Kidney Week

Abstract: FR-PO562

Treatment of Severe Hyponatremia in the Usual Clinical Scenarios: Time to Include Urinary Output in Algorithms?

Session Information

• Fluid, Electrolyte, and Acid-Base Disorders: Clinical
  November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

• 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical

Authors

• Gonzalez Rivera, Grecia Jaet, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico

Grecia Jaet Gonzalez Rivera,

• Felix Bauer, Karina Charlotte, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico

Karina Charlotte Felix Bauer,

• Gindl-Bracho, Alfonso, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico

Alfonso Gindl-Bracho,

• Correa-Rotter, Ricardo, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico

Ricardo Correa-Rotter,

• Ramirez-Sandoval, Juan Carlos, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico

Juan Carlos Ramirez-Sandoval,

Background

Rapid correction of severe hyponatremia (Na <125 mEq/L) can lead to adverse outcomes, including osmotic demyelinization syndrome. Although non-modifiable risk factors for rapid correction are widely described, most clinical algorithms do not include bedside biomarker during treatment.

Methods

Retrospective cohort of 249 hospitalized patients with severe hypotonic hyponatremia. We assessed the association between rapid correction (sNa increase of >8 mEq/L/24 h) and clinical variables during first hours of treatment, including renal free water loss ([U_Na+U_k]/S_Na),U_Na,U_osm, and water balance.

Results

Median age was 62 (IQR 22-91) years, 54% were women, 47% had AKI, 71% cirrhosis, 45% CKD 3-4, 7% heart failure, and 14% received 3% IV hypertonic saline due symptomatic hyponatremia. In 36% previous use of diuretics was documented. Etiology of hyponatremia was not possible in the first 24h of assessment in 181(73%) subjects; in these cases, the main cause of hyponatremia was evident only retrospectively. Rapid correction during the first 24 h occurred in 17%. Diuresis during the first 12 h was higher in the rapid correction group (1.3 [IQR 0.5-2.6] mL/Kg/h Vs. 0.8 [IQR 0.4-1.2] mL/kg/h,P<0.001). In multivariate analysis, each mL/kg/h was associated with an OR of 1.57 (95% CI 1.12-2.20, P<0.009) for rapid correction. Assessment of U_Na, U_osm, and free water loss were not associated with the risk of rapid correction.

Conclusion

The only bedside prognostic marker to predict overcorrection was diuresis in the first 6-12 hours after treatment initiation, urinary indices had no association with rapid correction. The high prevalence of comorbidities in real clinical scenarios greatly limits the diagnostic value of current algorithms, as cases of hyponatremia are rarely "pure". Preventive measures for rapid correction should include hourly diuresis evaluation.