Rapid Bolus vs. Continuous Infusion of Hypertonic Saline for Hyponatremia

Correction of symptomatic hyponatremia is a delicate balance: It must occur quickly enough to prevent cerebral edema but slowly enough to prevent osmotic demyelination syndrome. Few randomized trials have assessed whether this judicious correction with hypertonic saline should occur via a continuous infusion or fixed bolus.

In a multicenter randomized open-label study, researchers in South Korea investigated the safety of hypertonic 3% saline bolus versus infusion in 178 patients with sodium levels <125 mmol/L and moderate to severe symptoms of hyponatremia. The bolus group received initial rapid boluses of 2 mL/kg (moderate hyponatremia) or 4 mL/kg (severe), with subsequent boluses of 2 mL/kg every 6 hours during the first 24 hours. The con…