients admitted to a tertiary care hospital, Guntur. Int J Contemp Med Res 7(2):B37–B40
Chandregowda MK, Unnikrishnan A (2021) Study of clinical profile of hyponatremia in elderly patients admitted to medical wards at Mandya institute of medical sciences, Mandya. Int Surg J 8:390–4