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Rising serum sodium levels are associated with a concurrent development of metabolic alkalosis in critically ill patients

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Abstract

Purpose

Changes in electrolyte homeostasis are important causes of acid–base disorders. While the effects of chloride are well studied, only little is known of the potential contributions of sodium to metabolic acid–base state. Thus, we investigated the effects of intensive care unit (ICU)-acquired hypernatremia on acid–base state.

Methods

We included critically ill patients who developed hypernatremia, defined as a serum sodium concentration exceeding 149 mmol/L, after ICU admission in this retrospective study. Data on electrolyte and acid–base state in all included patients were gathered in order to analyze the effects of hypernatremia on metabolic acid–base state by use of the physical–chemical approach.

Results

A total of 51 patients were included in the study. The time of rising serum sodium and hypernatremia was accompanied by metabolic alkalosis. A transient increase in total base excess (standard base excess from 0.1 to 5.5 mmol/L) paralleled by a transient increase in the base excess due to sodium (base excess sodium from 0.7 to 4.1 mmol/L) could be observed. The other determinants of metabolic acid–base state remained stable. The increase in base excess was accompanied by a slight increase in overall pH (from 7.392 to 7.429, standard base excess from 0.1 to 5.5 mmol/L).

Conclusions

Hypernatremia is accompanied by metabolic alkalosis and an increase in pH. Given the high prevalence of hypernatremia, especially in critically ill patients, hypernatremic alkalosis should be part of the differential diagnosis of metabolic acid–base disorders.

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Acknowledgments

There was no financial support for the realization of this study.

Conflicts of interest

None of the authors has a conflict of interest.

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Authors and Affiliations

  1. Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland

    Gregor Lindner

  2. Department of Nephrology, Medical University of Graz, Graz, Austria

    Christoph Schwarz

  3. Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Vienna, Austria

    Heidelinde Grüssing

  4. Department of Respiratory Medicine, University of Munich, Munich, Germany

    Nikolaus Kneidinger

  5. Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria

    Andreas Fazekas & Georg-Christian Funk

  6. Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria

    Andreas Fazekas & Georg-Christian Funk

Authors
  1. Gregor Lindner
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  2. Christoph Schwarz
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  3. Heidelinde Grüssing
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  4. Nikolaus Kneidinger
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  5. Andreas Fazekas
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  6. Georg-Christian Funk
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Corresponding author

Correspondence to Gregor Lindner.

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Lindner, G., Schwarz, C., Grüssing, H. et al. Rising serum sodium levels are associated with a concurrent development of metabolic alkalosis in critically ill patients. Intensive Care Med 39, 399–405 (2013). https://doi.org/10.1007/s00134-012-2753-3

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  • DOI: https://doi.org/10.1007/s00134-012-2753-3

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