Evaluation and management of hypernatremia in adults: clinical perspectives

Effect of fosfomycin-induced hypernatremia on patients' hospital stay length and survival

BACKGROUND AND OBJECTIVE

Hypernatremia is a possible side effect of intravenous fosfomycin. The aim of this study was to investigate the effects of changes in sodium (Na) levels on hospital stay and survival in patients hospitalized in the intensive care unit receiving fosfomycin.

SUBJECTS AND METHODS

This study was conducted retrospectively on the files of patients over the age of 60, who were admitted to the Internal Medicine Intensive Care Unit. Plasma sodium levels were observed and documented over a period of 14 days. The patients were divided into two groups (Hypernatremia group Na > 145 mEq/L vs normonatremia group 135-145 mEq/L). In addition, daily sodium changes were noted for 14 days in patients.

RESULTS

The mean age of the patients was 75 years. Hospitalization days were longer for hypernatremia patients (31.5 days vs 41 days, p = 0.003). Patients with hypernatremia had an extended duration of stay in the intensive care unit. (21 days vs 31 days p = 0.002). The 1-month survival rate was 61.4% in patients with hypernatremia and 24.9% in patients without hypernatremia (p = 0.004). The absence of hypernatremia increases mortality by 2.09 times (95% CI 1.35-3.23). When discharge and mortality rates were analyzed according to sodium fluctuation, discharged patients exhibited a lower sodium fluctuation (4 min/max (-10/19) vs 6 min/max (-16/32) p < 0.001).

CONCLUSION

In conclusion, the strength of our study is that it specifically focuses on the consequences of the sodium fluctuation on patient management and provides results.

Effects of hypernatremia on the microglia

Signs and symptoms of hypernatremia largely indicate central nervous system dysfunction. Acute hypernatremia can cause demyelinating lesions similar to that observed in osmotic demyelination syndrome (ODS). We have previously demonstrated that microglia accumulate in ODS lesions and minocycline protects against ODS by inhibiting microglial activation. However, the direct effect of rapid rise in the sodium concentrations on microglia is largely unknown. In addition, the effect of chronic hypernatremia on microglia also remains elusive. Here, we investigated the effects of acute (6 or 24 h) and chronic (the extracellular sodium concentration was increased gradually for at least 7 days) high sodium concentrations on microglia using the microglial cell line, BV-2. We found that both acute and chronic high sodium concentrations increase NOS2 expression and nitric oxide (NO) production. We also demonstrated that the expression of nuclear factor of activated T-cells-5 (NFAT5) is increased by high sodium concentrations. Furthermore, NFAT5 knockdown suppressed NOS2 expression and NO production. We also demonstrated that high sodium concentrations decreased intracellular Ca2+ concentration and an inhibitor of Na+/Ca2+ exchanger, NCX, suppressed a decrease in intracellular Ca2+ concentrations and NOS2 expression and NO production induced by high sodium concentrations. Furthermore, minocycline inhibited NOS2 expression and NO production induced by high sodium concentrations. These in vitro data suggest that microglial activity in response to high sodium concentrations is regulated by NFAT5 and Ca2+ efflux through NCX and is suppressed by minocycline.

Correction of In-Patient Severe Hypernatremia in an 81-Year-Old Female With Hypopituitarism

Hypernatremia has been significantly associated with in-hospital mortality and discharge to long-term care facilities. The appropriate correction of electrolyte disturbances, especially sodium, is important to consider to prevent the addition of central nervous system disturbances, such as cerebral edema and eventual brain injury. The importance of maintaining a proper correction of hypernatremia has been well studied and used in clinical practice. Choosing to use a hypotonic solution is a key principle. It is of utmost importance to adjust the rate of correction based on the patient's symptoms, underlying etiology, and associated comorbidities. This case demonstrates how a correction formula was used and adjusted accordingly in an 81-year-old female with severe hypernatremia and metabolic encephalopathy with multiple comorbidities, including hypopituitarism. It is noteworthy to examine the correction rate, how it was calculated and delivered, and how the main cause of the hypernatremia was determined. Considering all these factors can help to properly administer any additional corrective medications, such as desmopressin (DDAVP) in a patient with diabetes insipidus (DI) secondary to hypopituitarism, or adjust the correcting rate based on signs, symptoms, and laboratory findings.

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.