Nephritis, nephrotic syndrome, and nephrosis Therefore, we examined the impact of abnormal serum sodium on 6-mo and 1-yr direct medical costs using longitudinal data from a large managed care claims database. 17 To our knowledge, there are no published studies examining the direct costs of hypernatremia. However, the study relied on 1 yr of inpatient discharge data to determine disease prevalence and on physician panel estimates to assess resource use. A recent study suggested that the direct costs of treating hyponatremia range from $1.6 billion to $3.6 billion annually and that inpatient costs represent approximately 70% of this value. 16Īlthough the clinical consequences of abnormal serum sodium, particularly in the case of hyponatremia, are well documented, relatively little is known about the relationship between abnormal serum sodium and medical costs. 11 In patients with acute ST-elevation myocardial infarction, serum sodium 160 mmol/L was an independent predictor of mortality in a neurologic/neurosurgical intensive care unit. 10 In a more recent trial, patients hospitalized for worsening heart failure with hyponatremia at admission (serum sodium ≤135 mmol/L) experienced significantly greater in-hospital and 60-d mortality, compared with patients with normal or high serum sodium. In a study of patients with suspected congestive heart failure at admission, serum sodium ≤135 mmol/L was independently associated with major complications during hospitalization, greater length of stay, higher hospital costs, and greater inpatient mortality. Similar results have been found for patients with heart failure and myocardial infarction. After adjustment for age, sex, length of stay, and several clinical factors, hyponatremia was a significant independent predictor of mortality. 9 studied the relationship between hyponatremia at the time of hospital admission and treatment outcomes. In a cohort of 4123 elderly patients, Terzian et al. 8 However, hyponatremia and hypernatremia of all severity levels have significant effects on morbidity and mortality. 7 Hypernatremia may also be asymptomatic until it exceeds a certain threshold, at which point central nervous system dysfunction develops. 5, 6 Mild, chronic hyponatremia is often asymptomatic neurologic and gastrointestinal symptoms generally increase as the condition worsens. 4 Hypernatremia is less common, ranging from 0.3% to 8.9% in hospitalized adults. Estimates of the prevalence of hyponatremia range from 1% in general acute care populations 1, 2 to 18% among elderly nursing home residents 3 and nearly 30% in intensive care settings. In conclusion, hyponatremia is a significant independent predictor of 6-mo and 1-yr direct medical costs.Ībnormal serum sodium is the most common electrolyte disorder in the United States. Costs associated with hypernatremia were not significantly different from those incurred by patients with normal serum sodium. Controlling for age, sex, region, and comorbidities, hyponatremia was a significant independent predictor of costs at 6 mo (41.2% increase in costs 95% confidence interval, 30.3% to 53.0%) and at 1 yr (45.7% increase 95% confidence interval, 34.2% to 58.2%). During the period analyzed, there were 1274 patients (0.8%) with hyponatremia (serum sodium 145 mmol/L). The impact of hyponatremia and hypernatremia on 6-mo and 1-yr direct medical costs was examined by analyzing data from the Integrated HealthCare Information Services National Managed Care Benchmark Database. The direct medical costs of abnormal serum sodium levels are not well understood. An abnormal serum sodium level is the most common electrolyte disorder in the United States and can have a significant impact on morbidity and mortality.
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