Pre-emptive use of glucose 5% as the standard drug solvent reduces hypernatremia in critically ill patients.

IF 3.9 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal Pub Date : 2024-11-04 eCollection Date: 2024-11-01 DOI:10.1093/ckj/sfae328

Jan-Hendrik B Hardenberg, Julius Valentin Kunz, Kerstin Rubarth, Mirja Mittermaier, Mareen Pigorsch, Felix Balzer, Martin Witzenrath, Ricarda Merle Hinz, Roland Körner, Kai-Uwe Eckardt, Felix Knauf, Carl Hinrichs, Philipp Enghard

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引用次数: 0

Abstract

Background: Hypernatremia presents a common complication in intensive care unit (ICU) patients, associated with increased mortality and length of stay. This study investigates the effect of sodium chloride 0.9% compared with glucose 5% solution as the standard intravenous drug diluent on the prevalence of hypernatremia in a medical ICU.

Methods: This is a retrospective before-and-after study comparing two consecutive patient groups before and after the standard drug solvent was changed from sodium chloride 0.9% to glucose 5% solution for compatible medications. A total of 265 adult COVID-19 patients admitted between October 2020 and March 2021 to the study ICU were included, with 161 patients in the timeframe when sodium chloride 0.9% was employed as the standard drug solvent and 104 patients when glucose 5% was used. Routine sodium measurements from arterial and venous blood gases, along with heparinized lithium plasma, were analyzed. The daily sodium concentrations and the prevalence of severe hypernatremia (>150 mmol/l) were assessed during the first 8 days after ICU admission.

Results: Baseline characteristics were similar between the two groups. The cumulative volume of intravenous drug diluents was comparable. In the glucose 5% group, about half of the total drug diluent volume was glucose 5% [mean (SD): 2251.6 (2355.4) ml], compared to 135.0 (746.9) ml (P < .001) in the control group. Average sodium concentrations diverged after day two, with the glucose 5% group consistently showing lower sodium levels (mean difference of ∼2.5 mmol/l). Severe hypernatremia occurred less frequently in the glucose 5% group (6.6% vs. 20%).

Conclusion: Glucose 5% solution as the standard intravenous drug solvent significantly reduced sodium concentrations and the occurrence of severe hypernatremia. This simple modification in solvent choice may serve as a preventive strategy against hypernatremia in the ICU. Further prospective research is necessary to determine associated clinical outcomes.

Trial registration: The trial was registered in the German Clinical Trials Register (DRKS00031877).

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预先使用 5%的葡萄糖作为标准药物溶媒，可减少危重病人的高钠血症。

背景：高钠血症是重症监护病房（ICU）患者常见的并发症，与死亡率和住院时间的延长有关。本研究探讨了在内科重症监护病房中，将 0.9% 氯化钠溶液与 5% 葡萄糖溶液作为标准静脉药物稀释剂相比，对高钠血症发生率的影响：这是一项回顾性前后对比研究，比较了将标准药物溶媒从0.9%氯化钠改为5%葡萄糖溶液之前和之后的两组连续患者。研究共纳入了 2020 年 10 月至 2021 年 3 月期间入住研究重症监护室的 265 例 COVID-19 成人患者，其中 161 例患者的标准药物溶媒为 0.9% 氯化钠，104 例患者的标准药物溶媒为 5%葡萄糖。研究人员分析了动脉和静脉血气的常规钠测量值以及肝素化锂血浆。评估了入住重症监护室后头8天的每日钠浓度和严重高钠血症（>150毫摩尔/升）的发生率：结果：两组患者的基线特征相似。静脉注射药物稀释剂的累积量相当。在 5%葡萄糖组中，约一半的药物稀释剂总量为 5%葡萄糖[平均值（标度）：2251.6 (2355.4) ml]，而在 5%葡萄糖组中，药物稀释剂总量为 135.0 (746.9) ml (P 结论：5%葡萄糖组的药物稀释剂总量为 135.0 (746.9) ml：将 5%葡萄糖溶液作为标准静脉注射药物溶剂可显著降低钠浓度和严重高钠血症的发生率。这种对溶剂选择的简单改变可作为重症监护病房预防高钠血症的策略。有必要进一步开展前瞻性研究，以确定相关的临床结果：试验已在德国临床试验注册中心（DRKS00031877）注册。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Kidney Journal Medicine-Transplantation

CiteScore

6.70

自引率

10.90%

发文量

242

审稿时长

8 weeks

期刊介绍： About the Journal Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.