ICU acquired hypernatremia treated by enteral free water - A retrospective cohort study.

Abstract

ICU acquired hypernatremia (IAH) is associated with increased morbidity and mortality, however treatment remains controversial. This study aims to determine the effect of enteral free water suppletion in patients with IAH. Retrospective single center study in a tertiary ICU. patients with IAH and treatment with enteral free water. patients with renal replacement therapy, diabetic ketoacidosis or hyperosmolar hyperglycaemic state. change in plasma sodium (in mmol/l) after 5days treatment. Responders were defined as patients with a decrease in sodium level of 5mmol/l or more. In total 382 consecutive patients were included. The median sodium level at the start of water therapy was 149mmol/l (IQR 147-150). The median volume of enteral water was 4423ml (IQR 3349-5379ml) after 5days and mean sodium decrease was 1.87mmol/l (SD 4.84). There was no significant correlation between the volume of enteral water and sodium decrease (r2=0.01). Treatment with enteral free water did not result in a clinically relevant decrease in serum sodium level in patients with IAH. In addition, the volume of enteral free water and the use of diuretics was unrelated with sodium change over 5days.