Dysnatremias are also associated with increased mortality in critically ill patients. For critically ill patients, dysnatremias are among the most common electrolyte abnormalities. Alterations in plasma sodium may be a consequence of iatrogenic interventions such as intravenous fluid administration and medication or may portend altered physiology and may be a marker for a rapid decline in health. Sodium metabolism is usually tightly regulated at the cellular and organ level. Increased variability in plasma sodium may be associated with death in severely burned patients. Additionally, large variation in sodium ranges in the first 10 days of admission may be associated with increased mortality (OR 1.35 (95% CI 1.06 to1.7)). Adjusting for TBSA, age, ventilator days, and intensive care unit (ICU) stay, a higher CV of sodium measurements was associated with mortality (OR 5.8 (95% confidence interval (CI) 1.5 to 22)). Coefficient of variation (CV) was significantly higher in non-survivors (2.85 ± 1.1) than survivors (2.0 ± 0.7). Non-survivors had a significantly higher median number of hypernatremic (> 145 meq/l) measurements (2 vs. While mean sodium was significantly higher for non-survivors (138 ± 3 milliequivalents/liter (meq/l)) than for survivors (135 ± 2 meq/l), mean sodium levels remained within the laboratory reference range (135 to 145 meq/l) for both groups. 42 ± 16 years) and suffered from a more severe burn injury (50 ± 25% vs. The median number of serum sodium measurements per patient was 22. Serum sodium was measured 10,310 times overall. Twenty-nine patients died for a mortality rate of 14%. Mean age and %TBSA for the study was 45 ± 18 years and 32 ± 19%. Two hundred twelve patients met entry criteria. We used multivariate logistic regression analysis to determine if hypernatremia, hyponatremia, or sodium variability independently increased the odds ratio (OR) for death. All patients included in the study had at least three serum sodium levels checked during admission. We performed a retrospective review of adult burn patients with a burn injury of 15% total body surface area (TBSA) or greater from 2010 to 2014. Based on these findings, we hypothesized that high plasma sodium variability is a marker for increased mortality in severely burn-injured patients. Hypernatremia in burn patients is also associated with poor survival. Pulmonary function tests taken & reveal normal FEV1/FVC & decreased FEV1.Dysnatremias are associated with increased mortality in critically ill patients. Lab studies: Hb = 12 g/dL Hct = 35% WBC = 12,000/mm^3 Neutrophils = 68% Bands = 3% Creatinine = 1.1 mg/dL Sodium = 136 mEq/L Potassium = 5 mEq/L Calcium = 9.6 mg/dL Amiodarone levels = 1.6 ug/mL (normal levels, 1-3 ug/mL) Chest radiograph shows patchy alveolar infiltrates. Cardiac exam shows apical impulse, & no murmurs or gallops are appreciated. Physical exam reveals lung with diffuse crackles, decreased air movement, & pleural rub. Vital signs are temp 37.6 C (99.6 F), BP 120/60 mmHg, pulse 98/min, & respirations 20/min. She mentions that she has lost weight, even though her appetite is good. She drinks 2 glasses of wine a day & smoked cigarettes for 20 years but quit 10 years ago. Med history positive for flu 1 week ago treated with amantadine, ventricular tachycardia treated with implantable cardioverter-defibrillator (ICD) & amiodarone, & OCP for last year since she began menopause. Most likely diagnosis?Ĥ7 yo African-American woman + SOB, chest pain w/ respirations, & nonproductive cough that has been going on last 3-4 months. Pulmonary function tests taken & reveal normal FEV1/FVC & decreased FEV1. 47 yo African-American woman + SOB, chest pain w/ respirations, & nonproductive cough that has been going on last 3-4 months.
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