Glucocorticoid Treatment Association with Intensive Care Unit Acquired Hypernatremia in Septic Shock Patients

Abstract

Abstract Background Hypernatremia is one of the major electrolyte disorders associated with death among critically ill patients. Intensive care unit (ICU)-acquired hypernatremia is a frequent complication, occurring in 4–52% of patients. Even mild hypernatremia seems to be deleterious in ICU patients. This metabolic disturbance has been consistently associated with increased ICU length of stay, morbidity and mortality. Aim of the Work this observational prospective study aims to evaluate ICU-acquired hypernatremia in patient in septic shock treated by low dose corticosteroid. Primary aim: What is the incidence of ICU-acquired hypernatremia in patients with septic shock treated with low dose glucocorticoids? Second aim: What are the factors that contribute to the development of ICU-acquired hypernatremia? Patients and Methods this study is a prospective cohort study conducted at Ain Shams university hospitals. The duration of the study 6 months and the total of cases is 120 cases with septic shock were enrolled in the study. Results Outcomes of the studied patients, we reported 52 (43.33%) patients developed ICU- acquired hypernatremia. The median of ICU stay was 10 days days. Regarding complications, 44 (36. 7%) patients had mechanical ventilation, 42 (35%) patients developed acute kidney injury, 10(8.3%) patients developed GIT bleeding and 6 (5%) patients had major surgery complications. Mortality occurred in 50 (41 %) patients. We proved that there was a significant relationship between incidence of ICU-acquired hypernatremia and duration of steroid administration as hypernatremia was increased in patients administered steroids more than 7 days (P value <0.001). There was a significant relationship between ICU- acquired hypernatremia and sodium bicarbonate as medications, and significant relationship was found between ICU- acquired hypernatremia and complications (mechanical ventilation, acute kidney injury, while insignificant relationship between ICU-aquired hypernatremia and GIT bleeding and major surgery as complications and infusion fluid. Conclusion we clearly demonstrated that prolonged duration of corticosteroid even low dose hydrocortisone is strongly associated with ICU acquired hypernatremia, ICU acquired hypernatremia associated with risk factors may decrease free water can patients received, also associated with prolonged ICU stay and increasing risk of mortality. Consequently, when we administer glucocorticoid to critically ill patients, close monitoring of their serum sodium concentrations should be required especially when glucocorticoid is administered for longer periods.