Highlights
- •Disorders of sodium and potassium are common in patients with community-acquired pneumonia.
- •Hyponatremia was the most prevalent electrolyte disorder (28.8%) and significantly associated with longer hospital stay.
- •Hypokalemia was present in 15.6% of patients with community-acquired pneumonia.
- •Use of loop diuretics was independently associated with 30-day readmission to the hospital.
- •Higher Pneumonia Severity Index risk class was an independent predictor of 180-day pneumonia recurrence.
Abstract
Introduction
: Disorders of sodium and potassium are common and predictors of adverse outcome.
Prevalence and impact on outcome of hypokalemia, hyperkalemia, hyponatremia and hypernatremia
were investigated in emergency patients with community-acquired pneumonia (CAP).
Methods
: Patients 18 years presenting to our emergency department between January 1st 2017 and December
31st 2018 with on-admission electrolyte measurements were included. Chart reviews
were performed to identify patients with CAP.
Results
: 19.948 cases had measurements of sodium and potassium of which 469 had CAP (2.4%).
Prevalence of hypo- and hypernatremia was significantly increased in patients with
compared to those without CAP (hyponatremia: 28.8% vs. 10.5% respectively, p<0.0001;
hypernatremia: 1.9% vs. 0.6% respectively, p=0.002). The prevalence of hypo- and hyperkalemia
was significantly higher in patients with than without CAP (hypokalemia 15.6% vs.
11.4% respectively, p=0.004; hyperkalemia: 4.5% vs. 2.0% respectively, p=0.001). Hyponatremia
was significantly associated with longer hospital stay in patients with CAP (regression
coefficient 0.194, standard error 0.079, p=0.015). None of the investigated electrolyte
disorders were predictive of 30-day re-admission and 180-day pneumonia recurrence
rates. Use of loop diuretics was an independent predictor for 30-day re-admission
(OR 2.351 (1.099-5.03). p=0.028). Pneumonia Severity Index (PSI) risk class was an
independent predictor of 180-day pneumonia recurrence (OR 1.494 (1.022-2.184), p=0.038).
Conclusion
: Dysnatremias and dyskalemias are common findings complicating CAP in emergency patients.
Prevalence of hyponatremia was highest followed by hypokalemia. Hyponatremia was an
independent predictor of prolonged length of hospital stay. Loop diuretic use was
associated with 30-day readmission and PSI risk class with 180-day pneumonia recurrence.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Internal MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Impact of diuretic therapy-associated electrolyte disorders present on admission to the emergency department: a cross-sectional analysis.BMC Med. 2013; 11 (Mar 27): 83https://doi.org/10.1186/1741-7015-11-83
- Characteristics, symptoms, and outcome of severe dysnatremias present on hospital admission.Am J Med. 2012; 125 (Nove1-1125.e7): 1125
- Incidence and prognosis of dysnatremias present on ICU admission.Intensive Care Med. 2010; 36 (304-11)
- Hypernatremia in the critically ill is an independent risk factor for mortality.Am J Kidney Dis. 2007; 50 (Dec952-7)
- Influence of hypernatremic-hyperosmolar state on hemodynamics of patients with normal and depressed myocardial function.Crit Care Med. 1986; 14 (Oct913-4)
- Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits.Am J Med. 2006; 119 (Jane1-8): 71
- Attention and postural balance are much more affected in older than in younger adults with mild or moderate chronic hyponatremia.Eur J Intern Med. 2017; 41 (Jun): e25-e26
- Psychomotor deficits associated with hyponatremia: a retrospective analysis.Clin Neuropsychol. 2012; 26: 74-87
- Etiology and symptoms of severe hypokalemia in emergency department patients.Eur J Emerg Med. 2014; 21 (Feb): 46-51
- A retrospective study of emergency department potassium disturbances: severity, treatment, and outcomes.Clin Exp Emerg Med. 2017; 4 (Jun 30): 73-79
- Hypokalemia in acute medical patients: risk factors and prognosis.Am J Med. 2015; 128 (Jan60-7.e1)
- Conference Participants: Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 97. 2020: 42-61 (Jan)
National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) 2009 - 2010. https://www.cdc.gov/nchs/data/ahcd/combined_tables/2009-2010_combined_web_table01.pdf (Accessed on June 06, 2018).
- Clinical practice. The syndrome of inappropriate antidiuresis.N Engl J Med. 2007 May 17; 356 (2064-72)
- ProHOSP Study Group: Hyponatremia and anti-diuretic hormone in Legionnaires' disease.BMC Infect Dis. 2013; 13 (Dec 11): 585
- Hypernatremia in critically ill patients.J Crit Care. 2013; 28 (Apre11-20): 216
- Disorders of serum sodium in emergency patients: salt in the soup of emergency medicine.Anaesthesist. 2013; 62 (Apr): 296-303
- Mild to moderate hyponatremia at discharge is associated with increased risk of recurrence in patients with community-acquired pneumonia.Eur J Intern Med. 2020; (Jan. S0953-6205 (19) 30439-X)
- Hyponatraemia in patients with community-acquired pneumonia; prevalence and aetiology, and natural history of SIAD.Clin Endocrinol (Oxf). 2019; 90 (May): 744-752
- Hyponatraemia is independently associated with in-hospital mortality in patients with pneumonia.Eur J Intern Med. 2018; (Aug. 54): 46-52
- Hyponatremia and hospital outcomes among patients with pneumonia: a retrospective cohort study.BMC Pulm Med. 2008; 8 (Aug. 18): 16
- CAPNETZ study group.: Dysnatremia, vasopressin, atrial natriuretic peptide and mortality in patients with community-acquired pneumonia: results from the german competence networt CAPNETZ.Respir Med. 2014; (Nov. 108): 1696-1705
- Acquired Fanconi syndrome in patients with Legionella pneumonia.BMC Nephrol. 2013; 14 (Aug; 2): 171
- Fanconi Syndrome Associated with Hyponatremia in Two Patients with Legionella Pneumonia.Intern Med. 2016; 55: 3479-3484
- Hyperkalemia With High-Dose Trimehoprim-Sulfamethoxazole Therapy.Am J Kidney Disease. 1993; (Oct)
- Severe Hyponatremia and Hyperkalemia Induced by Trimethoprim-Sulfamethoxazole in Patients With Pneumocystis Carinii Pneumonia.Intern Med. 1995; (Feb)
Ewig S., Höffken G., Kern W.V., Rohde G., Flick H., Krause R. et al: Management of adult community-acquired pneumonia and prevention – update 2016 published by the German Respiratory Society, the Paul-Ehrlich-Society for Chemotherapy, the German Society for Infectious Diseases, the Competence Network CAPNETZ, the Austrian Respiratory Society the Austrian Society for Infectious and Tropical Diseases and the Swiss Respiratory Society. https://www.awmf.org/uploads/tx_szleitlinien/020-020l_S3_ambulant_erworbene_Pneumonie_Behandlung_Praevention_2016-02-2.pdf. Accessed on September 28th 2020.
- A prediction rule to identify low-risk patients with community-acquired pneumonia.N Engl J Med. 1997; 336 (10.1056/NEJM199701233360402): 243-250
- Creatinine-based definitions: from baseline creatinine to serum creatinine adjustment in intensive care.Crit Care. 2016; 20 (Mar 15): 69
- Incident Hyperkalemia, Hypokalemia, and Clinical Outcomes During Spironolactone Treatment of Heart Failure With Preserved Ejection Fraction: Analysis of the TOPCAT Trial.J Card Fail. 2018; 24 (MayEpub 2018 Mar 20): 313-320https://doi.org/10.1016/j.cardfail.2018.03.002
Article info
Publication history
Published online: December 24, 2020
Accepted:
December 4,
2020
Received in revised form:
November 5,
2020
Received:
July 29,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
