330: Low Frequency of Overly Rapid Serum Sodium Correction During Treatment of Euvolemic or Hypervolemic Hyponatremia With Conivaptan

2007 ◽  
Vol 50 (3) ◽  
pp. S104
Author(s):  
L.E. Wagoner ◽  
S. Rosansky ◽  
D. Zeltser ◽  
J.G. Verbalis ◽  
B. McNutt ◽  
...  
Keyword(s):  
Serum Sodium ◽  
Low Frequency ◽  
Sodium Correction

scholarly journals Multifactorial diabetes insipidus during pregnancy: a challenging diagnosis

2021 ◽  
Vol 14 (3) ◽  
pp. e238410
Author(s):  
Alexandra Novais Araújo ◽  
Maria Cunha ◽  
Tiago Marques ◽  
Maria João Guerreiro Martins Bugalho
Keyword(s):  
Diabetes Insipidus ◽  
Serum Sodium ◽  
Antiretroviral Treatment ◽  
Growth Restriction ◽  
Obstetric Ultrasound ◽  
Adequate Treatment ◽  
Foetal Growth ◽  
Foetal Growth Restriction ◽  
Underlying Disorder ◽  
Sodium Correction

Diabetes insipidus (DI) is characterised by thirst and polydipsia with hypotonic polyuria. Several forms exist, namely, central or pituitary, nephrogenic and gestational and must be differentiated for adequate treatment. We describe the case of a 41-year-old woman chronically infected with HIV who had been recently medicated with a tenofovir-based antiretroviral treatment and who, at 22 weeks of pregnancy, presented with transient gestational DI. Obstetric ultrasound revealed oligohydramnios and foetal growth restriction that did not improve despite serum sodium correction. The severity of the case suggested the presence of an underlying disorder and elevated copeptin levels indicated that an underlying subclinical form of nephrogenic DI, possibly induced by HIV-related nephropathy or tenofovir use, was present and rendered clinically overt during pregnancy.

Osmotic demyelination syndrome following slow correction of hyponatraemia

2021 ◽  
Vol 14 (8) ◽  
pp. e241407
Author(s):  
Isabel Saunders ◽  
David M Williams ◽  
Aliya Mohd Ruslan ◽  
Thinzar Min
Keyword(s):  
Antidiuretic Hormone ◽  
Serum Sodium ◽  
Inflammatory Markers ◽  
Urine Osmolality ◽  
Fluid Restriction ◽  
Osmotic Demyelination Syndrome ◽  
Electrolyte Disturbance ◽  
Osmotic Demyelination ◽  
Sodium Correction ◽  
Hospital Inpatients

Hyponatraemia is the most common electrolyte disturbance observed in hospital inpatients. We report a 90-year-old woman admitted generally unwell following a fall with marked confusion. Examination revealed a tender suprapubic region, and investigations observed elevated inflammatory markers and bacteriuria. Admission investigations demonstrated a serum sodium of 110 mmol/L with associated serum osmolality 236 mmol/kg and urine osmolality 346 mmol/kg. She was treated for hyponatraemia secondary to syndrome of inappropriate antidiuretic hormone (SIADH) and urosepsis. However, her serum sodium failed to normalise despite fluid restriction, necessitating treatment with demeclocycline and hypertonic saline. Despite slow reversal of hyponatraemia over 1 month, the patient developed generalised seizures with pontine and thalamic changes on MRI consistent with osmotic demyelination syndrome (ODS). This case highlights the risk of ODS, a rare but devastating consequence of hyponatraemia treatment, despite cautious sodium correction.

Serum sodium correction rate and the outcome in severe hyponatremia

2017 ◽  
Vol 35 (11) ◽  
pp. 1691-1694 ◽  
Author(s):  
Mauro Giordano ◽  
Tiziana Ciarambino ◽  
Emanuela Lo Priore ◽  
Pietro Castellino ◽  
Lorenzo Malatino ◽  
...  
Keyword(s):  
Serum Sodium ◽  
Severe Hyponatremia ◽  
Correction Rate ◽  
Sodium Correction

scholarly journals Osmotic Demyelination Syndrome Following Correction of Hyponatremia by ≤10 mEq/L per day

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0004402021
Author(s):  
Srijan Tandukar ◽  
Richard H. Sterns ◽  
Helbert Rondon-Berrios
Keyword(s):  
Risk Factors ◽  
Serum Sodium ◽  
Alcohol Use Disorder ◽  
Neurological Deficits ◽  
Osmotic Demyelination Syndrome ◽  
European Guidelines ◽  
Osmotic Demyelination ◽  
Chronic Hyponatremia ◽  
The Mean ◽  
Sodium Correction

Background: Overly rapid correction of chronic hyponatremia may lead to osmotic demyelination syndrome. European guidelines recommend a correction to ≤10 mEq/L in 24 hours to prevent this complication. However, osmotic demyelination syndrome may occur despite adherence to these guidelines. Methods: We searched the literature for reports of osmotic demyelination syndrome with rates of correction of hyponatremia <10 mEq/L in 24 hours. The reports were reviewed to identify specific risk factors for this complication. Results: We identified 19 publications with a total of 21 patients that were included in our analysis. The mean age was 52 years of which 67% were male. All of the patients had community acquired chronic hyponatremia. Twelve patients had an initial serum sodium <115 mEq/L, of which seven had an initial serum sodium ≤105 mEq/L. Other risk factors identified included alcohol use disorder (n=11), hypokalemia (n=5), liver disease (n=6), and malnutrition (n=11). The maximum rate of correction in patients with serum sodium <115 mEq/L was at least 8 mEq/L in all but 1 patient. In contrast, correction was <8 mEq/L in all but 2 patients with serum sodium >115 mEq/L. Among the latter group, osmotic demyelination syndrome developed before hospital admission or was unrelated to hyponatremia overcorrection. Four patients died (19%), 5 had full recovery (24%) and 9 (42%) had varying degrees of residual neurological deficits. Conclusions: Osmotic demyelination syndrome can occur in patients with chronic hyponatremia with a serum sodium <115 mEq/L despite rates of serum sodium correction <10 mEq/L in 24 hours. In patients with severe hyponatremia and high risk features, especially those with serum sodium <115 mEq/L, we recommend limiting serum sodium correction to <8 mEq/L. Thiamine supplementation is advisable for any hyponatremic patient whose dietary intake has been poor.

scholarly journals Improving on the Adrogué-Madias Formula

Kidney360 ◽  
2020 ◽  
pp. 10.34067/KID.0005882020
Author(s):  
Sheldon Chen ◽  
Michael Shieh ◽  
Robert Chiaramonte ◽  
Jason Shey
Keyword(s):  
Serum Sodium ◽  
Fluid Volume ◽  
Linear Scaling ◽  
Non Linear ◽  
Actual Volume ◽  
New Equation ◽  
Sodium Correction ◽  
Approximate Answer ◽  
Original Formula ◽  
Negative Volume

The Adrogué-Madias (A-M) formula is correct as written, but technically it only works when adding one liter of an intravenous (IV) fluid. For all other volumes, the A-M algorithm gives an approximate answer, one that diverges further from the truth as the IV volume is increased. If one liter of an IV fluid is calculated to change the serum sodium by some amount, then it was long assumed that giving a fraction of the liter would change the serum sodium by a proportional amount. We challenged that assumption and now prove that the A-M change in [sodium] is not scalable in a linear way. Rather, the delta [Na] needs to be scaled in a way that accounts for the actual volume of IV fluid being given. This is accomplished by our improved version of the A-M formula in a mathematically rigorous way. Our equation accepts any IV fluid volume, eliminates the illogical infinities, and, most importantly, incorporates the scaling step so that it cannot be forgotten. However, the non-linear scaling makes it harder to obtain a desired delta [Na]. Therefore, we reversed the equation so that clinicians can enter the desired delta [Na], keeping the rate of sodium correction safe, and then get an answer in terms of the volume of IV fluid to infuse. The improved equation can also unify the A-M formula with the corollary A-M loss equation wherein one liter of urine is lost. The method is to treat loss as a negative volume. Since the new equation is just as straightforward as the original formula, we believe that the improved form of A-M is ready for immediate use, alongside frequent [sodium] monitoring.

scholarly journals Treatment of symptomatic hyponatremia with hypertonic saline – a real-life observational study

2021 ◽  
Author(s):  
Irina Chifu ◽  
Amelie Gerstl ◽  
Björn Lengenfelder ◽  
Dominik Schmitt ◽  
Nils Nagler ◽  
...  
Keyword(s):  
Observational Study ◽  
Hypertonic Saline ◽  
Serum Sodium ◽  
Real Life ◽  
Saline Group ◽  
University Hospital ◽  
Level Of Evidence ◽  
European Guidelines ◽  
Increased Risk ◽  
Sodium Correction

Objective: Treatment of symptomatic hyponatremia is not well established. European guidelines recommend bolus-wise administration of 150ml of 3% hypertonic saline. This recommendation is based, however, on low level of evidence. Design: Observational study Methods: Sixty-two consecutive hyponatremic patients admitted to the emergency department or intensive care unit of the University Hospital Wuerzburg were divided in subgroups according to treatment (150ml bolus of 3% hypertonic saline or conventional treatment), and symptom severity. Treatment target was defined as an increase in serum sodium by 5-10mEq/L within first 24h and maximum 8mEq/L during subsequent 24h. Results: 33/62 patients (53%) presented with moderate and 29/62 (47%) with severe symptoms. 36 were treated with hypertonic saline and 26 conventionally. In the hypertonic saline group serum sodium increased from 116±7 to 123±6 (24h) and 127±6mEq/L (48h) and from 121±6 to 126±5 and 129±4mEq/L in the conventional group, respectively. Overcorrection at 24h occurred more frequent in patients with severe than moderate symptoms (38% vs. 6%, p<0.05). Diuresis correlated positively with the degree of sodium overcorrection at 24h (r=0.6, p<0.01). Conventional therapies exposed patients to higher degrees of sodium fluctuations and an increased risk for insufficient sodium correction at 24h compared to hypertonic saline (RR 2.8, 95% CI 1.4-5.5). Conclusion: Sodium increase was more constant with hypertonic saline, but overcorrection rate was high, especially in severely symptomatic patients. Reducing bolus-volume and reevaluation before repeating bolus infusion might prevent overcorrection. Symptoms caused by exsiccosis can be misinterpreted as severely symptomatic hyponatremia and diuresis should be monitored.

Evaluation of Serum Sodium Correction Rates for Management of Hyponatremia in Hospitalized Patients

2021 ◽  
pp. 106002802110197
Author(s):  
Christine T. Pham ◽  
Hagar S. Kassab ◽  
Jackie P. Johnston
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Serum Sodium ◽  
Neurological Outcome ◽  
Retrospective Chart Review ◽  
Hospitalized Patients ◽  
Lengths Of Stay ◽  
Institutional Review ◽  
Poor Neurological Outcome ◽  
Sodium Correction

Background: Appropriate correction of hyponatremia can reduce complications such as osmotic demyelination syndrome (ODS). Objective: To evaluate rates of serum sodium correction in hyponatremic hospitalized patients and identify factors associated with higher rates of overcorrection. Methods: This is an institutional review board–approved single-center, retrospective chart review of patients ≥18 years of age with at least 1 serum sodium <130 mEq/L during hospitalization. The primary end point was percentage of patients appropriately corrected for hyponatremia. Appropriate correction was defined as a sodium change ≤12 mEq/L over 24 hours and 18 mEq/L over 48 hours, and overcorrection was defined as an increase in serum sodium exceeding these cutoffs. Secondary end points included incidence of ODS, poor neurological outcome, intensive care unit (ICU) and hospital lengths of stay (LOSs), and in-hospital mortality. Results: Of 234 patients evaluated, 100 were included. Mean age was 72 ± 16 years, and 47% were male. Overcorrection occurred in 14 patients. There was no incidence of ODS. Rates of poor neurological outcome ( P = 0.77), ICU ( P = 0.09) and hospital LOS ( P = 0.13), and in-hospital mortality ( P = 0.20) were similar between appropriately corrected and overcorrected patients. Using a logistic regression analysis, severe hyponatremia (serum sodium < 120 mEq/L; P = 0.0122) and history of alcohol use disorder ( P < 0.001) were risk factors found to be associated with overcorrection. Conclusion and Relevance: Overcorrection of hyponatremia occurred in 14% of patients in this study. To minimize this risk, further caution should be taken when managing patients presenting with identified risk factors.

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