• Journal of Korean Neurosurgical Society
• /
• 제66권1호
• /
• pp.95-104
• /
• 2023

Objective : Hypernatremia is a common complication encountered during the treatment of neurocritically ill patients. However, it is unclear whether clinical outcomes correlate with the severity of hypernatremia in such patients. Therefore, we investigated the impact of hypernatremia on mortality of these patients, depending on the degree of hypernatremia. Methods : Among neurosurgical patients admitted to the intensive care unit (ICU) in a tertiary hospital from January 2013 to December 2019, patients who were hospitalized in the ICU for more than 5 days and whose serum sodium levels were obtained during ICU admission were included. Hypernatremia was defined as the highest serum sodium level exceeding 150 mEq/L observed. We classified the patients into four subgroups according to the severity of hypernatremia and performed propensity score matching analysis. Results : Among 1146 patients, 353 patients (30.8%) showed hypernatremia. Based on propensity score matching, 290 pairs were included in the analysis. The hypernatremia group had higher rates of in-hospital mortality and 28-day mortality in both overall and matched population (both p<0.001 and p=0.001, respectively). In multivariable analysis of propensity score-matched population, moderate and severe hypernatremia were significantly associated with in-hospital mortality (adjusted odds ratio [OR], 4.58; 95% confidence interval [CI], 2.15-9.75 and adjusted OR, 6.93; 95% CI, 3.46-13.90, respectively) and 28-day mortality (adjusted OR, 3.51; 95% CI, 1.54-7.98 and adjusted OR, 10.60; 95% CI, 5.10-21.90, respectively) compared with the absence of hypernatremia. However, clinical outcomes, including in-hospital mortality and 28-day mortality, were not significantly different between the group without hypernatremia and the group with mild hypernatremia (p=0.720 and p=0.690, respectively). The mortality rates of patients with moderate and severe hypernatremia were significantly higher in both overall and matched population. Interestingly, the mild hypernatremia group of matched population showed the best survival rate. Conclusion : Moderate and severe hypernatremia were associated with poor clinical outcomes in neurocritically ill patients. However, the prognosis of patients with mild hypernatremia was similar with that of patients without hypernatremia. Therefore, mild hypernatremia may be allowed during treatment of intracranial hypertension using hyperosmolar therapy.

• Clinical and Experimental Pediatrics
• /
• 제49권5호
• /
• pp.463-469
• /
• 2006

Sodium is the major cation of the extracellular fluid and the primary determinant of extracellular osmolality. Therefore, hypernatremia causes water movement out of cells, while hyponatremia causes water movement into cells, resulting in cellular shrinkage and cellular swelling, respectively. Serious central nervous system symptoms may complicate both conditions. Since hypernatremia and hyponatremia are accompanied by abnormalities in water balance, it is essential to understand the mechanisms regulating extracellular osmolality and volume as well as the pathophysiology of hypernatremia and hyponatremia, in order to manage both conditions with swiftness and safety.

• Neonatal Medicine
• /
• 제18권1호
• /
• pp.89-95
• /
• 2011

목적: 고나트륨혈증은 미숙아에서 자주 볼 수 있으며 심한 경우 뇌출혈을 일으킬 수 있다. 이에 미숙아 중 극소 저체중 출생아(<1,250 g)에서 과나트륨혈증의 발생빈도, 출현시기, 발생의 위험요인을 알아보며, 뇌출혈 발생과의 관계도 알아보고자 본 연구를 시행하였다. 방법: 2006년 1월부터 2009년 12월까지 원광대학교 병원NICU에서 7일 이상 생존하였던 1,250 g 미만의 극소 저체중 출생아 55예를 대상으로 하였다. 환아들의 의무기록을 이용하여 출생 후 6일 동안 고나트륨혈증의 발생빈도, 출현시기, 고나트륨혈증 유발의 위험 요인으로 알려진 Na 투여량, 수액 공급량, 소변배출양, 체중 감소, 그리고 뇌출혈 발생 유무를 후향적으로 조사하고, 이들을 혈청 나트륨이 단 1회라도 150 mEq/L 이상으로 검사된 경우의 고나트륨혈증군과 비고나트륨혈증군으로 구분하여 비교 하였다. 결과: 1,250 g 미만의 극소 저체중 출생아에서, 1) 고나트륨혈증의 빈도는 52.7%이고, 처음 출현한 시기는 출생 후 2.8${\pm}$1.3일이었다. 2) 고나트륨혈증을 보인 군의 Na 투여량이 보이지 않은군에 비해 더 많아 보였으나 의의는 없었다. 3) 고나트륨혈증을 보인 군과 보이지 않은 군의 수액투여량은 차이가 없었다. 4) 고나트륨혈증을 보인 군과 보이지 않은 군의 소변배출량은 차이가 없었다. 5) 고나트륨혈증을 보인 군(3.52${\pm}$2.19%)의 체중 감소가 보이지 않은 군(2.00${\pm}$3.24%)에 비해 생후 3일째 의의 있는 감소를 보였으며(P<0.05) 이후에도 체중감소의 정도가 더 심하였으나 의의는 없었다. 6) 뇌출혈의 빈도는 38.2% (21/55명)이었으며, 고나트륨혈증을 보인 군(14/29명, 41.4%)과 보이지 않은 군(9/26명, 34.6%)의 뇌출혈 발생 빈도의 차이는 의의가 없었다. 결론: 극소 저체중 출생아에서 출생초기의 고나트륨혈증은 자주 유발되며 출생 초기의 심한 체중감소가 발생의 중요 요인으로 보이나, 약간 높은 혈청내 Na 농도는 뇌출혈 발생에 영향이 적은 것으로 보인다.

• Journal of Korean Neurosurgical Society
• /
• 제66권3호
• /
• pp.332-339
• /
• 2023

Objective : The present study aimed to investigate the clinical characteristics of electrolyte imbalance in patients with moderate to severe traumatic brain injury (TBI) who underwent craniotomy and its influence on prognosis. Methods : A total of 156 patients with moderate to severe TBI were prospectively collected from June 2019 to June 2021. All patients underwent craniotomy and intracranial pressure (ICP) monitoring. We aimed to explore the clinical characteristics of electrolyte disturbance and to analyze the influence of electrolyte disturbance on prognosis. Results : A total of 156 patients with moderate and severe TBI were included. There were 57 cases of hypernatremia, accounting for 36.538%, with the average level of 155.788±7.686 mmol/L, which occurred 2.2±0.3 days after injury. There were 25 cases of hyponatremia, accounting for 16.026%, with the average level of 131.204±3.708 mmol/L, which occurred 10.2±3.3 days after injury. There were three cases of hyperkalemia, accounting for 1.923%, with the average level of 7.140±1.297 mmol/L, which occurred 5.3±0.2 days after injury. There were 75 cases of hypokalemia, accounting for 48.077%, with the average level of 3.071±0.302 mmol/L, which occurred 1.8±0.6 days after injury. There were 105 cases of hypocalcemia, accounting for 67.308%, with the average level of 1.846±0.104 mmol/L, which occurred 1.6±0.2 days after injury. There were 17 cases of hypermagnesemia, accounting for 10.897%, with the average level of 1.213±0.426 mmol/L, which occurred 1.8±0.5 days after injury. There were 99 cases of hypomagnesemia, accounting for 63.462%, with the average level of 0.652±0.061 mmol/L, which occurred 1.3±0.4 days after injury. Univariate regression analysis revealed that age, Glasgow coma scale (GCS) score at admission, pupil changes, ICP, hypernatremia, hypocalcemia, hypernatremia combined with hypocalcemia, epilepsy, cerebral infarction, severe hypoproteinemia were statistically abnormal (p<0.05), while gender, hyponatremia, potassium, magnesium, intracranial infection, pneumonia, allogeneic blood transfusion, hypertension, diabetes, abnormal liver function, and abnormal renal function were not statistically significant (p>0.05). After adjusting gender, age, GCS, pupil changes, ICP, epilepsy, cerebral infarction, severe hypoproteinemia, multivariate logistic regression analysis revealed that hypernatremia or hypocalcemia was not statistically significant, while hypernatremia combined with hypocalcemia was statistically significant (p<0.05). Conclusion : The incidence of hypocalcemia was the highest, followed by hypomagnesemia, hypokalemia, hypernatremia, hyponatremia and hypermagnesemia. Hypocalcemia, hypomagnesemia, and hypokalemia generally occurred in the early post-TBI period, hypernatremia occurred in the peak period of ICP, and hyponatremia mostly occurred in the late period after decreased ICP. Hypernatremia combined with hypocalcemia was associated with prognosis.

• 정신신체의학
• /
• 제4권1호
• /
• pp.91-97
• /
• 1996

Lithium is a widely used important drug in the treatment of manic-depressive illness and its prevention of relapse. However, this drug has a Low therapeutic index, therefore, it has many attendant side effects. The most prevalent renal effect of lithium is impairment of concentrating ability and this defect appeared into overt polyuria. A renal lesion is confined to the collecting tubule and 12-20% of patients taking lithium suffer from nephrogenic diabetes insipidus. This nephrogenic diabetes insipidus causes the states of extracellular fluid depletion, hypernatremia and precipitates lithium intoxication. In such situation, symptoms of nephrogenic diabetes insipidus and lithium intoxication are very similar, so we should be very cautious to discriminate them. We herein report a patient characterized by a prolonged stuporous state, hypernatremia and severe nephrogenic diabetes insipidus during lithium therapy.

• Childhood Kidney Diseases
• /
• 제13권2호
• /
• pp.261-266
• /
• 2009

횡문근융해증은 횡문근 손상에 의해 근육을 구성하는 세포 성분들이 혈액 내로 유리되면서 발생하는 증후군으로 다발성 외상, 약물 또는 알코올 남용, 전해질 불균형, 세균과 바이러스 감염, 극심한 운동, 고체온과 저체온, 고혈당과 저혈당 등 매우 다양한 원인들에 의해 발생할 수 있다. 저자들은 고나트륨혈증과 제 1형 파라인플루엔자 감염에 의한 횡문근융해증을 경험하였기에 이를 보고하는 바이다.

• 대한수의학회지
• /
• 제51권4호
• /
• pp.319-323
• /
• 2011

A 12-year-old spayed female Yorkshire terrier dog was presented with two-weeks history of lethargy, mental dullness and polydipsia. Neurologic examination revealed proprioceptive defect of all limbs and loss of swallowing gag reflex. The dog revealed persistent dehydration, hypernatremia, hyperosmolarity and hyposthenuria. On magnetic resornance imaging (MRI), the mass were heterogeneous signality on T1 weighted images, hyperintense signality on T2 weighted image with contrast enhancement on hypothalamohypophyseal lesion. Based on these findings, the dog was suspected as having pituitary gland tumor. Through water deprivation test and response to desmopressin acetate (1-deamino-8-D-arginine, DDAVP), this case was diagnosed by central diabetes insipidus (CDI). This paper reports the clinical sign, MRI, response to the exogenous antidiuretic hormone of CDI due to suspected pituitary tumor in a dog and DDAVP administration was evaluated effective therapy to correct hypernatremia induced by CDI.

• 한국임상수의학회:학술대회논문집
• /
• 한국임상수의학회 2007년도 추계국제학술대회 및 컨퍼런스
• /
• pp.606-606
• /
• 2007

• 한국임상수의학회:학술대회논문집
• /
• 한국임상수의학회 2006년도 춘계학술대회
• /
• pp.114-114
• /
• 2006

• Clinical and Experimental Pediatrics
• /
• 제50권5호
• /
• pp.430-435
• /
• 2007

Even though we drink and excrete water without recognition, the amount and the composition of body fluid remain constant everyday. Maintenance of a normal osmolality is under the control of water balance which is regulated by vasopressin despite sodium concentration is the dominant determinant of plasma osmolality. The increased plasma osmolality (hypernatremia) can be normalized by the concentration of urine, which is the other way of gaining free water than drinking water, while the low plasma osmolality (hyponatremia) can be normalized by the dilution of urine which is the only regulated way of free water excretion. On the other hand, volume status depends on the control of sodium balance which is regulated mainly by renin-angiotensin-aldosterone system, through which volume depletion can be restored by enhancing sodium retention and concomitant water reabsorption. This review focuses on the urine concentration and dilution mechanism mediated by vasopressin and the associated disorders; diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion.