Abstract: SA-OR48
Mortality and Neurologic Complications Associated with Rapid vs. Slow Correction of Severe Hyponatremia
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical Advances
October 26, 2024 | Location: Room 4, Convention Center
Abstract Time: 04:50 PM - 05:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Ayus, Juan Carlos, University of California Irvine School of Medicine, Irvine, California, United States
- Cherne, Pablo Nicolas, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Fuentes, Nora, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Libovich, Ezequiel P., Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Vartorelli, Sofia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Naudi, Camila, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Bonetto, Gino, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Moreira, Jessica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Flamini Marczuk, Martina, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Moritz, Michael L., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
- Murujosa, Anaclara, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Background
Hyponatremia guidelines recommend limiting the rate of correction within the first 24 hours for patients with serum sodium (SNa) ≤ 120 mEq/L to prevent osmotic demyelination syndrome (ODS). Recent studies suggest rapid correction of ≥ 8 mEq/L in the first 24 hours may reduce mortality without increasing ODS risk.
Methods
A single-center retrospective observational study conducted in Buenos Aires, Argentina, evaluating the impact of rapid (≥ 8 mEq/L) versus slow correction (< 8 mEq/L) of severe hyponatremia on mortality and ODS. Hospitalized adults with severe hyponatremia (SNa ≤ 120 mEq/L) upon admission between 2010 and 2023 were enrolled. Analysis involved logistic regression and propensity score-inverse probability weighting, adjusting for confounders
Results
The cohort included 2037 patients. Rapid correction occurred in 53%, with mean 24-h rates of 12.4 ± 3.9 mEq/L and 4.1 ± 2.6 mEq/L for rapid and slow groups, respectively. Rapid correction was associated with lower in-hospital and 30-day mortality. The adjusted odds ratio (OR) for in-hospital mortality was 0.59 (0.44 - 0.76), adjusted OR was 0.66 (0.49 - 0.89). ODS incidence was rare (0.14%) and not linked to rapid correction.
Conclusion
Rapid correction of severe hyponatremia by ≥ 8 mEq/L within 24-h is associated with decreased adjusted mortality without an increased risk of ODS.
Rapid vs slow correction within 24-h of admission
| Characteristic | < 8 mEq/l/24hours | ≥ 8 mEq/l/24hours | p |
| No. of patients | 939 | 1098 | - |
| Age – years | 77.8 ± 13.8 | 76.8 ± 14 | 0.149 |
| Male sex | 319 (34) | 302 (27.5) | 0.002 |
| Charlson Comorbidity Index ≥ 6 | 298 (31.7) | 356 (32.4) | 0.777 |
| SNa at admission (mEq/L) | 116.6 ± 3.6 | 115.4 ± 4.3 | < 0.001 |
| Δ SNa at 24-hour post- admission (mEq/L) | 4.1 ± 2.6 | 12.4 ± 3.9 | < 0.001 |
| In – hospital mortality | 138 (14.7) | 100 (9.1) | < 0.001 |
| 30-Day mortality | 173 (18.4) | 136 (12.4) | < 0.001 |
| ODS | 2 | 1 | < 0.001 |