The Magnitude, Associated Factors and Outcome of Dysnatremia and Dyskalemia in the Icus of Three Tertiary Hospitals in Ethiopia

Atiklet Zerihun Zewdie^1, , Addisu Melkie Ejigu¹, Henok Bahru Wodajeneh¹, Muluken Alemayehu Workiye², Ayanaw Guadie Mamo³, Eyosias Lemma Teshome⁴ and Mahlet Seyoum Shiferaw⁵

¹Department of Internal Medicine, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

²Department of Internal Medicine, Menilik II Comprehensive Specialized Hospital, Addis Ababa, Ethiopia

³Department of Internal Medicine, University of Gondar Hospital, Gondar, Ethiopia

⁴Department of Internal Medicine, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

⁵Department of Radiology, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Cite this paper:
Atiklet Zerihun Zewdie, Addisu Melkie Ejigu, Henok Bahru Wodajeneh, Muluken Alemayehu Workiye, Ayanaw Guadie Mamo, Eyosias Lemma Teshome and Mahlet Seyoum Shiferaw. The Magnitude, Associated Factors and Outcome of Dysnatremia and Dyskalemia in the Icus of Three Tertiary Hospitals in Ethiopia. American Journal of Medical Sciences and Medicine. 2024; 12(3):51-63. doi: 10.12691/ajmsm-12-3-1

Abstract

Background: Electrolyte disturbance is common in critically ill patients and it is independently associated with increased short-term and long-term morbidity and mortality. The main objective of this study was to assess the prevalence, associated factors and outcome of dysnatrmia and dyskalemia in the ICUs of BLH, St peter's and Yekatit 12 hospitals. Methods: This was a prospective, hospital-based cohort study of critically ill patients admitted to the ICUs of BLH, St peter's and Yekatit12 hospital between May 1, 2021 and August 31, 2021. A structured questionnaire was used to collect information on sociodemographic characteristics, clinical profile at admission, and outcomes at discharge.To identify determinants of dysnatremia and dyskalemia, bivariable and multivariable binary logistic regression analyses were done. Statistical significance was considered at the level of significance of 5%, and adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to present the estimates of the strength of the association. Result: A total of 159 patients included in the study. The majority (64.2%) of study participants are from St. Peter. More than one-third (38.4%) of them were in the age group of 31-50 years. The frequency of hyponatremia was 49.68% while Hypernatremia has been found in 25.48% of ICU admitted patients. The magnitude of hypo and hyperkalemia is found out to be 39.49% and 24.2% respectively. A total of 70.06% of patients were dysnatremic while 61.15% were dyskalemic.The odds of hyponatremia increase 4.53 times with admission diagnosis of endocrine than non-endocrine admissions [AOR=4.53; 95% CI: 1.64 - 12.53], Similarly the odds of hyponatremia increased 3.95 times with those taking beta blockers [AOR= 3.95; 95% CI: 1.43 - 10.97].hypernatremia increased 3.17 times in those who took sedatives as compared to those who didn’t [AOR=3.17; 95% CI: 1.28- 7.86] and in those with diagnosis of AKI in their hospital stay.a single unit increase on the mean chloride increased the odds of hypernatremia by1.16 times [AOR=1.16; 95% CI: 1.08- 1.24].Those with admission diagnosis of COVID 19 were 75% less risk of developing hypokalemia than those with non-covid admissions [AOR=0.25; 95% CI: 0.11- 0.61].Those with use of beta blockers were 95% less risk of developing hyperkalemia as compared to those who don’t use betablockers [AOR=0.05; 95% CI: 0.01-0.48]. one unit increase in the mean urea increases the risk of hyperkalemia by 1.02 times [AOR=1.02; 95% CI: 1.01- 1.03]. Hypernatremia increased the risk of death 2.73 times among patients in the ICU than those with no hypernatremia. [AOR=2.73; 95% CI: 1.28- 5.85]. similarly, those patients in the ICU with hyperkalemia were 2.43 times more at risk to die than those with no hyperkalemia. [AOR=2.43; 95% CI: 1.13- 5.25]. Conclusion: This study demonstrated that dysnatrmia and dyskalemia are frequent findings in the critically ill. There are different determinant factors for the development of dysnatremia and dyskalemia in the ICU. Critically ill patients with hypernatremia and hyperkalemia had a higher incidence of thirty-day ICU mortality.

Keywords:
dysnatremia dyskalemia thirty-day ICU mortality

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References:

[1]	Kraft MD, Btaiche IF, Sacks GS, et al. Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Heal Pharm 2005; 62: 1663–1682.
[2]	Samaritan BG. Electrolyte disturbances associated with medications in the critically ill. Int J Intenive Care 2012; 19: 83–88.
[3]	In NM, In P, Sadeghi-bojd S, et al. Electrolyte Disturbances in PICU : A Cross Sectional Study. Epub ahead of print 2019.
[4]	Lee JW. Fluid and electrolyte disturbances in critically ill patients. Electrolyte and Blood Pressure 2010; 8: 72–81.
[5]	Padhi R, Panda B, Jagati S, et al. Hyponatremia in critically ill patients. Indian J Crit Care Med 2014; 18: 83–87.
[6]	Sim JK, Ko RE, Na SJ, et al. Intensive care unit-acquired hyponatremia in critically ill medical patients. J Transl Med 2020; 18: 1–9.
[7]	Zahid M, Khan A, Abbas S, et al. Frequency of dyskalemia and dysnatremia in surgical intensive care unit. Dysnatremia Dyskalemia Pak Armed Forces Med J 2014; 1: 39–43.
[8]	Rafat C, Flamant M, Gaudry S, et al. Hyponatremia in the intensive care unit : How to avoid a Zugzwang situation ? Ann Intensive Care. Epub ahead of print 2015.
[9]	Arora SK. Hypernatremic Disorders in the Intensive Care Unit. 2013; 28: 37–45.
[10]	F F, Darmon M, Timsit J, et al. Association between hypernatraemia acquired in the ICU and mortality : a cohort study. 2010; 2510–2515.
[11]	Alansari M, Abdulmomen A, Hussein M, et al. Acquired hypernatremia in a general surgical Intensive Care Unit: Incidence and prognosis. Saudi J Anaesth 2016; 10: 409–413.
[12]	Viera AJ, Wouk N. Potassium Disorders: Hypokalemia and Hyperkalemia.
[13]	Gerçek A, Umuroǧlu T, Inci F, et al. The etiology and incidence of hypokalemia in intensive care unit. Marmara Med J 2003; 16: 32–35.
[14]	Care I, Dépret F, Peacock WF, et al. Management of hyperkalemia in the acutely ill patient. Ann Intensive Care. Epub ahead of print 2019.
[15]	Brueske B, Sidhu MS, Schulman-Marcus J, et al. Hyperkalemia is associated with increased mortality among unselected cardiac intensive care unit patients. J Am Heart Assoc; 8. Epub ahead of print 2019.
[16]	Ali K, Workicho A, Kebede Gudina E. Hyponatremia in patients hospitalized with heart failure: a condition often overlooked in low-income settings. Int J Gen Med 2016; 2016: 9–267.
[17]	Yuan J, Zou XR, Han SP, et al. Prevalence and risk factors for cardiovascular disease among chronic kidney disease patients: Results from the Chinese cohort study of chronic kidney disease (C-STRIDE). BMC Nephrol. Epub ahead of print 2017.
[18]	Diribsa GC, Kinfe Y, Abdissa SG. Assessment of Renal Function and Electrolyte Balance in Patients with Cardiovascular Disease at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Sci J Med Res 2019; 03: 70–78.
[19]	Mousavi SJ. Comparison of the Serum Electrolyte Levels among Patients Died and Survived in the Intensive Care Unit Comparison of the Serum Electrolyte Levels among Patients Died and Survived in the Intensive Care Unit.
[20]	Kadri A. General characteristics of patients with electrolyte imbalance admitted to emergency department. World J Emerg Med 2013; 4: 113.
[21]	Nicolini EA, Nunes RS, Santos G V., et al. Could dysnatremias play a role as independent factors to predict mortality in surgical critically ill patients? Med (United States) 2017; 96: 5–9.
[22]	Oude Lansink-Hartgring A, Hessels L, Weigel J, et al. Long-term changes in dysnatremia incidence in the ICU: a shift from hyponatremia to hypernatremia. Ann Intensive Care 2016; 6: 1–8.
[23]	Marshall DC, Salciccioli JD, Goodson RJ, et al. The association between sodium fluctuations and mortality in surgical patients requiring intensive care. J Crit Care 2017; 40: 63–68.
[24]	Tongyoo S, Viarasilpa T, Permpikul C. Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit. J Int Med Res 2018; 46: 1254–1262.