Faster sodium correction prevents 90-day death, delayed neurologic events in hyponatremia patients

Faster sodium correction results in a reduced risk for 90-day death or delayed neurologic events among patients with severe hyponatremia, reveals a study.

“Slow correction of severe hyponatremia is recommended to prevent osmotic demyelination syndrome but is associated with higher mortality,” according to the authors.

This retrospective cohort study was conducted across 21 community hospitals of an integrated health system in northern California, US, and involved adults hospitalized with a serum sodium level of ≤120 mEq/L between 2008 and 2023. Participants underwent maximum 24-h rate of serum sodium correction (slow: <8 mEq/L; medium: 8‒12 mEq/L; fast: >12 mEq/L [reference]).

The authors generated standardized risk differences (RDs) using targeted maximum likelihood estimation and assessed the heterogeneity of effect across grades of predicted risk. A composite of 90-day death or delayed neurologic events (ie, new demyelination, paralysis, epilepsy, or altered consciousness between 3 and 90 days from admission) was the primary outcome.

During the study period, a total of 13,988 patients (median age 74 years, 63 percent female) were hospitalized with severe hyponatremia. Among those with comorbidities, 24 percent had congestive heart failure, 18 percent had liver disease, 14 percent had alcohol dependence, and 10 percent had metastatic cancer.

The primary outcome occurred in 3,000 patients (21 percent), with 90-day death in 2,554 (18 percent) and 90-day delayed neurologic events in 587 (4 percent).

Both the medium (RD, ‒5.6 percentage points, 95 percent confidence interval [CI], ‒7.1 to ‒4.0) and fast 24-h sodium correction (RD, ‒9.0 percentage points, 95 percent CI, ‒11.1 to ‒6.9) correlated with lower adjusted risk for the primary outcome relative to slow correction. Furthermore, RDs increased with higher predicted risk, while risk ratios remained similar.

“Treatment guidelines should be re-examined,” the authors said.