Recommendations for Treatment of Symptomatic Hyponatremia

Oh, Man S.; Kim, Ho-Jung; Carroll, Hugh J.

doi:10.1159/000188576

Cited by 54 publications

(22 citation statements)

References 29 publications

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“…Caution must be exercised to avoid inappropriate correction of the sodium imbalance, which could result in further complications, morbidity, and death. 1,2,[53][54][55][56][57][58][59][60][61][62][63][64][65][66] Hyponatremia. Hyponatremia (serum sodium concentration of <135 meq/L) may reflect increased, decreased, or normal total body sodium concentrations and necessitates assessment of serum osmolality.…”

Section: Sodiummentioning

confidence: 99%

“…Serum sodium concentrations should be corrected at a rate of 1-2 meq/L/hr for patients with symptomatic hyponatremia or severe acute hyponatremia (e.g., change in serum sodium concentration of >0.5 meq/L/hr or onset in less than 48 hours) 6,10,55,56,[58][59][60]71 and no faster than 0.5 meq/L/hr when hyponatremia is chronic (i.e., develops over more than two or three days) or when the time over which the hyponatremia developed is unknown. 54,55,58,61,63 The maximum recommended increase in serum sodium concentration is 8-12 meq/L per 24 hours, 9,54,55,59,[61][62][63][64][65] with complete correction over 48-96 hours. Fifty percent of the estimated sodium deficit is usually administered over the first 24 hours and the remainder over the next 24-72 hours.…”

Section: Sodiummentioning

confidence: 99%

“…A reasonable short-term treatment goal is to correct the serum sodium to 120-130 meq/L 55,56,59,61,63,65,72,73 or lower in patients whose serum sodium concentration is ≤105 meq/L. 55,63,65,72,73 Serum sodium concentration should not be corrected initially to more than 135 meq/L 56 and should not exceed the upper limit of normal (145 meq/L) at any time during treatment. Serum sodium levels should be monitored frequently (e.g., every 2-4 hours) until the patient is asymptomatic, then every 4-8 hours until the serum sodium is within the normal range.…”

Section: Sodiummentioning

confidence: 99%

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Treatment of electrolyte disorders in adult patients in the intensive care unit

Kraft

Btaiche²,

Sacks³

et al. 2005

American Journal of Health-System Pharmacy

238

202

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Purpose. The treatment of electrolyte disorders in adult patients in the intensive care unit (ICU), including guidelines for correcting specific electrolyte disorders, is reviewed. Summary. Electrolytes are involved in many metabolic and homeostatic functions. Electrolyte disorders are common in adult patients in the ICU and have been associated with increased morbidity and mortality, as has the improper treatment of electrolyte disorders. A limited number of prospective, randomized, controlled studies have been conducted evaluating the optimal treatment of electrolyte disorders. Recommendations for treatment of electrolyte disorders in adult patients in the ICU are provided based on these studies, as well as case reports, expert opinion, and clinical experience. The etiologies of and treatments for hyponatremia hypotonic and hypernatremia (hypovolemic, isovolemic, and hypervolemic), hypokalemia and hyperkalemia, hypophosphatemia and hyperphosphatemia, hypocalcemia and hypercalcemia, and hypomagnesemia and hypermagnesemia are discussed, and equations for determining the proper dosages for adult patients in the ICU are provided. Treatment is often empirical, based on published literature, expert recommendations, and the patient's response to the initial treatment. Actual electrolyte correction requires individual adjustment based on the patient's clinical condition and response to therapy. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders in order to provide the optimal therapy to patients. Conclusion. Treatment of electrolyte disorders is often empirical, based on published literature, expert opinion and recommendations, and patient's response to the initial treatment. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders to provide optimal therapy for patients.

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Section: Sodiummentioning

confidence: 99%

Section: Sodiummentioning

confidence: 99%

Section: Sodiummentioning

confidence: 99%

See 1 more Smart Citation

Treatment of electrolyte disorders in adult patients in the intensive care unit

Kraft

Btaiche²,

Sacks³

et al. 2005

American Journal of Health-System Pharmacy

238

202

View full text Add to dashboard Cite

show abstract

“…We also found that 8.7% of these patients had a shift in SNa of 10 mmol/L in 24 h following surgery; a degree of change known to be associated with ODS. 5,7 A rapid correction in SNa was associated with a greater intraoperative positive fluid balance and use of intra-operative CRRT. Patients with a rapid correction were more likely to require neurological tests in the post-transplant phase, had more neurological deficits, and abnormal findings on formal swallowing assessments.…”

Section: Key Findingsmentioning

confidence: 99%

“…[1][2][3][4][5] Both animal and human data showed that the absolute rise in SNa within a 24-or 48-hour period is highly predictive for the development of ODS. [4][5][6][7] The exact margin by which SNa can be safely raised in a day remains controversial, but the literature supports an increase of not greater than 8-12 mmol/L per 24 h or 18 mmol/L over 48 h. 7,8 Many cirrhotic patients develop hyponatremia and more than 30% are hyponatremic at the time of liver transplantation (LTx). 9,10 Hyponatremia is mediated, in part, by elevated circulating levels of arginine vasopressin due to vasodilatation-induced reductions in effective circulating volume.…”

Section: Introductionmentioning

confidence: 99%

Serum sodium shift in hyponatremic patients undergoing liver transplantation: a retrospective cohort study

et al. 2014

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We aimed to describe the pre-operative incidence of hyponatremia in patients undergoing liver transplantation (LTx), as well as the rate and consequences of rapid perioperative sodium rises in these patients. Methods: This was a retrospective before and after observational study performed at a University-affiliated LTx center between January 2007 and June 2013. The primary exposure was pre-operative hyponatremia, defined as a serum sodium (SNa) 5133 mmol/L. The primary outcome was occurrence of a rapid SNa shift, defined as 10 mmol/L in the first 24 h following LTx. The rates of rapid peri-operative SNa shift were compared before and after a focused quality assurance (QA) initiative performed in July 2009. Results: Of 366 LTx, 69 (18.9%) had pre-operative hyponatremia, 6 (8.7%) of whom had a rapid rise in serum sodium (SNa). Rapid rise was associated with a greater intra-operative positive fluid balance (p50.001) and use of intra-operative continuous renal replacement therapy (CRRT) (p ¼ 0.017). A rapid rise in SNa was associated with more neurological investigations in the post-transplant period (brain computed tomography, electroencephalogram, swallow studies), increased neurological deficits (p ¼ 0.006), more abnormal swallowing assessments (p ¼ 0.003), a tendency for more neurology consultations (p ¼ 0.058), increased discharge to a rehabilitation or long-term care facility (p50.001), and increased 6-month mortality (p50.001). Following a QA initiative, rapid peri-operative rises in SNa among hyponatremic patients was significantly reduced (20% vs. 0%, p50.003). Conclusion: Pre-operative hyponatremia and rapid peri-operative SNa shifts are associated with a more complicated post-operative course and worse outcomes following LTx. Increased education and awareness, along with process changes, such as standardizing CRRT prescription, can reduce iatrogenic rapid peri-operative shifts in SNa.

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Fluid and Electrolyte Therapy in Children

Somers

2009

Pediatric Nephrology

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Recommendations for Treatment of Symptomatic Hyponatremia

Cited by 54 publications

References 29 publications

Treatment of electrolyte disorders in adult patients in the intensive care unit

Treatment of electrolyte disorders in adult patients in the intensive care unit

Serum sodium shift in hyponatremic patients undergoing liver transplantation: a retrospective cohort study

Fluid and Electrolyte Therapy in Children

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