The Effectiveness Of Enteral Table Salt In Hyponatremia At The Kenyatta National Hospital Critical Care Unit

Abstract

Introduction: Hyponatremia, defined as serum sodium level of less than 135mEq/L [1], is the most common electrolyte abnormality in hospitalised patients. It is estimated to occur in 2-4% of hospitalised patients and in 15-30% of critically ill patients [2]. Mortality for patients with acute hyponatremia is quoted as high as 50% while that of chronic hyponatremia at 10-20%[3,4]. The principles of management of hyponatremia might not be applicable in many CCU cases creating the dilemma of what to do in situations where fluid cannot be restricted or the underlying condition is not responding to treatment fast enough. This together with the inconsistent supply of hypertonic saline and the unavailability of the newer drugs and slow sodium tablets has resulted in the use of enteral table salt in correcting hyponatremia at our KNH CCU set up[5-10]. There is paucity of data on enteral table salt as the sole agent in correcting hyponatremia especially in the critical care set up. In the management of syndrome of inappropriate ADH secretion (SIADH), Binu et al[11] and Rose BD[12] describe the use of oral salt and furosemide but not in a critical care setup, neither do they discuss the effectiveness. Another case report by Karen et al [13] also describes the use of oral sodium in hyponatremia but in an outpatient set up and does not discuss its effectiveness. Objective: The primary objective was to determine the effectiveness of enteral table salt in correcting hyponatremia at the Kenyatta National Hospital Main Critical Care Unit. The secondary objective was to determine the safety or associated side effects of enteral table salt at the Kenyatta National Hospital Main Critical Care Unit. Research Methodology: This was a prospective observational study. Patients with hyponatremia where table salt had been prescribed were included in the study. Serial plasma sodium levels were analyzed from the moment the table salt was prescribed using a standardized analyzer. Associated side effects were also documented as well as changes in the patients’ clinical status. The study utilised 40 consenting adult patients who fit the inclusion criteria during the course of their treatment. Data was entered into and managed in Microsoft Excel 2013 data entry sheet pre-coded to reflect the design of the data collection tool. Data cleaning was done continuously during data collection and the final dataset was exported to SPSS version 21.0 statistical software for analysis. The study findings were presented using tables and graphs. Findings: 32 patients (80%) had normal sodium levels after 1 or 2 days of table salt administration while 4 patients (10%) had hypernatremia and 4 patients (10%) persisted with hyponatremia despite 2 days of table salt administration. This translates to 90% effectiveness in correcting hyponatremia within 48 hours. Of the 80% with normal sodium levels, 65% were corrected within 24 hours while the remaining 15% required 48 hours of table salt administration. The overall mean change in sodium levels was 6.8mmol/L. The overall mean change in sodium levels per 104meq/L (equivalent to sodium content in 1 tea spoon of salt) intake of sodium was xv 1.7mmol/L. The average dosing frequency was 2.25 tea spoons of salt per day (ranging from 1 to 4 tea spoons of table salt per day). Only 1 patient (2.5%) developed diarrhoea and 2 patients (5%) had deteriorating consciousness. No patient experienced any of the other associated side effects namely; Nausea/Vomiting, Convulsions, Abnormal posturing/Movement and Nystagmus. Conclusion: We, therefore, conclude from our findings that enteral table salt is 90% effective in correcting hyponatremia in the critical care set up. We also conclude that it is relatively safe.