Disorders of serum
sodium are common findings in patients presenting to the emergency department (ED). The aim of this study was to systematically investigate the prevalence, symptoms, etiology, treatment as well as the course of
hypernatremia present on admission to the ED. All adult patients with measurements of serum
sodium presenting to the ED between 01 January 2017 and 31 December 2020 were included in this retrospective cohort study. Chart reviews were performed for all patients with
hypernatremia defined as serum sodium > 147 mmol/L. 376 patients (0.7%) had a serum sodium > 145 mmol/L on admission and 109 patients (0.2%) had clinically relevant hypernatremia > 147 mmol/L. Main symptoms included
somnolence (42%) followed by disorientation (30%) and recent falls (17%). An impaired sense of thirst was the main cause of
hypernatremia as present in 76 patients (70%), followed by a lack of free access to water in 50 patients (46%). Regarding treatment, only one patient received targeted oral hydration and 38 patients (35%) experienced inadequate correction of
hypernatremia as defined as either a correction of < 2 mmol/L or further increasing
sodium during the first 24 h. 25% of patients with
hypernatremia died during the course of their
hospital stay. Patients who died had significantly lower correction rates of serum
sodium (0 mmol/L (-3 - 1.5) versus - 6 mmol/L (-10 - 0), p < 0.001).
Hypernatremia is regularly encountered in the ED and patients present with unspecific
neurologic symptoms. Initial treatment and correction of
hypernatremia are frequently inadequate with no decrease or even increase in serum
sodium during the first 24 h.