Email Alerts
RSS
Turn off MathJax
Article Contents
Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  >  > Accepted Manuscript
Zhang Yue,Zhao Deli,Zhang Wanfu,et al.Analysis of influencing factors for the occurrence of transient hypernatremia in patients with extensively severe burns[J].Chin J Burns Wounds,2026,42(10):1-10.DOI: 10.3760/cma.j.cn501225-20251219-00534.
Citation: Zhang Yue,Zhao Deli,Zhang Wanfu,et al.Analysis of influencing factors for the occurrence of transient hypernatremia in patients with extensively severe burns[J].Chin J Burns Wounds,2026,42(10):1-10.DOI: 10.3760/cma.j.cn501225-20251219-00534.
shu

Analysis of influencing factors for the occurrence of transient hypernatremia in patients with extensively severe burns

doi: 10.3760/cma.j.cn501225-20251219-00534

  • Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China

Funds:

General Program of National Natural Science Foundation of China 82673295

General Support of the China Postdoctoral Science Foundation 2025M774457

More Information
    Abstract
  •   Objective  To investigate the influencing factors for the occurrence of transient hypernatremia (TH) in patients with extensively severe burns.  Methods  This study was a bidirectional cohort study. Clinical data of 126 patients with extensively severe burns (97 males and 29 females, aged 18 to 64 years) who met the inclusion criteria and were admitted to the First Affiliated Hospital of Air Force Medical University from August 2021 to December 2025 were retrospectively analyzed. The incidence of hypernatremia was recorded. Among 118 patients who underwent surgical treatment, patients who underwent first escharectomy at ≤5 days after injury were included in early escharectomy group (n=39), and patients who underwent first escharectomy at >5 days after injury were included in late escharectomy group (n=79). The incidence of hypernatremia was compared between the two groups of patients. According to whether received air-fluidized bed (AFB) therapy, patients were divided into AFB group (n=89) and non-AFB group (n=37). The incidence of hypernatremia was compared between the two groups of patients, and independent risk factors for the occurrence of hypernatremia in patients with extensively severe burns were screened. For patients who underwent pulse contour cardiac output (PiCCO) monitoring during the shock stage, extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were compared between 20 patients with hypernatremia and 35 patients without hypernatremia. Fifty-five patients with extensively severe burns (35 males and 20 females, aged 20 to 63 years) who met the inclusion criteria and were admitted to this hospital from May to December 2025 were prospectively enrolled. At 3 days after injury, eschar tissue, wound skin tissue, and peripheral venous blood were collected. Using the random number table method, samples from 5 patients with hypernatremia (set as high Na+ group) and 5 patients without hypernatremia (set as non-high Na+ group) were selected. Sodium content in eschar was determined by inductively coupled plasma mass spectrometry. Serum levels of interleukin-1 (IL-1), IL-6, tumor necrosis factor-α (TNF-α), and hyaluronic acid were detected by enzyme-linked immunosorbent assay. Protein expression level of sodium voltage-gated channel alpha subunit 5 (SCN5A) in wound skin tissue was detected by Western blotting.  Results  In the retrospective cohort study of 126 patients, 50 patients (39.7%) developed hypernatremia 3 to 5 days after injury, among whom 41 patients had TH, and 9 patients died. In the 41 patients with TH, the serum sodium began to increase 2 to 3 days after injury, peaked 5 to 8 days after injury, and gradually recovered by 10 days after injury. The incidence of hypernatremia of patients in late escharectomy group was 32.9% (26/79), which was significantly higher than 7.7% (3/39) in early escharectomy group (χ2=8.96, P<0.05). The incidence of hypernatremia of patients in AFB group was significantly higher than that in non-AFB group (P<0.05). The results of multivariate logistic regression analysis showed that AFB therapy was not an independent risk factor for hypernatremia in patients with extensively severe burns (OR=1.80, with a 95% CI of 0.40 to 8.20, P>0.05), while both total burn area and full-thickness burn area were independent risk factors for hypernatremia in patients with extensively severe burns (with ORs of 3.50 and 2.10, respectively, 95% Cis of 1.90 to 6.70 and 1.20 to 3.80, respectively, P<0.05). Among patients who underwent PiCCO monitoring during the shock stage, EVLWI and PVPI in patients with hypernatremia were significantly higher than those in patients without hypernatremia (with t values of 3.45 and 4.28, respectively, P<0.05). In the prospective cohort study, sodium content in eschar at 3 days after injury in high Na+ group of patients was (128±9) mmol/kg, which was significantly higher than (102±6) mmol/kg in non-high Na+ group (t=5.38, P<0.05). Compared with those in non-high Na+ group, serum levels of IL-1, IL-6, TNF-α, and hyaluronic acid in high Na+ group of patients were significantly increased 3 days after injury (P<0.05), while the protein expression level of SCN5A in wound skin tissue was significantly decreased (P<0.05).  Conclusions  TH after extensively severe burns is not merely an elevation in serum sodium, but involves sodium accumulation in the eschar, inflammation-mediated sodium redistribution, and sodium release during the reabsorption phase. Early escharectomy can effectively reduce the risk of occurrence of TH in patients with extensively severe burns, and its mechanism may be associated with the removal of some sodium-containing eschar and a reduction in sodium release.

     

    • FullText(HTML)
  • loading
    • References(35)
  • [1]
    MengerMM,WenzH,BambergM,et al.Severe burn injuries - the day the sodium starts rising[J].In Vivo,2024,38(2):747-753.DOI: 10.21873/invivo.13497.
    [2]
    SedghianiI,MoklineA,FredjH,et al.Hypernatremia risk factors and prognostic impact in burn patients: a case control study[J].Ann Burns Fire Disasters,2021,34(2):135-139.
    [3]
    RuggC,StröhleM,SchmidS,et al.The link between hypermetabolism and hypernatremia in severely burned patients[J].Nutrients,2020,12(3):774.DOI: 10.3390/nu12030774.
    [4]
    Van RegenmortelN,MoersL,LangerT,et al.Fluid-induced harm in the hospital: look beyond volume and start considering sodium. from physiology towards recommendations for daily practice in hospitalized adults[J].Ann Intensive Care,2021,11(1):79.DOI: 10.1186/s13613-021-00851-3.
    [5]
    Markl-Le LevéA,HillingerP,WoykeS,et al.The urea-creatinine ratio as marker of catabolism is affected by continuous renal replacement therapy[J].Diagnostics (Basel),2025,15(11):1408.DOI: 10.3390/diagnostics15111408.
    [6]
    StatlenderL,ShochatT,RobinsonE,et al.Urea to creatinine ratio as a predictor of persistent critical illness[J].J Crit Care,2024,83:154834.DOI: 10.1016/j.jcrc.2024.154834.
    [7]
    PaulusMC,MelchersM,van EsA,et al.The urea-to-creatinine ratio as an emerging biomarker in critical care: a scoping review and meta-analysis[J].Crit Care,2025,29(1):175.DOI: 10.1186/s13054-025-05396-6.
    [8]
    沈嘉生,许永安.外泌汗腺汗液分泌离子通道调控机制研究进展[J].中华烧伤与创面修复杂志,2022,38(8):794-798.DOI: 10.3760/cma.j.cn501120-20210517-00191.
    [9]
    KanC,SkaggsJD.Current commonly used dynamic parameters and monitoring systems for perioperative goal-directed fluid therapy: a review[J].Yale J Biol Med,2023,96(1):107-123.DOI: 10.59249/JOAP6662.
    [10]
    VouloagkasI,AgbariahA,ZegkosT,et al.The many faces of SCN5A pathogenic variants: from channelopathy to cardiomyopathy[J].Heart Fail Rev,2025,30(1):247-256.DOI: 10.1007/s10741-024-10459-x.
    [11]
    姜彬,都勇,夏一兰,等.特重度烧伤患者代谢高涨期进行基于间接测热法的营养治疗的效果[J].中华烧伤与创面修复杂志,2025,41(1):94-100.DOI: 10.3760/cma.j.cn501225-20240320-00103.
    [12]
    高建川,柴家科,杨红明,等.早期切痂对重度烧伤患者静息能量消耗的影响[J].中华烧伤杂志,2004,20(1):37-39.DOI: 10.3760/cma.j.issn.1009-2587.2004.01.119.
    [13]
    Gwyn-JonesA,AfolabiT,BonneyS,et al.Major burns in adults: a practice review[J].Emerg Med J,2024,41(10):630-634.DOI: 10.1136/emermed-2024-214046.
    [14]
    RepellinM,CartonF,LolloG,et al.Alcian blue staining to visualize intracellular hyaluronic acid-based nanoparticles[J].Methods Mol Biol,2023,2566:313-320.DOI: 10.1007/978-1-0716-2675-7_25.
    [15]
    RajkumarJ,ChandanN,LioP,et al.The skin barrier and moisturization: function, disruption, and mechanisms of repair[J].Skin Pharmacol Physiol,2023,36(4):174-185.DOI: 10.1159/000534136.
    [16]
    KlotzT,IbrahimA,MaddernG,et al.Devices measuring transepidermal water loss: a systematic review of measurement properties[J].Skin Res Technol,2022,28(4):497-539.DOI: 10.1111/srt.13159.
    [17]
    NakanishiS,KamezonoR,NakataniM,et al.Comprehensive analysis of elemental distribution in human skin using laser ablation inductively coupled plasma mass spectrometry[J].Skin Res Technol,2021,27(4):576-581.DOI: 10.1111/srt.12986.
    [18]
    ArlatiS,AseniP.From evaporation to edema: a scoping review of physical and biological determinants of early fluid distribution in burn patients[J].Eur Burn J,2026,7(2):21.DOI: 10.3390/ebj7020021.
    [19]
    KlotzT,MoranH,VuP,et al.Commonly recommended moisturising products: effect on transepidermal water loss and hydration in a scar model[J].Burns,2025,51(8):107629.DOI: 10.1016/j.burns.2025.107629.
    [20]
    SivakumarAD,SharmaR,ThotaC,et al.WASP: wearable analytical skin probe for dynamic monitoring of transepidermal water loss[J].ACS Sens,2023,8(11):4407-4416.DOI: 10.1021/acssensors.3c01936.
    [21]
    ShinJ,SongJW,FlavinMT,et al.A non-contact wearable device for monitoring epidermal molecular flux[J].Nature,2025,640(8058):375-383.DOI: 10.1038/s41586-025-08825-2.
    [22]
    Olde EngberinkR,SelvarajahV,VogtL.Clinical impact of tissue sodium storage[J].Pediatr Nephrol,2020,35(8):1373-1380.DOI: 10.1007/s00467-019-04305-8.
    [23]
    MlejnekP,LiškaF,ŠilhavýJ,et al.Early reduction of skin potassium without sodium accumulation in the pathogenesis of salt sensitivity in primary aldosteronism[J].Front Pharmacol,2025,16:1575972.DOI: 10.3389/fphar.2025.1575972.
    [24]
    McIntoshM,CervantesH,OakesL,et al.Wound progression and healing in patients with deep tissue pressure injuries when placed on air-fluidized therapy versus low air loss support surface beds[J].J Wound Ostomy Continence Nurs,2025,52(4):279-284.DOI: 10.1097/WON.0000000000001196.
    [25]
    McNabbLJ,HyattJ.Effect of an air-fluidized bed on insensible water loss[J].Crit Care Med,1987,15(2):161-162.DOI: 10.1097/00003246-198702000-00017.
    [26]
    HellenthalK,BrabenecL,WagnerNM.Regulation and dysregulation of endothelial permeability during systemic inflammation[J].Cells,2022,11(12):1935.DOI: 10.3390/cells11121935.
    [27]
    YinB,JiangZ,ShiJ,et al.Hyaluronidase reverses the effect of hyaluronic acid without destroying normal skin structure[J].J Cosmet Dermatol,2026,25(5):e70870.DOI: 10.1111/jocd.70870.
    [28]
    SpasovskiG,VanholderR,AllolioB,et al.Clinical practice guideline on diagnosis and treatment of hyponatraemia[J].Intensive Care Med,2014,40(3):320-331.DOI: 10.1007/s00134-014-3210-2.
    [29]
    ZhangY,LiM,WangY,et al.Exosome/metformin-loaded self-healing conductive hydrogel rescues microvascular dysfunction and promotes chronic diabetic wound healing by inhibiting mitochondrial fission[J].Bioact Mater,2023,26:323-336.DOI: 10.1016/j.bioactmat.2023.01.020.
    [30]
    AbazariM,GhaffariA,RashidzadehH,et al.A systematic review on classification, identification, and healing process of burn wound healing[J].Int J Low Extrem Wounds,2022,21(1):18-30.DOI: 10.1177/1534734620924857.
    [31]
    ZhuZ,ZhouS,LiS,et al.Neutrophil extracellular traps in wound healing[J].Trends Pharmacol Sci,2024,45(11):1033-1045.DOI: 10.1016/j.tips.2024.09.007.
    [32]
    LuJ,ZhaoZ,PanL,et al.Hyaluronidase: structure, mechanism of action, diseases and therapeutic targets[J].Mol Biomed,2025,6(1):50.DOI: 10.1186/s43556-025-00299-y.
    [33]
    ZhangY,LiM,SongS,et al.Multiple dynamic crosslinked multifunctional hydrogels with glucose/pH dual-responsive adipose-derived stem cells-exosomes-releasing for diabetic wound healing[J/OL].Burns Trauma,2025,13:tkaf059[2025-12-19].https://pubmed.ncbi.nlm.nih.gov/41355885/.DOI: 10.1093/burnst/tkaf059.
    [34]
    ChenY,YinW,LiuZ,et al.Exosomes derived from fibroblasts enhance skin wound angiogenesis by regulating HIF-1α/VEGF/VEGFR pathway[J/OL].Burns Trauma,2025,13:tkae071[2025-12-19].https://pubmed.ncbi.nlm.nih.gov/40433567/.DOI: 10.1093/burnst/tkae071.
    [35]
    Yılmaz AydınF,AydınE,KadirogluAK.Comparison of the treatment efficacy of continuous renal replacement therapy and intermittent hemodialysis in patients with acute kidney injury admitted to the intensive care unit[J].Cureus,2022,14(1):e21707.DOI: 10.7759/cureus.21707.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(4)  / Tables(2)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (11) PDF downloads(2) Cited by()
    Proportional views
    Related

    Copyright © Chinese Journal of Burns京ICP备07035254号-14

    E-mail：shaoshangzazhi@163.com

    Website：https://zhsszz.xml-journal.net/

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return