Positive water balance and consequences for water-electrolyte metabolism in patients with polytrauma

Abstract

Objective. To assess the effect of a three-day positive water balance (PWB) during infusion therapy on the level of blood plasma electrolytes (sodium, chlorine), hematocrit, the concentration of total hemoglobin and the influence of the studied factors on patient survival in the intensive care unit.

Materials and methods. In 47 patients with polytrauma who had multiple organ dysfunction and signs of systemic inflammation, using non-parametric analysis, the ROC-curve method, logistic regression, and relative risk analysis, we studied the effect of PWB on sodium and chlorine metabolism, hematocrit, total hemoglobin concentration and evaluated their relationship with treatment outcome. The subjects were divided into two groups: I — surviving patients whose PWB level for three days was less than 3,000 ml (n = 28) and II — the died (n = 19) whose PWB level for three days was more than 3,000 ml.

Results. The average value of sodium for three days was significantly higher in patients of group II: 140.267 ± 3.713 mmol/l against the patients (138.067 ± 2.515 mmol/l; p = 0.020906) of group I. By the end of three days, the level of total hemoglobin was statistically significantly lower in group II (101.89 ± 18.27 g/l) than in group I (120.30 ± 21.70 g/l); p < 0.000025. The hematocrit index was also significantly lower in patients of group II (29.40 ± 4.85 %) than in group I (34.30 ± 6.03 %); p < 0.000034.

Conclusion. At a PWB level of three days over 3,000 ml, there is an increase in blood sodium with a tendency to hypernatremia, a hemodilution effect with a decrease in hemoglobin and hematocrit. A negative effect of PWB on water-electrolyte metabolism, an acid-base state, the disorders of which cause an increased risk of death, is observed several times more often in patients with excess PWB (more than 3,000 ml in three days) than among patients with lower PWB (less than 3,000 ml for the same period).