Criteria for Hyponatremic Overcorrection: Systematic Review and Cohort Study of Emergently Ill Patients
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Department of Medicine, The Ottawa Hospital, ASB1-003, Ottawa, Ontario, Canada; 2Ottawa Hospital Research Institute, Ottawa, Canada; Department of Epidemiology & Community Medicine, The University of Ottawa, Ottawa, Canada; 4Institute for Clinical Evaluative Sciences @ uOttawa, Ottawa, Canada.
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BACKGROUND: Hyponatremia is the most common electrolyte disturbance amongst hospitalized patients. An overly rapid rate of correction of chronic hyponatremia is believed to increase the risk of poor clinical outcomes including osmotic demyelination syndrome (ODS). There is disagreement in the literature regarding the definition of hyponatremic overcorrection. METHODS: We performed a systematic review of all English language studies to identify those that calculated sodium correction rate and classified patients’ overcorrection status. We then identified all patients who presented to our hospital’s emergency department between 2003 and 2015 with a corrected serum sodium ≤ 116 mmol/L. All methods from the systematic review for sodium correction rate calculation and overcorrection status were applied to this cohort. RESULTS: We identified 24 studies citing 9 distinct sodium correction rate methods and 14 criteria for overcorrection. Six hundred twenty-four patients presenting with severe hyponatremia (median initial value 113 mMol) were identified. Depending on the method used, the median sodium correction rates in our cohort ranged from 0.271 to 1.13 mmol/L per hour. The proportion of patients classified with overcorrection with the different criteria varied almost 11-fold, ranging from 8.5 to 89.9%. CONCLUSION: Published methods disagree regarding the calculation of sodium correction rates and the definition of hyponatremic overcorrection. This leads to wide variations in sodium correction rates and the prevalence of overcorrection in patient cohorts. Definitions based on ODS risk are needed.
Clinical Significance • This is the most extensive examination of methods used to calculate hyponatremia correction rates and definitions of overcorrection. • There is little evidence available to guide definitions of overcorrection. • This is the first study to directly compare the different definitions of overcorrection in a large cohort study. • The heterogeneity of overcorrection definitions directly influences the prevalence of overcorrection in a given cohort. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-019-05286-y) contains supplementary material, which is available to authorized users. Received October 18, 2018 Revised April 3, 2019 Accepted July 24, 2019
KEY WORDS: hyponatremia; osmotic demyelination syndrome; outcome measurement; methodology. J Gen Intern Med DOI: 10.1007/s11606-019-05286-y © Society of General Internal Medicine 2019
INTRODUCTION
Hyponatremia is the most common electrolyte disorder encountered in the hospital, affecting more than 1 in 4 patients.1 Hyponatremia presents clinically from mild changes in cognition to potentially fatal comas that necess
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