Aims Hypernatremia in the critical care setting is frequently observed and is shown to be associated with higher mortality in adults. We studied the prevalence and factors surrounding the presence of hypernatremia in a paediatric critical care unit.
Method From April 2007 to March 2009, the presence of hypernatremia defined as sodium (Na) greater or equal to 150mmol/l was studied. Demographic details of patients, including the primary intensive care unit (ICU) diagnosis were noted. The duration and peak of hypernatremia along with fluid and diuretic management was reviewed.
Results 130 episodes of hypernatremia (10%) were detected in a total of 1301 ICU admissions over this period. Excluding 14 patients who had a head injury as cause for admission requiring active maintenance of higher sodium levels, there were 116 ICU patient episodes of hypernatremia in 104 patients (52 male, 52 female). Hypernatremia ranged from 150 – 182 mmol/l (median 155 mmol/l, IQR 152–158 mmol/l) with a duration range of 1–16 days (median 2 days, IQR 1–3 days) in the entire group. Management was variable from no active intervention to increasing fluids to administrating diuretics. ICU mortality was 4.6% (55 deaths) in the non-hypernatremic group compared to 19.0% (22 deaths) in the hypernatremic group of patients (p < 0.0001).
Conclusion Hypernatremia in the critical care setting is common and appears to be associated with increased mortality. Fluid management in the sick child can be challenging and the clinician needs to be alerted to initiate optimal fluid management in the hypernatremic child.