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Abstract: SA-PO730

Risk Factors of Under-Correction in Severe Hyponatremia: A Post Hoc Analysis of the SALSA Trial

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical


  • Ahn, Junmo, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi, Korea (the Republic of)
  • Seo, Jang Won, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi, Korea (the Republic of)
  • Oh, Yun Kyu, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Dongjak-gu, Seoul, Korea (the Republic of)
  • Kim, Sejoong, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Baek, Seon Ha, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi, Korea (the Republic of)

The under-correction of hyponatremia, non-optimal correction, is insufficient to improve cerebral edema, associated with increased mortality. Few prospective studies have identified the individuals at high risk of under-correction under controlled hypertonic saline treatment.


We conducted a post hoc analysis of a prospective randomized controlled study – the SALSA (Efficacy and Safety of Rapid Intermittent Correction Compared With Slow Continuous Correction With Hypertonic Saline) trial in 178 patients with glucose-corrected serum sodium (sNa) ≤125 mmol/L. Six subjects without sNa values during the entire follow-up period were excluded from the study. Under-correction was defined as sNa of less than 5 mmol/L within 24 hours or sNa of less than 10 mmol/L or 130 mmol/L within 24-48 hours.


Mean age was 72.8 years old and mean sNa concentrations were 118.2 mmol/L. Over 48-hour intervention period, mean changes in sNa at 24 hours and 48 hours were 8.6 and 11.5 mmol/L, respectively. Twenty-six of 172 patients (15.1%) experienced under-correction (10 patients within 24 hours and 21 patients within 48 hours). The under-correction group received more amount of hypertonic saline (486 ml vs 932 ml, P <0.001) and had less urine output for 48 hours (4117 mL vs 2647 mL, P = 0.004). High levels of urine osmolality, serum calcium and creatinine and lower levels of body mass index, systolic blood pressure, uric acid, and albumin were associated with greater risk for under-correction. The etiologies of hyponatremia and infusion methods of hypertonic saline were not associated with under-correction.


Among patients with symptomatic severe hyponatremia under controlled hypertonic saline treatment, under-correction occurred in 15% and were associated with baseline patient’s information.