Hyponatremia among critically ill adults, its severity and prognostic significance: A descriptive cross-sectional study

Objectives: The primary objective of the present study was to assess the clinical presentation of hyponatremia among adult (>18 years of age) critically ill patients of both gender admitted in the intensive medical care unit. The secondary objectives were to determine the severity of hyponatremia and its prognostic significance. Methods: This was an observational descriptive cross-sectional study conducted in an Intensive Medical Care unit, Department of General Medicine, of a tertiary healthcare facility in South India between January 2019 and December 2019. Results: The present study included a total of 200 patients with hyponatremia. The most common cause of hyponatremia was SIADH (47.0%), followed by 18.5% patients having cardiac causes. Two third patients (66.5%) required ventilator support. More than half the patients (54.0%) had euvolemic hypoosmolar, 36.0%had hypervolemic hypoosmolar, 7.5% had hypovolemic hypoosmolar, and 2.5% had hypervolemic isoosmolar hyponatremia. Nearly two thirds had moderate hyponatremia (61.0%), 29.0% had severe hyponatremia, and 10.0% had mild hyponatremia. Age more than 60 years, females, hypervolemic hydration status, urinary sodium excretion more than 20 were significant predictors of severe hyponatremia. Majority of the patients who died (77.0%) had severe hyponatremia in comparison with moderate (22.7%) and mild hyponatremia (0.0%); statistically significant difference (p<0.05). The mean (SD) serum sodium levels among patients who died was lower in comparison with patients who were alive (MD 6.80, 95% CI 4.50 to 9.09; p<0.05). Conclusion: Severe hyponatremia was associated with a significantly higher risk of mortality, emphasizing the clinical relevance of earlyrecognition and intervention in these cases.