Treatment of symptomatic hyponatremia with hypertonic saline: a real-life observational study.

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  • Additional Information
    • Source:
      Publisher: Oxford University Press Country of Publication: England NLM ID: 9423848 Publication Model: Print Cited Medium: Internet ISSN: 1479-683X (Electronic) Linking ISSN: 08044643 NLM ISO Abbreviation: Eur J Endocrinol Subsets: MEDLINE
    • Publication Information:
      Publication: 2023- : Oxford : Oxford University Press
      Original Publication: Oslo, Norway : Scandinavian University Press, c1994-
    • Subject Terms:
      Hyponatremia/*drug therapy ; Saline Solution, Hypertonic/*therapeutic use; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Critical Care/methods ; Female ; Fluid Therapy/methods ; Humans ; Hyponatremia/blood ; Hyponatremia/pathology ; Inappropriate ADH Syndrome/blood ; Inappropriate ADH Syndrome/drug therapy ; Inappropriate ADH Syndrome/pathology ; Male ; Middle Aged ; Severity of Illness Index ; Sodium/blood ; Treatment Outcome ; Young Adult
    • Abstract:
      Objective: Treatment of symptomatic hyponatremia is not well established. The European guidelines recommend bolus-wise administration of 150 mL of 3% hypertonic saline. This recommendation is, however, based 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 (150 mL bolus of 3% hypertonic saline or conventional treatment) and symptom severity. Treatment target was defined as an increase in serum sodium by 5-10 mEq/L within first 24 h and maximum 8 mEq/L during subsequent 24 h.
      Results: Thirty-three out of sixty-two patients (53%) were presented with moderate symptoms and 29/62 (47%) with severe symptoms. Thirty-six were treated with hypertonic saline and 26 conventionally. In the hypertonic saline group, serum sodium increased from 116 ± 7 to 123 ± 6 (24 h) and 127 ± 6 mEq/L (48 h) and from 121 ± 6 to 126 ± 5 and 129 ± 4 mEq/L in the conventional group, respectively. Overcorrection at 24 h occurred more frequent in patients with severe symptoms than with moderate symptoms (38% vs 6%, P < 0.05). Diuresis correlated positively with the degree of sodium overcorrection at 24 h (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 24 h 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 hypovolemia can be misinterpreted as severely symptomatic hyponatremia and diuresis should be monitored.
    • Comments:
      Comment in: Endocrine. 2023 Apr;80(1):234-235. (PMID: 36800146)
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    • Accession Number:
      0 (Saline Solution, Hypertonic)
      9NEZ333N27 (Sodium)
    • Publication Date:
      Date Created: 20210226 Date Completed: 20210428 Latest Revision: 20230404
    • Publication Date:
      20231215
    • Accession Number:
      PMC8052513
    • Accession Number:
      10.1530/EJE-20-1207
    • Accession Number:
      33635825