BACKGROUND AND OBJECTIVES: Data regarding dosage-response relationships for using hypertonic saline in treatment of hyponatremia are extremely limited. Objectives of this study were to assess adherence to previously published guidelines (limiting correction to <12 mEq/L per d and <18 mEq/L per 48 h) in treating hyponatremia with hypertonic saline and to determine the predictive accuracy of the Adrogué-Madias formula. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS: A retrospective review was conducted of all 62 adult, hyponatremic patients who were treated with hypertonic saline during 5 yr at a 528-bed, acute care, teaching hospital. RESULTS: Median infusion rate was 0.38 ml/kg per h, increasing serum sodium concentration by 0.47 +/- 0.05 mEq/L per h, 7.1 +/- 0.6 mEq/L per 24 h, and 11.3 +/- 0.7 mEq/L per 48 h. In 11.3% of cases, the increase was >12 mEq/L per 24 h and in 9.7% was >18 mEq/L per 48 h. No patient's rate was corrected by >25 mEq/L per 48 h. Among patients with serum sodium <120 mEq/L, the observed increase in sodium exceeded the rise predicted by the Adrogué-Madias formula in 74.2%; the average correction in overcorrectors was 2.4 times the predicted. Inadvertent overcorrection was due to documented water diuresis in 40% of cases. CONCLUSIONS: The Adrogué-Madias formula underestimates increase in sodium concentration after hypertonic saline therapy. Unrecognized hypovolemia and other reversible causes of water retention pose a risk for inadvertent overcorrection. Hypertonic saline should be infused at rates lower than those predicted by formulas with close monitoring of serum sodium and urine output.
BACKGROUND AND OBJECTIVES: Data regarding dosage-response relationships for using hypertonicsaline in treatment of hyponatremia are extremely limited. Objectives of this study were to assess adherence to previously published guidelines (limiting correction to <12 mEq/L per d and <18 mEq/L per 48 h) in treating hyponatremia with hypertonicsaline and to determine the predictive accuracy of the Adrogué-Madias formula. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS: A retrospective review was conducted of all 62 adult, hyponatremic patients who were treated with hypertonicsaline during 5 yr at a 528-bed, acute care, teaching hospital. RESULTS: Median infusion rate was 0.38 ml/kg per h, increasing serum sodium concentration by 0.47 +/- 0.05 mEq/L per h, 7.1 +/- 0.6 mEq/L per 24 h, and 11.3 +/- 0.7 mEq/L per 48 h. In 11.3% of cases, the increase was >12 mEq/L per 24 h and in 9.7% was >18 mEq/L per 48 h. No patient's rate was corrected by >25 mEq/L per 48 h. Among patients with serum sodium <120 mEq/L, the observed increase in sodium exceeded the rise predicted by the Adrogué-Madias formula in 74.2%; the average correction in overcorrectors was 2.4 times the predicted. Inadvertent overcorrection was due to documented water diuresis in 40% of cases. CONCLUSIONS: The Adrogué-Madias formula underestimates increase in sodium concentration after hypertonicsaline therapy. Unrecognized hypovolemia and other reversible causes of water retention pose a risk for inadvertent overcorrection. Hypertonicsaline should be infused at rates lower than those predicted by formulas with close monitoring of serum sodium and urine output.
Authors: Dominic C Marshall; Justin D Salciccioli; Ross J Goodson; Marco A Pimentel; Kristi Y Sun; Leo Anthony Celi; Joseph Shalhoub Journal: J Crit Care Date: 2017-02-13 Impact factor: 3.425
Authors: Jason D Woodfine; Manish M Sood; Thomas E MacMillan; Rodrigo B Cavalcanti; Carl van Walraven Journal: Clin J Am Soc Nephrol Date: 2019-06-12 Impact factor: 8.237
Authors: Anjana Perianayagam; Richard H Sterns; Stephen M Silver; Marvin Grieff; Robert Mayo; John Hix; Ruth Kouides Journal: Clin J Am Soc Nephrol Date: 2008-01-30 Impact factor: 8.237