HDCN Abstract:  ASN Annual Meeting -- San Diego  

Chawla A, Cappucio JD, Nigwekar SU, et al.

Mortality in Severe Hyponatremia: Do Patients Die ""OF"" or ""WITH"" a Low Serum Sodium Concentration?.

ASN Annual Meeting -- San Diego
J Am Soc Nephrol (Nov) 20:428A 2009

Background & objectives: Severe hyponatremia is reported to have high mortality. This study was designed to describe co-morbid illnesses associated with a fatal outcome and to correlate mortality with severity of hyponatremia.

Methods: All patients hospitalized with serum sodium (sNa) 120mEq/L from a single center over a 12 yr period were included. Data were abstracted to determine cause(s) and circumstances of death and their relation to sNa. Non-hypotonic hyponatremia was excluded. Demographic and clinical characteristics of patients who died with sNa 120mEq/L were compared to those who survived with sNa 110mEq/l.

Results: Of 583 patients with sNa 120mEq/l, 8.2% died. Mortality did not increase with lower sNa and was lowest among patients with sNa <110 mEq/l.

Causes and co-morbidities of hyponatremia differed amongst the 48 fatal cases with less severe hyponatremia (116 3 mEq/L) and the 34 survivors with more severe hyponatremia (107 3 mEq/L). Drug-induced hyponatremia was 3 times more common in survivors while hyponatremia due to renal failure was 13 times more common in those who died. Comorbidities were more common in fatal cases: sepsis (48% vs zero), acute kidney injury (58% vs 3%), CHF (48% vs 18%) and malignancy (33% vs 12%). Two-thirds of those who died had at least 2 underlying progressive and irreversible illnesses. Only 2 deaths in the last 12 years could possibly be ascribed to neurological complications of hyponatremia and even these had multiple co- morbidities.

Conclusions: Mortality in patients with hyponatremia is usually related to the nature of underlying illness rather than the severity of hyponatremia and is seldom related to a neurological complication of hyponatremia.

© Copyright 2009-2010 American Society of Nephrology.Reproduced with permission.
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