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Traditional teaching, based on low-quality evidence, recommends that clinicians avoid rapid overcorrection of hyponatremia for fear of precipitating osmotic demyelination syndrome (ODS). Several recent reports call this practice into question and raise concern about correcting serum sodium levels too slowly.
In a retrospective study, investigators identified 3000 patients with severe hyponatremia (sodium, <120 mEq/L) who were admitted to two Massachusetts hospitals during a 25-year period. In an adjusted analysis, slow correction (<6 mEq/L/24 hours) was associated with higher in-hospital mortality. Fast correction (>10 mEq/L/24 hours) was associated with shorter hospital stay and somewhat lower mortality. The overall incidence of ODS was low…