Ercan GÜNDÜZ, Yılmaz ZENGİN, MUSTAFA İÇER, HASAN MANSUR DURGUN, RECEP DURSUN, Ahmet GÜNDÜZALP, Mustafa İPEK, CAHFER GÜLOĞLU

Assessment of adult patients with hypernatremia: A single center experience

Amaç: Bu çalışmada acil servise başvuran ve hipernat- remi tespit edilen hastalarda semptomlar, klinik özellikler, prevalans ve sağ-kalım oranlarının belirlenmesi amaçlan- mıştır. Yöntemler: Çalışmaya, Ocak 2013-Aralık 2014 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi acil servisine başvuran, serum Na>148 mEq/L üzerinde olan hastalar dahil edildi. Çalışma retrospektif olarak gerçekleştirildi. Bulgular: Acil servise başvuran olgularda hipernatremi prevalansı %0,21 olarak tespit edildi. Tüm hastaların yaş ortalaması 69±22, median yaş 72 yıl idi. Ortalama has- tanede kalma süresi 13,3±10,9 gün idi. Mortalite oranı %75,7 ve mortalite gelişen hastalarda erkek cinsiyet ha- kimiyeti (%56) tespit edildi. Mortalite ile şifa grubu istatis- tiksel olarak karşılaştırıldığında; hastanede kalma süresi, glukoz, üre, kreatinin ve kalsiyum ortalamaları açısından anlamlı fark tespit edildi (p< 0.05). Hastalarımızın acil ser- vise başvuru yakınmaları sıklık sırasına göre bilinç deği- şikliği (%92,7), oral alım bozukluğu (%82,4), ateş (%48,6) idi. Eşlik eden komorbid durumlar ise sıklık sırasına göre serebrovasküler hastalık (%36,9), Demans/Alzheimer (%32,4), Hipertansiyon (%28,9) idi. Sonuç: Sonuç olarak hipernatremi yaşlı, oral alımı bozuk, serebrovasküler hastalığı ve demansı olanlarda daha sık görülebilen ve yüksek mortaliteyle seyreden bir sıvı-elekt- rolit bozukluğudur.

Hipernatremili erişkin hastaların değerlendirilmesi: Tek merkez deneyimi

Objective: In the present study, determination of symp- toms, clinical characteristics, prevalence and recovery rates was aimed in patients who applied to the emergen- cy service and diagnosed with hypernatremia. Methods: Patients who applied to Dicle University Medi- cal School Emergency Service during January 2013-De- cember 2014 and whose serum Na>148 mEq/L were in- cluded in the study. The study was conducted retrospec- tively. Results: Hypernatremia prevalence was determined as 0.21% in the cases who applied to the emergency ser- vice. The average age in all patients was 69±22 and the median age was 72 years. The average hospitalization period was 13.3±10.9 days. The mortality rate was 75.7% and male gender domination (56%) was determined in patients who developed mortality. When mortality and recovery groups were compared statistically; significant difference was determined (p<0.05) in terms of hospi- talization period, glucose, urea, creatinine and calcium averages. The complaints of our patients who applied to the emergency service were changes in consciousness (92.7%), oral intake disorder (83.4%) and fever (48.6%) based on frequency order. The accompanying comorbid states were cerebrovascular illness (36.9%), Dementia/ Alzheimer (32.4%) and hypertension (28.9%) based on frequency order. Conclusion: Consequently, hypernatremia is a fluid- electrolyte disorder progressing with high mortality and could be observed in older patients and in patients whose oral intake is defective and who have cerebrovascular ill- ness and dementia.

PDF

___

1. Liamis G, Tsimihodimos V, Doumas M, et al. Clinical and laboratory characteristics of hypernatraemia in an internal medicine clinic. Nephrol Dial Transplant 2008;23:136-143. 2. Palevsky PM, Bhagrath R, Greenberg A, et al. Hypernatremia in hospitalized patients. Ann Intern Med 1996;124:197-203. 3. Aiyagari V, Deibert E, Diringer MN, et al. Hypernatremia in the neurologic intensive care unit: How high is too high? J Crit Care 2006;21:163-172. 4. Tayman C, Tanbul A, Aydemir S, et al. Anne sütüne bağlı hipernatremik dehidratasyonun klinik bulguları ve tedavi önerileri. Dicle Tıp Dergisi 2010;37:254-262. 5. Adrogue HJ, Madias NE. Hypernatremia. N Engl J Med 2000;342:1493-1499. 6. Brenner B, Singer G. Fluid and electrolyte disturbances. In: Kasper D, Braunwald E, Fauci A, et al, eds. Harrisons prin- ciples of internal medicine. 16th ed. New York: Mc-Graw- Hill; 2005:251263. 7. Yucel N, Sahin I, Akgun FS, et al. Hypernatremia in The Emergency Department .Turk Neph Dial Transpl 2012;21:124-129. 8. Çağlar Ş, Süleymanlar G, Ecder T, et al. Sıvı, elektrolit ve asit-baz dengesi bozuklukları. İç Hastalıkları. Ankara Gün- eş Kitabevi, 2003;1251-1285. 9. Verbalis JG. Disorders of body water homeostasis. Best Pract Res Clin Endocrinol Metab 2003;17:471503. 10. Palevsky PM. Hypernatremia. In: Greenberg A, Cheung A, Coffman T, et al, eds. Primer on kidney diseases. 4th ed. Philadelphia: Elsevier Saunders; 2005:5865. 11. Parikh C, Berl T. Disorders of water metabolism. In: Fee- hally J, Floege J, Johnson R, eds. Comprehensive clini- cal nephrology. 3rd ed. Philadelphia: Mosby Elsevier; 2007:93110. 12. Liamis G, Milionis HJ, Elisaf M, et al. A review of drug- induced hypernatremia. NDT Plus 2009;2:339-346. 13. Mandal AK, Saklayen MG, Hillman NM, et al. Predictive factors for high mortality in hypernatremic patients. Am J Emerg Med 1997;15:130-132. 14. Fried LF, Palevsky PM, et al. Hyponatremia and hyperna- tremia. Med Clin North Am 1997;81:585-609. 15. Ohare AM, Bertenthal D, Covinsky KE, et al. Mortality risk stratification in chronic kidney disease: one size for all ages? J Am Soc Nephrol 2006;34:126-132. 16. Ismail N, Becker BN. Treatment options and strategies in uremia: current trends and future directions. Semin Nephrol 1994; 14:292-299. 17. Borra SI, Beredo R, Kleinfeld M, et al. Hypernatremia in the aging. J Natl Med Assoc 1995;87:220-224. 18. Achinger SV, Moritz ML, Ayus JC: Dysnatremias: Why are patients still dying? South Med J 2006;99:353-362.