الفهرس 
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Abstract
Hypernatremia is one of the major electrolyte disorders associated with death among critically ill patients. Intensive care unit (ICU)-acquired hypernatremia is a frequent complication, occurring in 4–52% of patients. Even mild hypernatremia seems to be deleterious in ICU patients. This metabolic disturbance has been consistently associated with increased ICU length of stay, morbidity and mortality.
ICU- acquired hypernatremia is thought to be mainly iatrogenic, related to excess sodium and insufficient free water intakes, it is tempting to link the large volumes of intravenous 0.9% saline received during initial fluid resuscitation of severe sepsis and early ICU-acquired hypernatremia. ICU–acquired hypernatremia is defined as hypernatremia occurring after ICU admission in patients with normal serum sodium at ICU admission.
Our aimed of this study: this observational prospective study aims to evaluate ICU-acquired hypernatremia in patient in septic shock treated by low dose corticosteroid.
Primary aim: What is the incidence of ICU-acquired hypernatremia in patients with septic shock treated with low dose glucocorticoids?
Second aims: What are the factors that contribute to the development of ICU-acquired hypernatremia? And what is the impact of development of hypernatremia on mortality and long stay on ICU?
This study is a prospective cohort study conducted at Ain Shams university hospitals. The duration of the study 6 months and the total of cases is 120 cases with septic shock were enrolled in the study.
Outcomes of the studied patients, we reported 52 (43.33%) patients developed ICU-acquired hypernatremia. The median of ICU stay was 10 days days. Regarding complications, 44 (36. 7%) patients had mechanical ventilation, 42 (35%) patients developed acute kidney injury, 10(8.3%) patients developed GIT bleeding and 6 (5%) patients had major surgery complications. Mortality occurred in 50 (41 %) patients. We proved that there was a significant relationship between incidence of ICU-acquired hypernatremia and duration of steroid administration as hypernatremia was increased in patients administered steroids more than 7 days (P value <0.001). There was a significant relationship between ICU-acquired hypernatremia and sodium bicarbonate as medications, and significant relationship was found between ICU- acquired hypernatremia and complications (mechanical ventilation, acute kidney injury, while insignificant relationship between ICU-acquired hypernatremia and GIT bleeding and major surgery as complications and infusion fluid.
Logistic regression of ICU-acquired hypernatremia impact on ICU stay and mortality, ICU-acquired hypernatremia was significantly associated with increased ICU stay (P value <0.001) and increased risk of mortality (P value <0.001).
The present study, we clearly demonstrated that prolonged duration of corticosteroid even low dose hydrocortisone is strongly associated with ICU acquired hypernatremia, ICU-acquired hypernatremia associated with risk factors may decrease free water can patients received, also associated with prolonged ICU stay and increasing risk of mortality. Consequently, when we administer glucocorticoid to critically ill patients, close monitoring of their serum sodium concentrations should be required especially when glucocorticoid is administered for longer periods.