Abstract: TH-PO1114

Risk Factors and Outcomes of Rapid Correction of Severe Hyponatremia

Session Information

Category: Fluid, Electrolytes, and Acid-Base

  • 704 Fluid, Electrolyte, Acid-Base Disorders

Authors

  • George, Jason Christopher, Geisinger Medical Center, Danville, Pennsylvania, United States
  • Bucaloiu, Ion D., Geisinger Medical Center, Danville, Pennsylvania, United States
  • Zafar, Waleed, Geisinger, Dnville, Pennsylvania, United States
  • Chang, Alex R., Geisinger Medical Center, Danville, Pennsylvania, United States
Background

Rapid correction of serum sodium is a concern in patients with severe hyponatremia and can have serious clinical consequences, including central pontine myelinolysis (CPM). Clinical risk factors of rapid correction and incidence of CPM has not been well-studied among patients with severe hyponatremia.

Methods

Using data from 1,352 inpatients in Geisinger Health System from 2001-2016 with serum sodium ≤120 mEq/L on admission, we examined possible predictors of overcorrection (demographics, comorbidity, medication, lab, and physical measurement data). Rapid correction of sodium (≥10mEq/L) was determined using sodium values closest to the 24 hour timepoint. CPM was determined by diagnostic codes and chart review of all brain MRIs.

Results

Mean age was 65.2 (SD 15.5) years, 54.9% were female, and 65.1% had a history of chronic hyponatremia (last outpatient sodium <135 mEq/L). The median change in sodium at 24 hours was 7.1 mEq/L (IQR 3.6–11.0), and 396 (29.3%) patients had rapid sodium correction. After multivariate adjustment, risk factors for overcorrection included female gender, schizophrenia, hypo- and hyperkalemia on presentation, and repletion of other electrolytes (Table). History of chronic hyponatremia, outpatient loop diuretic use, and treatment at an academic center were associated with lower risk for rapid sodium correction. A total of 357 (26.4%) patients had brain MRIs completed during follow-up with 10 patients showing evidence of CPM (7 had documented rapid correction).

Conclusion

Consideration of various contributing factors, including age, gender, medications and co-morbidities could provide useful risk stratification for preventing rapid sodium correction and CPM.