Hydrochlorothiazide in ICU-acquired hypernatremia – a randomized controlled trial

Abstract Purpose Thiazides are suggested as a treatment for ICU-acquired hypernatremia (IAH). Primary aim of the study was reducing serum sodium concentration (sNa) in patients with IAH with hydrochlorothiazide (HCT) in comparison to placebo. Secondary endpoints were a difference in urine sodium con...

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Bibliographic Details
Published in:	Journal of critical care
Main Authors:	van IJzendoorn, M.C.O. Marjolein, Buter, H. Hanneke, Kingma, W.P. Peter, Koopmans, M. Matty, Navis, G.J. Gerjan, Boerma, E.C. Christiaan
Format:	Journal Article
Language:	English
Published:	2016
Subjects:	Critical Care point-of-care testing serum sodium concentration hypernatremia sNa critical care uNa thiazide-induced hyponatremia electrolytes FE na FWC ICU-acquired hypernatremia POCT patient data management system urine sodium concentration AKI urine potassium concentration thiazide diuretics free-water clearance fractional sodium excretion sodium IAH LOS TIH SCC uK hydrochlorothiazide HCT length of stay acute kidney injury sodium-chloride cotransporter PDMS
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Summary:	Abstract Purpose Thiazides are suggested as a treatment for ICU-acquired hypernatremia (IAH). Primary aim of the study was reducing serum sodium concentration (sNa) in patients with IAH with hydrochlorothiazide (HCT) in comparison to placebo. Secondary endpoints were a difference in urine sodium concentration (uNa) and duration of severe IAH. Materials A monocentric, double-blind placebo-controlled trial was conducted in 50 patients with IAH and (urine potassium + uNa) < sNa in a spot urine sample. Patients were randomized to HCT 25 mg or placebo 1qd for maximal 7 days. Patients on renal replacement therapy, on medication inducing diabetes insipidus or with recent use of diuretics were excluded. IAH was defined as sNa ≥ 143 mmol/l. Results At baseline sNa and uNa were comparable between groups. During the study period sNa decreased significantly with median 4 mmol/l in both groups, with no significant difference between groups (P = .32). Median uNa increased significantly in both groups (46 [16–86]mmol/l in the HCT-group, 20 [10–66]mmol/l in the placebo group), with no difference between groups (P = .34). Median duration of sNa ≥ 145 mmol/l was 3 days in both groups (P = .91). Conclusion HCT 25 1qd did not significantly affect sNa nor uNa in patients with IAH.
ISSN:	0883-9441
DOI:	10.1016/j.jcrc.2016.11.035