Pre-emptive use of glucose 5% as the standard drug solvent reduces hypernatremia in critically ill patients

Jan-Hendrik B Hardenberg; Julius Valentin Kunz; Kerstin Rubarth; Mirja Mittermaier; Mareen Pigorsch; Felix Balzer; Martin Witzenrath; Ricarda Merle Hinz; Roland Körner; Kai-Uwe Eckardt; Felix Knauf; Carl Hinrichs; Philipp Enghard

doi:10.1093/ckj/sfae328

Pre-emptive use of glucose 5% as the standard drug solvent reduces hypernatremia in critically ill patients

Clin Kidney J. 2024 Nov 4;17(11):sfae328. doi: 10.1093/ckj/sfae328. eCollection 2024 Nov.

Authors

Jan-Hendrik B Hardenberg^{1

2}, Julius Valentin Kunz¹, Kerstin Rubarth³, Mirja Mittermaier^{4

5}, Mareen Pigorsch³, Felix Balzer⁶, Martin Witzenrath^{4

7}, Ricarda Merle Hinz¹, Roland Körner¹, Kai-Uwe Eckardt¹, Felix Knauf¹, Carl Hinrichs¹, Philipp Enghard^{1

8}

Affiliations

¹ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Nephrology and Medical Intensive Care, Augustenburger Platz 1, Berlin, Germany.
² Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Digital Clinician Scientist Program, Charitéplatz 1, Berlin, Germany.
³ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, Berlin, Germany.
⁴ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Infectious Diseases, Respiratory Medicine and Critical Care Medicine, Charitéplatz 1, Berlin, Germany.
⁵ Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Digital Clinician Scientist Program, Charitéplatz 1, Berlin, Germany.
⁶ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, Berlin, Germany.
⁷ German Center for Lung Research (DZL), Berlin, Germany.
⁸ German Rheumatism Research Center Berlin (DRFZ), An Institute of the Leibniz Foundation, Berlin, Germany.

Abstract

Background: Hypernatremia presents a common complication in intensive care unit (ICU) patients, associated with increased mortality and length of stay. This study investigates the effect of sodium chloride 0.9% compared with glucose 5% solution as the standard intravenous drug diluent on the prevalence of hypernatremia in a medical ICU.

Methods: This is a retrospective before-and-after study comparing two consecutive patient groups before and after the standard drug solvent was changed from sodium chloride 0.9% to glucose 5% solution for compatible medications. A total of 265 adult COVID-19 patients admitted between October 2020 and March 2021 to the study ICU were included, with 161 patients in the timeframe when sodium chloride 0.9% was employed as the standard drug solvent and 104 patients when glucose 5% was used. Routine sodium measurements from arterial and venous blood gases, along with heparinized lithium plasma, were analyzed. The daily sodium concentrations and the prevalence of severe hypernatremia (>150 mmol/l) were assessed during the first 8 days after ICU admission.

Results: Baseline characteristics were similar between the two groups. The cumulative volume of intravenous drug diluents was comparable. In the glucose 5% group, about half of the total drug diluent volume was glucose 5% [mean (SD): 2251.6 (2355.4) ml], compared to 135.0 (746.9) ml (P < .001) in the control group. Average sodium concentrations diverged after day two, with the glucose 5% group consistently showing lower sodium levels (mean difference of ∼2.5 mmol/l). Severe hypernatremia occurred less frequently in the glucose 5% group (6.6% vs. 20%).

Conclusion: Glucose 5% solution as the standard intravenous drug solvent significantly reduced sodium concentrations and the occurrence of severe hypernatremia. This simple modification in solvent choice may serve as a preventive strategy against hypernatremia in the ICU. Further prospective research is necessary to determine associated clinical outcomes.

Trial registration: The trial was registered in the German Clinical Trials Register (DRKS00031877).

Keywords: drug diluent; drug solvent; glucose 5%; hypernatremia; sodium chloride 0.9%.