The Magnitude and Associated Factors of Dysnatremia and Dyskalemia in the ICUs of BLH, St Peter's and Yekatit 12 Hospitals.
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Date
2021-12
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Addis Abeba University
Abstract
Background: Electrolyte disturbance is common in critically ill patients and it is independently
associated with increased short-term and long-term morbidity and mortality.
Objectives: The main objective of this study was to assess the prevalence, associated factors and
outcome of dysnatrmia and dyskalemia in the ICUs of BLH, St peter's and Yekatit 12 hospitals.
Methods: This was a prospective, hospital-based cohort study of critically ill patients admitted to
the ICUs of BLH, St peter's and Yekatit12 hospital between May 1, 2021 and August 31, 2021.
A structured questionnaire was used to collect information on sociodemographic characteristics,
clinical profile at admission, and outcomes at discharge. Trained physician data clerks collected
the data from the chart, interview and electronic medical records. Data was entered into EpiInfo
3.1 and was exported to SPSS version 25 for analysis. To identify determinants of dysnatremia
and dyskalemia, bivariable and multivariable binary logistic regression analyses were done.
Statistical significance was considered at the level of significance of 5%, and adjusted odds ratio
(AOR) with 95% confidence interval (CI) was used to present the estimates of the strength of the
association.
Result: A total of 157 patients included in the study. The majority (64.2%) of study participants
are from St. Peter. More than one-third (38.4%) of them were in the age group of 31-50 years.
The frequency of hyponatremia was 49.68% while Hypernatremia has been found in 25.48% of
ICU admitted patients. The magnitude of hypo and hyperkalemia is found out to be 39.49% and
24.2% respectively. A total of 70.06% of patients were dysnatremic while 61.15% were
dyskalemic.The odds of hyponatremia increase 4.53 times with admission diagnosis of endocrine
than non-endocrine admissions [AOR=4.53; 95% CI: 1.64 - 12.53], Similarly the odds of
hyponatremia increased 3.95 times with those taking beta blockers [AOR= 3.95; 95% CI: 1.43 -
10.97].hypernatremia increased 3.17 times in those who took sedatives as compared to those who
didn’t [AOR=3.17; 95% CI: 1.28- 7.86] and in those with diagnosis of AKI in their hospital
stay.a single unit increase on the mean chloride increased the odds of hypernatremia by1.16
times [AOR=1.16; 95% CI: 1.08- 1.24].Those with admission diagnosis of COVID 19 were 75% less risk of developing hypokalemia than those with non-covid admissions [AOR=0.25; 95% CI:
0.11- 0.61].Those with use of beta blockers were 95% less risk of developing hyperkalemia as
compared to those who don’t use betablockers [AOR=0.05; 95% CI: 0.01-0.48]. one unit
increase in the mean urea increases the risk of hyperkalemia by 1.02 times [AOR=1.02; 95% CI:
1.01- 1.03]. Hypernatremia increased the risk of death 2.73 times among patients in the ICU than
those with no hypernatremia. [AOR=2.73; 95% CI: 1.28- 5.85]. similarly, those patients in the
ICU with hyperkalemia were 2.43 times more at risk to die than those with no hyperkalemia.
[AOR=2.43; 95% CI: 1.13- 5.25].
Conclusion: This study demonstrated that dysnatrmia and dyskalemia are frequent findings in
the critically ill. There are different determinant factors for the development of dysnatremia and
dyskalemia in the ICU. Critically ill patients with hypernatremia and hyperkalemia had a higher
incidence of thirty-day ICU mortality.
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Keywords
Dysnatremia, Dyskalemia, thirty-day ICU mortality