Résumé
Les dysnatrémies sont des désordres hydroélectrolytiques fréquents. Elles témoignent le plus souvent d’un trouble primitif de l’osmolarité extracellulaire. Enfin, elles peuvent être un motif d’hospitalisation en réanimation lorsqu’elles sont profondes ou d’installation rapide, ou une complication acquise pendant l’hospitalisation. Au-delà des complications neurologiques usuelles, un nombre croissant de travaux soulignent l’association entre dysnatrémies et pronostic défavorable. Cette association a été mise en évidence aussi bien en réanimation qu’en chirurgie, en médecine ou chez les brûlés. Enfin, elle concerne aussi bien les hyponatrémies que les hypernatrémies, et cela qu’elles soient acquises au cours du séjour ou présentes dès l’admission. Cette association est probablement expliquée en partie par des facteurs confondants : motif d’admission, sévérité du patient, impact des traitements reçus. La prévention ou le traitement des dysnatrémies pourraient de plus être un reflet de la qualité des soins et expliquer ainsi l’impact pronostique des dysnatrémies. Enfin, de possibles effets systémiques extraneurologiques des dysnatrémies ont été suggérés et pourraient participer à cette association pronostique. Ces données suggèrent de prêter une plus grande attention à ce désordre hydroélectrolytique et de mettre en place une prise en charge adaptée à chaque fois que possible, y compris en l’absence de symptomatologie neurologique.
Abstract
Dysnatremia is common either on admission or during the stay in the intensive care unit (ICU). Natremia is related to free water metabolism and intracellular water content. Profound and acute dysnatremia may represent the major reason for ICU admission. Besides the usual neurological symptoms of severe dysnatremia, increasing evidences suggest that dysnatremia may be associated with adverse outcome. Several studies have demonstrated that mild-to-severe dysnatremia are associated with poor outcome in the critically-ill, post-operative, burnt and hospitalized patients with various comorbidities. Confounding factors including case-mix, underlying comorbidities, and medications may influence fatal outcome associated with dysnatraemia, which becomes the main reason for ICU admission. Dysnatraemia also represents a marker of quality of care and attention paid by the physicians in charge to salt and water homeostasis. Finally, deleterious effects of mild-to-severe dysnatraemia on organ function cannot be ruled out. The relationship between changes in serum sodium and hospital mortality suggests that more attention should be paid to this metabolic disturbance. Even mild asymptomatic abnormal serum sodium concentration should be treated adequately.
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Claisse, G., Darmon, M. Dysnatrémie : faut-il y prêter attention ?. Réanimation 23, 638–644 (2014). https://doi.org/10.1007/s13546-014-0930-9
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DOI: https://doi.org/10.1007/s13546-014-0930-9