Study of moderate to severe hyponatremia in patients admitted to medical intensive care units (MICU) in a tertiary care hospital

 

Dnyaneshwar Malharrao Ghuge^1*, Balasaheb Eknathrao Karad²

 

Abstract              Background: Hyponatremia is one of the most common electrolyte disturbances, occurring in approximately 14%–42% of hospitalized patients, and it is associated with higher mortality. Appropriate management of hyponatremia is often challenging due to both numerous pathophysiological mechanisms and multiple underlying pathological conditions.⁸ In present article we aimed to study etio-pathogenesis of moderate to severe hyponatremia in patients admitted to MICU in a tertiary care hospital. Material and Methods: Present study was an observational study conducted in the ICU of department of general medicine in patients more than 18 yrs age, with documented hyponatremia ( serum sodium concentration less than 135 meq/L). Data was collected in a proforma, data entered in Microsoft excel sheet. Statistical analysis was done using descriptive statistics.Results: During study period, 72 patients with hyponatremia were included in present study. Most common age group was more than 70 years age and 40-49 years (21 %) followed by 50-59 years (19 %). Male (63%) patients were more than female (38%) patients. Patients with hyponatremia were classified based on serum sodium levels into mild (130–134 mEq/L), moderate (125–129 mEq/L), and severe (<125 mEq/L). Mild, moderate and severe hyponatremia was noted 47%, 32% and 21% patients. In present study, most common etiology of hyponatremia was GI fluid loss (AGE, vomiting) (22%), cerebrovascular accident (13%), chronic liver disease (13%), malignancy (11%) and renal failure (10%). Clinically patients were distributed as euvolemic (most common -64%), hypervolemic (13%) or hypovolemic (24%). Patients were diagnosed to have syndrome of inappropriate antidiuretic hormone secretion (SIADH) if they satisfied the Bartter and Schwartz criteria. In present study we noted 13% incidence SIADH. Patients responded well to standard treatment. 10% mortality was noted. There were no cases of central pontine myelinolysis Conclusion: Euvolumic, mild, asymptomatic hyponatremia is common in medical intensive care units.

Keywords: electrolyte disturbance, hyponatremia, serum sodium, medical intensive care unit