The Experts below are selected from a list of 8487 Experts worldwide ranked by ideXlab platform
Kunihiko Itoh - One of the best experts on this subject based on the ideXlab platform.
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Risk factors for Hypernatremia in patients with short- and long-term tolvaptan treatment
European Journal of Clinical Pharmacology, 2016Co-Authors: Keita Hirai, Tatsuki Shimomura, Hideaki Moriwaki, Hidetoshi Ishii, Takayuki Shimoshikiryo, Daiki Tsuji, Kazuyuki Inoue, Toshihiko Kadoiri, Kunihiko ItohAbstract:Purpose The long-term efficacy of tolvaptan, a vasopressin V2 receptor antagonist, has been reported. However, the safety of long-term treatment remains to be fully elucidated. We assessed the safety profile of tolvaptan with respect to Hypernatremia. Methods This retrospective study included 371 patients treated with tolvaptan. Risk factors for Hypernatremia (serum sodium concentration ≥147 mEq/L) were determined. Results Hypernatremia occurred in 95 patients (25.6 %), of whom 71 (19.1 %) developed Hypernatremia within 7 days of tolvaptan treatment (early onset). Stepwise logistic regression analysis demonstrated that baseline serum sodium ≥140 mEq/L, an initial tolvaptan dosage >7.5 mg, and a BUN/serum creatinine ratio ≥20 were independent risk factors for early onset of Hypernatremia. Tolvaptan was prescribed for more than 7 days to 233 patients, of whom 123 were administrated tolvaptan for more than 1 month. Hypernatremia occurred in 24 of these patients (10.3 %) (late onset). Predictive factors for late onset of Hypernatremia were an average daily dosage of tolvaptan >7.5 mg and age ≥75 years. Conclusions A daily dosage of 7.5 mg or less was recommended to prevent Hypernatremia in short- as well as long-term tolvaptan treatment, and mainly elderly patients were at risk for Hypernatremia.
Douglas D Fraser - One of the best experts on this subject based on the ideXlab platform.
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Hypernatremia is associated with increased risk of mortality in pediatric severe traumatic brain injury
Journal of Neurotrauma, 2013Co-Authors: Ibrahim M Alharfi, Tanya Charyk Stewart, Shawn H Kelly, Gavin Morrison, Douglas D FraserAbstract:Abstract Acquired Hypernatremia in hospitalized patients is often associated with poorer outcomes. Our aim was to evaluate the relationship between acquired Hypernatremia and outcome in children with severe traumatic brain injury (sTBI). We performed a retrospective cohort study of all severely injured trauma patients (Injury Severity Score ≥12) with sTBI (Glasgow Coma Scale [GCS] ≤8 and Maximum Abbreviated Injury Scale [MAIS] ≥4) admitted to a Pediatric Critical Care Unit ([PCCU]; 2000–2009). In a cohort of 165 patients, 76% had normonatremia (135–150 mmol/L), 18% had Hypernatremia (151–160 mmol/L), and 6% had severe Hypernatremia (>160 mmol/L). The groups were similar except for lower GCS (p=0.002) and increased incidence of fixed pupil(s) on admission in both Hypernatremia groups (p<0.001). Mortality rate was four-fold and six-fold greater with Hypernatremia and severe Hypernatremia, respectively (p<0.001), and mortality rates were unchanged when patients with fixed pupils or those with central diabete...
E Schaefer - One of the best experts on this subject based on the ideXlab platform.
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early intensive care unit acquired Hypernatremia in severe sepsis patients receiving 0 9 saline fluid resuscitation
Acta Anaesthesiologica Scandinavica, 2014Co-Authors: A Van De Louw, C Shaffer, E SchaeferAbstract:Background Intensive care unit (ICU)-acquired Hypernatremia is associated with increased mortality and ascribed to excessive sodium/insufficient free water intakes. We aimed to determine whether the volume of intravenous 0.9% saline fluid resuscitation was associated with Hypernatremia in severe sepsis. Methods We retrospectively reviewed the charts of patients admitted to our medical ICU over 1 year with severe sepsis, and recorded all fluid intakes and plasma sodium levels (Nap) for 5 days along with clinical data. ΔNap was defined as the difference between maximal Nap reached and initial Nap. Hypernatremia was defined as Nap > 145 mmoles/l. Results Among 95 patients with severe sepsis, 29 developed Hypernatremia within 5 days (31%), reaching a maximum Nap of 149.1 ± 2.5 mmoles/l on average 3.8 ± 1.5 days after admission. For every 50-ml/kg increase in 0.9% saline intake for the first 48 h, the odds of Hypernatremia were 1.61 times larger [confidence interval (CI): 0.98–2.62; P = 0.06] and the mean of ΔNap increased by 1.86 mmoles/l (CI: 0.86–2.86; P < 0.001). Compared with non-hypernatremic patients, hypernatremic patients received more 0.9% saline within the first 48 h (111 ± 50 ml/kg vs. 92 ± 42 ml/kg, P < 0.05) and more other fluids from 48 to 96 h (64 ± 38 ml/kg vs. 42 ± 24 ml/kg, P < 0.05). Patients developing Hypernatremia had increased length of mechanical ventilation (12.0 ± 12.6 vs. 9.1 ± 7.2 days, P < 0.05) and ICU mortality (38.5% vs. 13%, P < 0.01). Conclusions Early acquired Hypernatremia is a frequent complication in severe sepsis patients and is associated with the volume of 0.9% saline received during the first 48 h of admission.
Shankar P. Gopinath - One of the best experts on this subject based on the ideXlab platform.
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Morbidity and mortality associated with Hypernatremia in patients with severe traumatic brain injury.
Neurosurgical focus, 2017Co-Authors: Aditya Vedantam, Claudia S. Robertson, Shankar P. GopinathAbstract:OBJECTIVE Hypernatremia is independently associated with increased mortality in critically ill patients. Few studies have evaluated the impact of Hypernatremia on early mortality in patients with severe traumatic brain injury (TBI) treated in a neurocritical care unit. METHODS A retrospective review of patients with severe TBI (admission Glasgow Coma Scale score ≤ 8) treated in a single neurocritical care unit between 1986 and 2012 was performed. Patients with at least 3 serum sodium values were selected for the study. Patients with diabetes insipidus and those with Hypernatremia on admission were excluded. The highest serum sodium level during the hospital stay was recorded, and Hypernatremia was classified as none (≤ 150 mEq/L), mild (151-155 mEq/L), moderate (156-160 mEq/L), and severe (> 160 mEq/L). Multivariate Cox regression analysis was performed to determine independent predictors of early mortality. RESULTS A total of 588 patients with severe TBI were studied. The median number of serum sodium measurements for patients in this study was 17 (range 3-190). No Hypernatremia was seen in 371 patients (63.1%), mild Hypernatremia in 77 patients (13.1%), moderate Hypernatremia in 50 patients (8.5%), and severe Hypernatremia in 90 patients (15.3%). Hypernatremia was detected within the 1st week of admission in 79.3% of patients (n = 172), with the majority of patients (46%) being diagnosed within 72 hours after admission. Acute kidney injury, defined as a rise in creatinine of ≥ 0.3 mg/dl, was observed in 162 patients (27.6%) and was significantly associated with the degree of Hypernatremia (p < 0.001). At discharge, 148 patients (25.2%) had died. Hypernatremia was a significant independent predictor of mortality (hazard ratios for mild: 3.4, moderate: 4.4, and severe: 8.4; p < 0.001). Survival analysis showed significantly lower survival rates for patients with greater degrees of Hypernatremia (log-rank test, p < 0.001). CONCLUSIONS Hypernatremia after admission in patients with severe TBI was independently associated with greater risk of early mortality. In addition to severe Hypernatremia, mild and moderate Hypernatremia were significantly associated with increased early mortality in patients with severe TBI.
Gregor Lindner - One of the best experts on this subject based on the ideXlab platform.
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intensive care acquired Hypernatremia after major cardiothoracic surgery is associated with increased mortality
Intensive Care Medicine, 2010Co-Authors: Gregor Lindner, Georgchristian Funk, Christoph Schwarz, Andrea Lassnigg, M Mouhieddine, Salemahmed Ahmad, M HiesmayrAbstract:Purpose Hypernatremia is common in the medical Intensive Care Unit (ICU) and has been described as an independent risk factor for mortality. Hypernatremia has not yet been studied in a collection of ICU patients after cardiothoracic surgery. Therefore, we wanted to determine the incidence of Hypernatremia in a surgical ICU and its association with outcomes of critically ill surgical patients.
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Hypernatremia in the critically ill is an independent risk factor for mortality
American Journal of Kidney Diseases, 2007Co-Authors: Gregor Lindner, Georgchristian Funk, Christoph Schwarz, Nikolaus Kneidinger, Alexandra Kaider, Bruno Schneeweiss, Ludwig Kramer, Wilfred DrumlAbstract:Background Hypernatremia is common in the intensive care unit (ICU). We assessed the prevalence of Hypernatremia and its impact on mortality and ICU length of stay (LOS). Study Design Retrospective analysis. Setting & Participants All patients admitted to a medical ICU of a university hospital during a 35-month observation period. Predictor Hypernatremia (serum sodium > 149 mmol/L) after admission to the ICU. Outcomes & Measurements Main outcomes were 28-day hospital mortality and ICU LOS. Demographic factors, main diagnosis, and severity of illness. Cox proportional hazards regression models were used for data analysis. Results Of 981 patients, 90 (9%) had Hypernatremia, on admission to the ICU in 21 (2%) and developed during the ICU stay in 69 patients (7%). Of these 981 patients, 235 (24%) died; LOS was 8 ± 9 (SD) days. Mortality rates were 39% and 43% in patients with Hypernatremia on admission or that developed after admission compared with 24% in patients without Hypernatremia ( P P Limitations Retrospective design, absence of data for long-term mortality. Conclusions Most cases of Hypernatremia in the ICU developed after admission, suggesting an iatrogenic component in its evolution. Hypernatremia is associated with increased mortality. Strategies for preventing Hypernatremia in the ICU should be encouraged.