Difference of Clinical Characteristics between Hospital-acquired Hypernatremia and Hypernatremia on Admission

Hypernatremia in adults is a common problem that has been associated with mortality rates ranging from 40% to 60%. Clinical characteristics of hospital-acquired hypernatremia have not been well defined. To evaluate the difference between hypernatremia on admission and hospital-acquired hypernatremia, we reviewed 50 patients with hypernatremia at Hanyang University Guri Hospital for 51-month period from 1 March 2001 to 31 May 2005. We defined hypernatremia as serum sodium concentration more than or equal to 150 mEq/L. Hospital-acquired hypernatremia was more frequently (62%) observed than hypernatremia on admission (38%). Patients with hypernatremia on admission (73.1+/-11.7 years) were older than those with hospital-acquired hypernatremia (59.3+/-13.7 years). Only 30% of patients was alert in mental status. Fifty six percent of all patients (n=50) had neurologic problem such as head injury, cerebral infarction or hemorrhage. Admission hypernatremia was caused by severe dehydration due to no access to water. Seventy seven percent of hospital-acquired hypernatremic patients were associated with diuretics and solute diuresis. Treatments of hospital-acquired hypernatremia were also delayed and inadequate. Rate of correction in 6, 12, 24 hours after peak sodium level was not different between hypernatremia on admission and hospital-acquired hypernatremia. More rapid correction during 6 hours in hypernatremia on admission was associated with higher mortality (survival 2.1+/-0.7 mEq/L, death 7.1+/-4.9 mEq/L, p<0.05). Higher mortality was observed in patients with more severe renal insufficiency. In conclusion, hospital-acquired hypernatremia is largely avoidable by clinical attention and appropriate therapy. Patients with cerebrovascular events or renal insufficiency, patients treated with diuretics or hypertonic solute need careful fluid management and the close monitoring of blood sodium level. Particularly, the rate of correction during the first 6 hours should be also managed very cautiously in hypernatermia on admission.

The Analysis of Causes and Treatments of Hyperkalemia / 대한신장학회잡지

BACKGROUND: Hyperkalemia is a common, potentially life-threatening disorder. We studied the causes and treatments of hyperkalemia in korean with and without dialysis. We also sought to analyze how to treat and prevent hyperkalemia. METHODS: we reviewed medical records of 60 patients with serum or plasma; potassium levels more than 6.0 mEq/L. Twenty of them had been on maintenance dialysis. We analyzed causes of hyperkalemia and studied the sequence of it's treatment. RESULTS: The causes of hyperkalemia were mostly related to noncompliance(55%) and diet(35%) in patients with dialysis. In contrast, acute renal failure (72.5%) and drugs(15%) were the leading causes in patients without dialysis. Drugs causing hyperkalemia included angiotensin-converting enzyme inhibitor, NSAID and potassium-sparing diuretics. Sequence of various treatments were in order intravenous calcium, dialysis, insulin and calcium polystyrene sulfonate in patients with dialysis but intravenous calcium, insulin, calcium polysyrene sulfonate with dialysis. There was no case of death by arrhythmia caused hyperkalemia. CONCLUSION: The prevention of hyperkalemia in korean included dietary potassium restriction and compliance on dialysis in patients with dialysis, and careful selection of drugs especially in patients with chronic renal failure without dialysis.

Pseudohyperkalemia on Maintenance Hemodialysis / 대한신장학회잡지

BACKGROUND: The serum to plasma potassium [K] difference in patients(n=42) on maintenance hemodialysis more than one year was analyzed to evaluate the prevalence of pseudohyperkalemia among them. METHODS: In all 42 hemodialysis patients, the following predialysis serum and plasma K concentration frequencies were as followed : serum K-normal (3.5-5.5 mEq/L) 24, high(>or=5.6 mEq/L) 18, low(

Evaluation of Bartter-like Syndrome Associated with Aminoglycoside Micronomocin Sulfate Administration During Acute Pyelonephritis Treatment / 대한신장학회잡지

The aminoglycoside antibiotics is widely used in the treatment of infectious caused by gram-negative bacteria and for synergistic effect with(beta-lactam antibiotics. However, its therapeutic usefulness is limited by this potential nephrotoxicity and by disturbance of electrolyte homeostasis resulting in hypomagnesemia, hypokalemia, hypocalcemia such as Bartter-like syndrome. Many case repots have been reported on development of Bartter-like syndrome after aminoglycosides administration. But these reports had the many differences of such as types of aminoglycosides, age of patients, duration and total dose of treatment, combined antibiotics and baseline diseases. Therefore, the purpose of this study is to assess the effects of micronomocin sulfate on magnesium, calcium and potassium status of patients in acute pyelonephritis. Twenty one patients in acute pyelonephritis(18 female/3 male, ages 20-75) was treated with single or combined antibiotics. Eleven of twenty one patients as study group were treated with both micronomicin sulfate(aminoglycoside, 4mg/kg/day, during 5-8days) and flomoxef sodium (3rd cephalosporine, 2g/day, during 5-8days), and ten of twenty one patients as control group were treated only with flomoxef sodium(3rd cephalosporine. 2g/day. during 5-8days). Renal values, plasma and urinary electrolytes were measured before and at the end of IV antibiotic therapy. After micronomicin sulfate administrated for 6.4+/-1.5days, serum Mg, Ca, K, FEMg (fractional excretion of Mg), TTKG(transtubular K concentration gradient) and FECa(fractional excretion of Ca) did not significantly change(p>0.05). Therefore, those results suggest that micromonicin sulfate therapy within dose of 240mg/day(4mg/kg/day) for 6.4+/-1.5days may not cause disturbance of electrolyte homeostasis such as Bartter-like syndrome in acute pyelonephritis. Howerever, electrolyte disturbance is an important complication when aminoglycosides is given in larges doses over extended periods. Therefore, monitoring of blood concentration and urinary losses of electrolyte should be carried out along with careful observation of Bartter-like syndrome.