Correction of serum sodium [Na+] in hyponatremia

Bottom line: Verbalis states that the goal is a minimum correction of 4-8 mmol/L per day; if the risk of osmotic demyelination syndrome (ODS) is high then a lower goal of 4-6 mmol/L is recommended. Recommended limits not to exceed are 8 mmol/L per day for those at high risk of ODS and 10-12 mmol/L per day (or 18 mmol/L in any 48-hour period) for those at normal risk of ODS. Overcorrection risks iatrogenic brain damage.

How and why recommendations for sodium serum correction have changed over time are covered in the following sources.

Verbalis, Joseph G, et al. “Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations.” The American journal of medicine 126.10 Suppl 1 (2013):S1-42.

Sterns, Richard H, Sagar UNigwekar, and John KevinHix. “The treatment of hyponatremia.” Seminars in nephrology 29.3 (2009):282-99.
This review article states, “A 4- to 6-mmol/L increase in serum sodium concentration is adequate in the most seriously ill patients…Virtually all investigators now agree that overcorrection of hyponatremia (which we define as 10 mmol/L in 24 hours, 18 mmol/L in 48 hours, and 20 mmol/L in 72 hours) risks iatrogenic brain damage….Accordingly, we suggest therapeutic goals of 6 to 8 mmol/L in 24 hours, 12 to 14 mmol/L in 48 hours, and 14 to 16 mmol/L in 72 hours.”

Adrogué, H J, and N EMadias. “Hyponatremia.” The New England journal of medicine 342.21 (2000):1581-9.
This review article states, “Most reported cases of osmotic demyelination occurred after rates of correction that exceeded 12 mmol per liter per day were used, but isolated cases occurred after corrections of only 9 to 10 mmol per liter in 24 hours or 19 mmol per liter in 48 hours.”

Sterns, R H, et al. “Neurologic sequelae after treatment of severe hyponatremia: a multicenter perspective.” Journal of the American Society of Nephrology 4.8 (1994):1522-30.
In this analysis of data for 56 patients, “no neurologic complications were observed among patients corrected by <12 mmol/L per 24 h or by <18 mmol/L per 48 h or in whom the average rate of correction to a serum sodum of 120 mmol/L was ≤0.55 mmol/L per hour.”

Karp, B I, and RLaureno. “Pontine and extrapontine myelinolysis: a neurologic disorder following rapid correction of hyponatremia.” Medicine 72.6 (1993):359-73.
This was a review of records for 20 patients who experienced neurologic dysfuntion after hyponatremia correction. Six patients were eliminated from further analysis, leaving 14 who experienced severe hyponatremia. Because of the development of neurologic disorders in the patients, the study concluded that the rate of correction should be kept below 10 mEq/L/24 hours and 21 mEq/L/48 hours.


About Lisa

I have been a Clinical Informationist (aka Medical Librarian) for Emory University since September 2013. Prior to that, I was a Medical Librarian for Lincoln Memorial University (LMU) from March 2007 to August 2013 and served its DeBusk College of Osteopathic Medicine, Caylor School of Nursing, and allied health programs. From January 2002 - March 2007, I served the Medical Assisting (MA), Occupational Therapy Assistant, Physical Therapy Assistant, Radiologic Technologist, and Nursing programs at South College in Knoxville, Tennessee. I graduated from The University of Tennessee School of Information Sciences with a Master of Science degree in December 2000.
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