Abstract: TH-PO1123

A Low Initial Serum Sodium Level Is Associated with an Increased Risk of Overcorrection in Patients with Chronic Profound Hyponatremia: A Retrospective Cohort Analysis

Session Information

Category: Fluid, Electrolytes, and Acid-Base

  • 704 Fluid, Electrolyte, Acid-Base Disorders

Authors

  • Aratani, Sae, Nippon Medical School Hospital, Tokyo, Japan
  • Hara, Masahiko, Osaka City University Graduate School of Medicine, Osaka, Japan
  • Nagahama, Masahiko, St. Luke's international hospital, Tokyo, TOKYO, Japan
  • Taki, Fumika, St. Lukes' International Hospital, Tokyo, Japan
  • Futatsuyama, Miyuki, st.luke's international hospial, Tokyo, Japan
  • Tsuruoka, Shuichi, Nippon Medical School , Tokyo, Japan
  • Komatsu, Yasuhiro, St. Lukes International Hospital, Tokyo, Japan
Background

Even with abundant evidence for osmotic demyelination in patients with hyponatremia, the risk factors for overcorrection have not been fully investigated. Therefore the purpose of this study is to clarify the risks for overcorrection during the treatment of chronic profound hyponatremia.

Methods

This is a single-center retrospective observational study. We enrolled 56 adult patients with a serum sodium (SNa) concentration of ≤125 mEq/L treated by nephrologists in an intensive care between February 2012 and April 2014. The impact of patient parameters on the incidence of overcorrection was estimated using univariable and multivariable logistic regression models. Overcorrection was defined as an increase of SNa by >10 mEq/L and >18 mEq/L during the first 24 and 48 hours, respectively.

Results

The median age was 78 years, 48.2% were male, and 94.6% of the patients presented with symptoms associated with hyponatremia. The initial median SNa was 115 mEq/L (quartile, 111–119 mEq/L). A total of 11 (19.6%) patients met the criteria for overcorrection with 9 (16.0%) occurring in 24 hours, 6 (10.7%) in 48 hours, and 4 (7.1%) in both 24 and 48 hours. Primary polydipsia, initial SNa, and early urine output were the significant risk factors for overcorrection on univariable analysis. Multivariable analysis revealed that the initial SNa had a statistically significant impact on the incidence of overcorrection with an adjusted odds ratio of 0.84 (95% confidence interval, 0.70–0.98; p=0.037) for every 1 mEq/L increase. Additionaly, the increase in SNa during the first 4 hours and early urine output were significantly higher in patients with overcorrection than in those without (p=0.001 and 0.005, respectively).

Conclusion

An initial low level of SNa was associated with an increased risk of overcorrection in patients with profound hyponatremia. In this regard, the rapid increase in SNa during the first 4 hours may play an important role.