Rising serum sodium levels are associated with a concurrent development of metabolic alkalosis in critically ill patients
type: Article
item type: journalArticle
is part of: Intensive Care Med
authors: Person
  surname: Lindner
  given name: G.
authors: Person
  surname: Schwarz
  given name: C.
authors: Person
  surname: Grussing
  given name: H.
authors: Person
  surname: Kneidinger
  given name: N.
authors: Person
  surname: Fazekas
  given name: A.
authors: Person
  surname: Funk
  given name: G. C.
subject: Alkalosis/*blood/*etiology
subject: Critical Illness
subject: Female
subject: Humans
subject: Hypernatremia/*complications
subject: Intensive Care Units
subject: Male
subject: Middle Aged
subject: Retrospective Studies
subject: Sodium/*blood
abstract: PURPOSE: Changes in electrolyte homeostasis are important causes of acid-base disorders. While the effects of chloride are well studied, only little is known of the potential contributions of sodium to metabolic acid-base state. Thus, we investigated the effects of intensive care unit (ICU)-acquired hypernatremia on acid-base state. METHODS: We included critically ill patients who developed hypernatremia, defined as a serum sodium concentration exceeding 149 mmol/L, after ICU admission in this retrospective study. Data on electrolyte and acid-base state in all included patients were gathered in order to analyze the effects of hypernatremia on metabolic acid-base state by use of the physical-chemical approach. RESULTS: A total of 51 patients were included in the study. The time of rising serum sodium and hypernatremia was accompanied by metabolic alkalosis. A transient increase in total base excess (standard base excess from 0.1 to 5.5 mmol/L) paralleled by a transient increase in the base excess due to sodium (base excess sodium from 0.7 to 4.1 mmol/L) could be observed. The other determinants of metabolic acid-base state remained stable. The increase in base excess was accompanied by a slight increase in overall pH (from 7.392 to 7.429, standard base excess from 0.1 to 5.5 mmol/L). CONCLUSIONS: Hypernatremia is accompanied by metabolic alkalosis and an increase in pH. Given the high prevalence of hypernatremia, especially in critically ill patients, hypernatremic alkalosis should be part of the differential diagnosis of metabolic acid-base disorders.
date: 2012-11-20
pages: 399-405
coverage: 23160772

Intensive Care Med
type: Journal
volume: 39
number: 3
identifier: DOI 10.1007/s00134-012-2753-3
identifier: ISSN 1432-1238 (Electronic) 0342-4642 (Linking)