Table 1.
Characteristics of adults admitted to ICU with hypernatremia at admission and hospital-acquired hypernatremia by slower versus rapid correction rate
| Characteristic | Admission Hypernatremia, n=122; n (%) or Median (IQR) | Hospital-Acquired Hypernatremia, n=327; n (%) or Median (IQR) | ||
|---|---|---|---|---|
| ≤0.5 mmol/L per h | >0.5 mmol/L per h | ≤0.5 mmol/L per h | >0.5 mmol/L per h | |
| Total, n (%) | 90 (74) | 32 (26) | 225 (69) | 102 (31) |
| Age, yr, median (IQR) | 83 (72–90) | 80 (61–86) | 64 (48–75) | 58 (48–75) |
| Sex, n (%) | ||||
| Men | 48 (53) | 8 (25) | 149 (67) | 66 (65) |
| Women | 42 (47) | 24 (75) | 76 (34) | 36 (35) |
| ICU first service, n (%) | ||||
| Medical ICU | 73 (81) | 25 (78) | 61 (27) | 46 (45) |
| Surgical ICU | 8 (9) | 0 | 58 (26) | 17 (17) |
| Coronary care unit | 5 (6) | 3 (9) | 20 (9) | 9 (9) |
| Trauma/surgical ICU | 2 (2) | 3 (9) | 60 (27) | 23 (23) |
| Cardiac surgery recovery unit | 1 (1) | 0 | 26 (12) | 5 (5) |
| Admission type, n (%) | ||||
| Elective | 1 (1) | 0 | 18 (8) | 6 (6) |
| Urgent/emergency | 89 (99) | 32 (100) | 207 (92) | 96 (94) |
| Insurance, n (%) | ||||
| Government | 2 (2) | 1 (3) | 7 (3) | 6 (6) |
| Medicaid | 4 (4) | 1 (3) | 22 (10) | 9 (9) |
| Medicare | 75 (83) | 22 (69) | 105 (47) | 42 (41) |
| Private | 9 (10) | 8 (25) | 81 (36) | 39 (38) |
| Self-pay | 0 | 0 | 10 (4) | 6 (6) |
| Race/ethnicity, n (%) | ||||
| White | 56 (62) | 18 (56) | 128 (57) | 54 (53) |
| Black | 17 (19) | 4 (13) | 23 (10) | 19 (19) |
| Hispanic | 3 (3) | 3 (9) | 8 (4) | 3 (3) |
| Asian | 6 (7) | 3 (9) | 4 (2) | 4 (4) |
| Others/unknown | 8 (9) | 4 (13) | 62 (28) | 22 (22) |
| Charlson Comorbidity Index, n (%) | ||||
| 0 | 22 (24) | 9 (28) | 51 (23) | 24 (24) |
| 1 | 20 (22) | 15 (47) | 52 (23) | 32 (31) |
| 2 | 21 (23) | 3 (9) | 39 (17) | 15 (15) |
| ≥3 | 27 (30) | 5 (16) | 83 (37) | 31 (30) |
| Comorbidities, n (%) | ||||
| CKD | 19 (21) | 1 (3) | 20 (9) | 11 (11) |
| ESKD | 0 | 0 | 3 (1) | 2 (2) |
| Liver disease (NA) | 1 (1) | 0 | 0 | 1 (1) |
| Congestive heart failure | 22 (24) | 7 (22) | 47 (21) | 21 (21) |
| Diabetes mellitus type 2 | 14 (16) | 6 (19) | 42 (19) | 11 (11) |
| Depression | 10 (11) | 8 (25) | 13 (6) | 4 (4) |
| Bipolar disorder | 3 (3) | 1 (3) | 14 (6) | 4 (4) |
| Schizophrenia | 1 (1) | 0 | 1 (0.4) | 0 |
| Epilepsy | 5 (6) | 0 | 6 (3) | 1 (1) |
| Stroke (infarction, ICH, SAH) | 5 (6) | 2 (6) | 69 (31) | 20 (20) |
| Myocardial infarction | 11 (12) | 0 | 23 (10) | 6 (6) |
| HIV infection | 1 (1) | 1 (3) | 0 | 1 (1) |
| Chronic obstructive pulmonary disease | 6 (7) | 5 (16) | 22 (10) | 6 (6) |
| Hypertension | 27 (30) | 10 (31) | 76 (34) | 29 (28) |
| Peripheral arterial disease | 1 (1) | 0 | 3 (1) | 3 (3) |
| Laboratory values at peak sodium level, median (IQR) | ||||
| Creatinine, mg/dl | 1.9 (1.3–2.9) | 1.2 (0.8–2.1) | 1.1 (0.8–1.6) | 1.2 (1.0–2.0) |
| BUN, mg/dl | 62 (40–85) | 36 (27–64) | 34 (20–52) | 23 (15–54) |
| Potassium, mmol/L | 3.9 (3.6–4.2) | 3.8 (3.6–4.1) | 3.8 (3.6–4.0) | 3.8 (3.5–4.1) |
| Phosphorus, mg/dl | 3.2 (2.4–3.9) | 2.5 (2.2–3.8) | 2.9 (2.3–3.8) | 3.0 (2.3–3.9) |
| Magnesium, mg/dl | 2.3 (2.1–2.7) | 2.2 (2.0–2.4) | 2.3 (2.0–2.5) | 2.1 (1.9–2.3) |
| Serum osmolality, mOsm/kg | 354 (345–367) | 358 (352–365) | 328 (323–337) | 331 (320–345) |
| Serum bicarbonate, mmol/L | 22 (19–25) | 24 (20–28) | 26 (23–29) | 23 (19–26) |
| Serum bicarbonate ≤20 mmol/L, n (%) | 31 (34) | 11 (34) | 30 (14) | 29 (28) |
| Albumin, g/dl | 2.8 (2.5–3.3) | 3.0 (2.6–3.2) | 2.9 (2.6–3.2) | 2.9 (2.5–3.5) |
| Urine sodium, mmol/L | 47 (20–75) | 68 (46–109) | 54 (33–82) | 61 (30–112) |
| Urine potassium, mmol/L | 65 (44–81) | 43 (28–73) | 39 (31–49) | 25 (17–41) |
| Urine osmolality, mOsm/kg | 514 (440–618) | 632 (440–752) | 489 (355–674) | 440 (322–558) |
| Medications, n (%) | ||||
| Thiazide diuretics | 1 (1) | 0 | 30 (13) | 9 (9) |
| Loop diuretics | 23 (26) | 12 (38) | 117 (52) | 50 (49) |
| In-hospital mortality, n (%) | 25 (28) | 8 (25) | 90 (40) | 45 (44) |
| DNR, n (%) | 43 (48) | 12 (38) | 61 (27) | 23 (23) |
| Length of stay, d, median (IQR) | 3 (2–5) | 3 (2–9) | 7 (3–5) | 4 (2–9) |
ICU, intensive care unit; IQR, interquartile range; NA, non-alcoholic; ICH, intracerebral hemorrhage; SAH, subarachnoid hemorrhage; DNR, do not resuscitate.