Sodium Correction in Hospitalized Patients with Chronic Hyponatremia

Chronic hyponatremia is common and associated with greater risks of falls, cognitive impairment, and mortality. Observational data suggest improved outcomes with correction of sodium levels, but randomized evidence has been lacking. Researchers conducted the first randomized open-label trial, including 2200 hospitalized adults with chronic hyponatremia; most patients had mild-to-moderate cases (median Na level, 127 mEq/l; severe hyponatremia, 6%).

Patients received either usual care or intensive sodium correction using an etiology-based, stepwise algorithm with daily reassessment and escalation (e.g., fluid restriction → urea administration → vaptan administration); treatment was intensified if the Na rise was <2 mEq/l/day and discont…