Correcting Severe Hyponatremia: Don't Go Too Slow

A meta-analysis shows that faster correction rates are associated with lower mortality and no excess risk for osmotic demyelination syndrome.

U.S. and European clinical practice guidelines for correcting hyponatremia recommend limiting serum sodium correction to <10 to 12 mEq/L in any 24-hour period and <18 mEq/L in any 48-hour period to prevent osmotic demyelination syndrome. However, these recommendations were based on low-quality evidence, and recent large studies have shown fewer deaths and no excess risk for osmotic demyelination syndrome with higher correction rates.

Researchers performed a meta-analysis of 16 studies (12,000 patients; mean age, 68) of patients with severe hyponatremia (serum sodium <120 mEq/L or <125 mEq/L with severe symptoms). Four correction-rate categories were distinguished, as follows:

Very rapid: >12 mEq/L per 24 hours
Rapid: >8 to 10 mEq/L per 24 hour…

Reviewing Author

Neil H. Winawer, MD, SFHM

Disclosures

Nothing to disclose

Neil H. Winawer, MD, SFHM

Disclosures

Nothing to disclose

Correcting Severe Hyponatremia: Don't Go Too Slow

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Reviewing Author