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Sodium Correction Practice and Clinical Outcomes in Profound Hyponatremia



      To assess the epidemiology of nonoptimal hyponatremia correction and to identify associated morbidity and in-hospital mortality.

      Patients and Methods

      An electronic medical record search identified all patients admitted with profound hyponatremia (sodium <120 mmol/L) from January 1, 2008, through December 31, 2012. Patients were classified as having optimally or nonoptimally corrected hyponatremia at 24 hours after admission. Optimal correction was defined as sodium correction in 24 hours of 6 through 10 mmol/L. We investigated the association between sodium correction and demographic and outcome variables, including occurrence of osmotic demyelination syndrome (ODS). Baseline characteristics by correction outcome categories were compared using the Kruskal-Wallis test for continuous variables and the χ2 test for categorical variables. Odds ratios for in-hospital mortality between groups were assessed using logistic regression. Adjusted differences in hospital length of stay (LOS) and intensive care unit (ICU) LOS were assessed using the Dunnett 2-tailed t test.


      A total of 412 patients satisfied inclusion criteria of whom 174 (42.2%) were admitted to the ICU. A total of 211 (51.2%) had optimal correction of their hyponatremia at 24 hours, 87 (21.1%) had undercorrected hyponatremia, and 114 (27.9%) had overcorrected hyponatremia. Both patient factors and treatment factors were associated with nonoptimal correction. There was a single case of ODS. Overcorrection was not associated with in-hospital mortality or ICU LOS. When adjusted for patient factors, undercorrection of profound hyponatremia was associated with an increase in hospital LOS (9.3 days; 95% CI, 1.9-16.7 days).


      Nonoptimal correction of profound hyponatremia is common. Fortunately, nonoptimal correction is associated with serious morbidity only infrequently.
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        • DeVita M.V.
        • Gardenswartz M.H.
        • Konecky A.
        • Zabetakis P.M.
        Incidence and etiology of hyponatremia in an intensive care unit.
        Clin Nephrol. 1990; 34: 163-166
        • Darmon M.
        • Diconne E.
        • Souweine B.
        • et al.
        Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change.
        Crit Care. 2013; 17: R12
        • Schrier R.W.
        • Bansal S.
        Diagnosis and management of hyponatremia in acute illness.
        Curr Opin Crit Care. 2008; 14: 627-634
        • Arieff A.I.
        Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women.
        N Engl J Med. 1986; 314: 1529-1535
        • Nzerue C.M.
        • Baffoe-Bonnie H.
        • You W.
        • Falana B.
        • Dai S.
        Predictors of outcome in hospitalized patients with severe hyponatremia.
        J Natl Med Assoc. 2003; 95: 335-343
        • Karp B.I.
        • Laureno R.
        Pontine and extrapontine myelinolysis: a neurologic disorder following rapid correction of hyponatremia.
        Medicine (Baltimore). 1993; 72: 359-373
        • Overgaard-Steensen C.
        Initial approach to the hyponatremic patient.
        Acta Anaesthesiol Scand. 2011; 55: 139-148
        • Spasovski G.
        • Vanholder R.
        • Allolio B.
        • et al.
        Clinical practice guideline on diagnosis and treatment of hyponatraemia.
        Nephrol Dial Transplant. 2014; 29: i1-i39
        • Sterns R.H.
        • Hix J.K.
        • Silver S.
        Treatment of hyponatremia.
        Curr Opin Nephrol Hypertens. 2010; 19: 493-498
        • Adrogué H.J.
        • Madias N.E.
        N Engl J Med. 2000; 342: 1581-1589
        • Sterns R.H.
        • Nigwekar S.U.
        • Hix J.K.
        The treatment of hyponatremia.
        Semin Nephrol. 2009; 29: 282-299
        • Brunner J.E.
        • Redmond J.M.
        • Haggar A.M.
        • Kruger D.F.
        • Elias S.B.
        Central pontine myelinolysis and pontine lesions after rapid correction of hyponatremia: a prospective magnetic resonance imaging study.
        Ann Neurol. 1990; 27: 61-66
        • Vaidya C.
        • Ho W.
        • Freda B.J.
        Management of hyponatremia: providing treatment and avoiding harm.
        Cleve Clin J Med. 2010; 77: 715-726
        • Nguyen M.K.
        Quantitative approaches to the analysis and treatment of the dysnatremias.
        Semin Nephrol. 2009; 29: 216-226
        • Hillier T.A.
        • Abbott R.D.
        • Barrett E.J.
        Hyponatremia: evaluating the correction factor for hyperglycemia.
        Am J Med. 1999; 106: 399-403
        • Graff-Radford J.
        • Fugate J.E.
        • Kaufmann T.J.
        • Mandrekar J.N.
        • Rabinstein A.A.
        Clinical and radiologic correlations of central pontine myelinolysis syndrome.
        Mayo Clin Proc. 2011; 86: 1063-1067
        • Ahmed A.
        • Thongprayoon C.
        • Pickering B.W.
        • et al.
        Towards prevention of acute syndromes: electronic identification of at-risk patients during hospital admission.
        Appl Clin Inform. 2014; 5: 58-72
        • Singh B.
        • Singh A.
        • Ahmed A.
        • et al.
        Derivation and validation of automated electronic search strategies to extract Charlson comorbidities from electronic medical records.
        Mayo Clin Proc. 2012; 87: 817-824
        • Vu T.
        • Wong R.
        • Hamblin P.S.
        • Zajac J.
        • Grossmann M.
        Patients presenting with severe hypotonic hyponatremia: etiological factors, assessment, and outcomes.
        Hosp Pract (1995). 2009; 37: 128-136
        • Sood L.
        • Sterns R.H.
        • Hix J.K.
        • Silver S.M.
        • Chen L.
        Hypertonic saline and desmopressin: a simple strategy for safe correction of severe hyponatremia.
        Am J Kidney Dis. 2013; 61: 571-578
        • Martin R.J.
        Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes.
        J Neurol Neurosurg Psychiatry. 2004; 75: iii22-iii28
        • Singh T.D.
        • Fugate J.E.
        • Rabinstein A.A.
        Central pontine and extrapontine myelinolysis: a systematic review.
        Eur J Neurol. 2014; 21: 1443-1450
        • Verbalis J.G.
        • Goldsmith S.R.
        • Greenberg A.
        • Schrier R.W.
        • Sterns R.H.
        Hyponatremia treatment guidelines 2007: expert panel recommendations.
        Am J Med. 2007; 120: S1-S21
        • Chawla A.
        • Sterns R.H.
        • Nigwekar S.U.
        • Cappuccio J.D.
        Mortality and serum sodium: do patients die from or with hyponatremia?.
        Clin J Am Soc Nephrol. 2011; 6: 960-965