Characteristics of Severe Hyponatremia in Hospitalized Patients; A Comparison according to the Presence of Liver Disease

Kim, Hyosang; Lee, Hajeong; Park, Hayne cho; Jeong, Ji Yong; Son, Min Jeong; Oh, Kook Hwan; Kim, Yon Su; Ahn, Curie; Han, Jin Suk; Kim, Suhnggwon; Joo, Kwon Wook

Abstract

PURPOSE: Liver disease is one of the most common causes of hyponatremia and improper management of severe hyponatremia may result in serious complications. We evaluated the prevalence and clinical characteristics of severe hyponatremic patients according to the presence of liver disease in hospitalized patients.
METHODS
We studied 12,729 hyponatremic patients during hospitalization in single tertiary referral hospital for 1 year. Hyponatremia was defined as serum sodium level <135 mmol/L and severe hyponatremia as < or =125 mmol/L at least twice.
RESULTS
Of 12,729 hyponatremic patients, 711 (0.13%) patients had severe hyponatremia and 290 (40.8%) patients with severe hyponatremia had liver disease. The main cause of severe hyponatremia was liver failure (69.7%) in patients with liver disease and excessive administration of hypotonic fluid (37.3%) in non-liver disease patients. The administration of hypertonic saline was the most common treatment both in liver and non-liver disease group. In severe hyponatremic liver disease patients, the serum sodium level was lower (128.8+/-7.1 at admission, 127.1+/-8.4 at discharge vs 132.1+/-7.5, 131.5+/-8.3 mmol/L) and the duration of severe hyponatremia (5 days vs 3 days) was longer than those in non-liver disease group. Of 589 patients with severe hyponatremic patients who had been treated for the sodium correction, 261 patients were recovered from severe hyponatremia to normal range of serum sodium, and lower correction rate was observed in liver disease group.
CONCLUSION
Liver failure was the most common cause of severe hyponatremia in hospitalized patients. Severe hyponatremia in patients with liver disease had poor clinical outcomes.