Session Date & Time: None. Available on demand.
*Purpose: Numerous medications administered in the hospital setting may contain hidden/additional amounts of sodium in the drug itself and via intravenous (IV) diluents or admixtures. In patients with liver disease, sodium from these non-dietary sources can worsen ascites/edema, volume overload, diuretic resistance and potentially prolong hospitalization.
*Methods: To determine the frequency and extent of iatrogenic sodium overload, we evaluated patients with liver disease (defined as MELD score > 15) who were admitted to the inpatient hepatology service at University of Colorado Hospital with a dietary sodium restriction order between 1/1/18 to 1/1/20. We excluded patients who received normal saline or Lactated Ringers as IV volume expanding therapy or if they had a history of liver transplant. Our primary outcome was the amount of additional daily sodium intake from oral and IV medications and their associated diluents/admixtures during each hospitalization encounter.
*Results: A total of 258 encounters from 201 patients were included in the analysis. The median daily sodium content from non-dietary sources was 96 mg (interquartile range, 0-573.85 mg). The most common admitting diagnoses were: alcoholic cirrhosis (15.5%) and hepatic failure with coma (8.1%). The average length of stay was 7 days. There were 111 encounters (43%) where patients received no additional sodium from medications. Of the remaining 147 encounters, patients from 94 encounters (36.4%), 20 encounters (7.8%), and 33 encounters (12.8%) received an additional average daily sodium between 1 mg to 1000 mg, > 1000 mg to 2000 mg, and > 2000 mg, respectively. The primary source of iatrogenic sodium intake was from IV antimicrobials and associated diluents/admixtures. The most common sources of iatrogenic sodium in patients with an average of > 1000 mg/day were IV vancomycin, ceftriaxone, piperacillin/tazobactam, metronidazole, and meropenem.
*Conclusions: Our results indicate that iatrogenic sodium overload from medication sources is a frequent occurrence (20.6% of encounters received > 1000 mg of additional sodium from medications) in hospitalized patients with liver disease. Diligence should be taken to minimize use of very high sodium-containing antibiotics when appropriate and use lower sodium-containing infusion solutions. Future research is warranted to evaluate the impact of excess sodium on outcomes of patients on the liver transplant wait list.
To cite this abstract in AMA style:Klem P, Mbau RMbanguKot, Crowther B, Lewis V, Lin S, Patrick E, Nadrash A, Schoeppler K, Kim I. Iatrogenic Sodium Exposure in Hospitalized Patients with Liver Disease [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/iatrogenic-sodium-exposure-in-hospitalized-patients-with-liver-disease/. Accessed June 23, 2021.
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