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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)., Competing Interests: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)

Context: Abnormalities in calcium metabolism are common in chronic kidney disease (CKD). Diminished urinary calcium excretion may promote vascular calcification and increased urinary calcium excretion may lead to nephrolithiasis and nephrocalcinosis, conditions associated with CKD., Objective: To study predictors of urinary calcium excretion and its association with adverse clinical outcomes in CKD., Design, Setting and Patients: This study assessed 3768 nondialysis participants in the Chronic Renal Insufficiency Cohort study from April 2003 to September 2008. Participants were followed up to October 2018., Exposure: Clinically plausible predictors of urinary calcium excretion and 24-h urinary calcium excretion at baseline., Main Outcome Measures: Urinary calcium excretion; incident end stage kidney disease (ESKD), CKD progression [50% estimated glomerular filtration rate (eGFR) decline or incident ESKD], all-cause mortality, and atherosclerotic cardiovascular disease events., Results: eGFR was positive correlated with 24-h urinary calcium excretion. The variables most strongly associated with 24-h urinary calcium excretion in males and females were 24-h urinary sodium (β = 0.19 and 0.28, respectively), serum parathyroid hormone (β = -0.22 and -0.20, respectively), loop diuretics (β = 0.36 and 0.26, respectively), thiazide diuretics (β = -0.49 and -0.53, respectively), and self-identified black race (β = -0.23 and -0.27, respectively). Lower urinary calcium excretion was associated with greater risks of adverse outcomes, but these associations were greatly attenuated or nullified after adjustment for baseline eGFR., Conclusion: Urinary calcium excretion is markedly lower in individuals with CKD compared to the general population. Determinants of urinary calcium excretion differed between sexes and levels of CKD. Associations between urinary calcium excretion and adverse clinical events were substantially confounded by eGFR., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)