Impact of age on the seasonal prevalence of hypernatremia in the emergency department: a single-center study

Dysnatremia in a changing climate: A global systematic review of the association between serum sodium and ambient temperature

OBJECTIVE

Both hyponatremia and hypernatremia have been reported to occur more frequently with higher ambient temperatures, although the underlying mechanisms are not well understood. Global temperatures are rising due to climate change, which may impact the incidence of dysnatremia worldwide. We aimed to identify, collate and critically appraise studies analyzing the relationship between climate measures (outdoor temperature, humidity) and serum sodium concentrations.

DESIGN

Systematic review, reported in accordance with PRISMA guidelines.

METHODS

MEDLINE and Embase were searched with relevant key terms. Studies assessing the effect on serum sodium measurement of elevated temperature or humidity versus a comparator were included.

RESULTS

Of 1466 potentially relevant studies, 34 met inclusion criteria, originating from 23 countries spanning all inhabited continents. The majority (30 of 34, 88%) reported a significant association between outdoor temperature and dysnatremia, predominantly lower serum sodium with increased ambient temperature. Humidity had a less consistent effect. Individuals aged above 65 years, children, those taking diuretics and antidepressants, those with chronic renal impairment or those undertaking physical exertion had increased vulnerability to heat-associated dysnatremia. The risk of bias was assessed to be high in all but four studies.

CONCLUSIONS

Higher ambient temperature is consistently associated with an increased incidence of hyponatremia. We infer that hyponatremia presentations are likely to rise with increasing global temperatures and the frequency of extreme heat events secondary to climate change. Evidence-based public health messages, clinician education and reduction in fossil fuel consumption are necessary to reduce the expected burden on healthcare services worldwide.

Microalgae-Based Disinfectant Formulation for Aseptic Processing of Ethiopian Ingredient-Sourced Functional Bread and Its Molecular Docking Analysis to Reduce Hypernatremia

The global prevalence of food-borne infections has become a major concern. Food-borne pathogens like Campylobacter jejuni, Salmonella enterica, and Clostridium botulinum cause food poisoning and even mortality, necessitating the maintenance of aseptic conditions during food processing. The sterilization of food processing facilities often requires chemical and heat treatment. The formulation of many chemical-based disinfectants includes chemicals generating toxic and carcinogenic by-products. The microalgae like Chlorella spp. reportedly exhibit antimicrobial activity and therefore, can be used for formulating safer and eco-friendly natural sanitizers. This study aims to aseptically prepare functional bread using Ethiopian ingredients, highlighting the application of microalgae-based disinfectant formulation and various disinfection techniques. The functional bread was designed to be potentially effective in reducing hypernatremia condition which is indicative of high levels of sodium in serum that can cause an array of symptoms including deaths in serious cases. The physico-chemical and sensory properties of the designed functional bread were analyzed. The interaction of phytochemicals in the ingredients with the target receptor (Vasopressin V2 receptor) and their drug-likeness were determined using molecular docking and Lipinski's rule of five analyses. The results suggest that the designed functional bread incorporating Ethiopian ingredients may serve as an effective dietary strategy to prevent hypernatremia. Aseptic processing of the bread ensures longer shelf life and prevention of spoilage by food pathogens.

Hypernatremia at presentation to the emergency department: a case series

Disorders of serum sodium are common findings in patients presenting to the emergency department (ED). The aim of this study was to systematically investigate the prevalence, symptoms, etiology, treatment as well as the course of hypernatremia present on admission to the ED. All adult patients with measurements of serum sodium presenting to the ED between 01 January 2017 and 31 December 2020 were included in this retrospective cohort study. Chart reviews were performed for all patients with hypernatremia defined as serum sodium > 147 mmol/L. 376 patients (0.7%) had a serum sodium > 145 mmol/L on admission and 109 patients (0.2%) had clinically relevant hypernatremia > 147 mmol/L. Main symptoms included somnolence (42%) followed by disorientation (30%) and recent falls (17%). An impaired sense of thirst was the main cause of hypernatremia as present in 76 patients (70%), followed by a lack of free access to water in 50 patients (46%). Regarding treatment, only one patient received targeted oral hydration and 38 patients (35%) experienced inadequate correction of hypernatremia as defined as either a correction of < 2 mmol/L or further increasing sodium during the first 24 h. 25% of patients with hypernatremia died during the course of their hospital stay. Patients who died had significantly lower correction rates of serum sodium (0 mmol/L (-3 - 1.5) versus - 6 mmol/L (-10 - 0), p < 0.001). Hypernatremia is regularly encountered in the ED and patients present with unspecific neurologic symptoms. Initial treatment and correction of hypernatremia are frequently inadequate with no decrease or even increase in serum sodium during the first 24 h.

Seasonal Changes in the Prevalence of Hyperkalemia in the Emergency Department: A Single Center Study

Background: Hyperkalemia is an electrolyte disorder frequently encountered in the emergency department. There are few studies on seasonal variation in the prevalence of hyperkalemia. The aim of this study was to investigate the seasonal changes in the prevalence of hyperkalemia in the emergency department. Materials and Methods: We retrospectively reviewed a total of 24,085 patients presented to the emergency department between January 2012 and December 2020. Age, gender, serum potassium level, and serum creatinine level were recorded. The definition used for hyperkalemia was a serum potassium level of ≥ 5.5 mEq/L. Renal function was divided into two categories: preserved (eGFR ≥ 60 mL/min/1.73 m²) or reduced (eGFR < 60 mL/min/1.73 m²). Results: The prevalence of hyperkalemia was 2.1% in patients with preserved renal function and was 11.9% in patients with reduced renal function (p < 0.001). The prevalence of hyperkalemia was highest in winter, followed by spring, autumn, and summer in patients with preserved renal function (p < 0.001) and those with reduced renal function (p < 0.001). There was a linear correlation between monthly weather temperature and the prevalence of hyperkalemia in patients with preserved renal function (r = −0.392; p < 0.001) and those with reduced renal function (r = −0.487; p < 0.001). Conclusions: we found that the prevalence of hyperkalemia was significantly higher in winter for both patients with preserved renal function and those with reduced renal function.

Seasonal variation in emergent hemodialysis initiation in the late elderly: A single-center study

BACKGROUND

The number of new dialysis patients, particularly among the elderly population, has been globally increasing. In Japan, patients aged ≥65 years and ≥75 years comprised 72% and 45% of patients on dialysis in 2018, respectively. Few studies have reported seasonal variations in the initiation of dialysis. We investigated the seasonal prevalence of the emergent hemodialysis initiation in the elderly.

METHODS

We reviewed 479 elderly patients who initiated hemodialysis between January 2006 and December 2018. Early elderly patients were defined as patients aged between 65 and 74 years, and late elderly patients were defined as those aged ≥75 years. Emergent hemodialysis initiation was defined as initiation with a temporary vascular catheter without elective permanent vascular access or unplanned hemodialysis initiation due to patients requiring critical care regardless of elective permanent vascular access. The information collected included age, sex, and details of the initiation of hemodialysis.

RESULTS

The early elderly group consisted of 199 patients, and the late elderly group consisted of 279 patients. In the late elderly group, hemodialysis initiation was most frequent in winter, followed by spring, autumn, and summer (p = 0.018). Moreover, emergent hemodialysis initiation was most frequent in winter, followed by spring, autumn, and summer (p = 0.009). Emergent hemodialysis initiation due to fluid overload was most frequent in winter, followed by autumn, spring, and summer (p < 0.001). Among late elderly patients who initiated hemodialysis, 78% did not have permanent hemodialysis access at the time of the initiation of hemodialysis.

CONCLUSION

In the late elderly group, hemodialysis initiation and emergent hemodialysis initiation were significantly more frequent in the winter than in the remaining seasons. In addition, emergent hemodialysis initiation due to fluid overload was most frequent in winter in the late elderly group.

The Prognostic Importance of Serum Sodium for Mortality among Critically Ill Patients Requiring Continuous Renal Replacement Therapy

BACKGROUND

Serum sodium derangement is common in critically ill patients requiring continuous renal replacement therapy (CRRT). We aimed to assess the association between serum sodium before and during CRRT with mortality.

METHODS

This is a historical cohort study of 1,520 critically ill patients receiving CRRT from December 2006 through November 2015 in a tertiary hospital in the United States. Using logistic regression analysis, we used serum sodium before CRRT, mean serum sodium, and serum sodium changes during CRRT to predict 90-day mortality after CRRT initiation.

RESULTS

Compared with the normal serum sodium levels, the odds ratio (OR) of 90-day mortality in patients with serum sodium before CRRT of 143-147 and ≥148 mmol/L were 1.45 (95% CI 1.03-2.05) and 2.24 (95% CI 1.33-3.87), respectively. There was no significant increase in 90-day mortality in serum sodium of ≤137 mmol/L. During CRRT, the mean serum sodium levels of ≤137 (OR 1.41; 95% CI 1.01-1.98) and ≥143 mmol/L (OR 1.52; 95% CI 1.14-2.03) were associated with higher 90-day mortality. The greater serum sodium changes during CRRT were associated with higher 90-mortality (OR 1.35; 95% CI 1.21-1.51 per 5-mmol/L increase).

CONCLUSION

Before CRRT initiation, hypernatremia and during CRRT, hypo- and hypernatremia were associated with increased mortality.

Restoration of dysnatremia and acute kidney injury benefits outcomes of acute geriatric inpatients

Dysnatremia and dyskalemia are common problems in acutely hospitalized elderly patients. These disorders are associated with an increased risk of mortality and functional complications that often occur concomitantly with acute kidney injury in addition to multiple comorbidities. In a single-center prospective observational study, we recruited 401 acute geriatric inpatients. In-hospital outcomes included all-cause mortality, length of stay, and changes in functional status as determined by the Activities of Daily Living (ADL) scale, Eastern Cooperative Oncology Group (ECOG) performance, and Clinical Frailty Scale (CFS). The prevalence of dysnatremia alone, dyskalemia alone, and dysnatremia plus dyskalemia during initial hospitalization were 28.4%, 14.7% and 32.4%, respectively. Patients with electrolyte imbalance exhibited higher mortality rates and longer hospital stays than those without electrolyte imbalance. Those with initial dysnatremia, or dysnatremia plus dyskalemia were associated with worse ADL scores, ECOG performance and CFS scores at discharge. Subgroup analyses showed that resolution of dysnatremia was related to reduced mortality risk and improved CFS score, whereas recovery of renal function was associated with decreased mortality and better ECOG and CFS ratings. Our data suggest that restoration of initial dysnatremia and acute kidney injury during acute geriatric care may benefit in-hospital survival and functional status at discharge.