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Kidney Week

Abstract: SA-PO737

Overcorrection in the Management of Hyponatremic Patients [Na+] ≤125 mmol/L Following Emergency Department Admission

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

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

Authors

  • Kore, Shruti, Westchester Medical Center, Valhalla, New York, United States
  • Coritsidis, George N., Westchester Medical Center, Valhalla, New York, United States
  • Gupta, Sanjeev, Westchester Medical Center, Valhalla, New York, United States
  • Beck, James, Westchester Medical Center, Valhalla, New York, United States
Background

Hyponatremia (HN) is the most common electrolyte abnormality. Treatment of a low serum sodium [Na+] level needs to be gradual to avoid overcorrection (OCx). We studied patients who were overcorrected and why.

Methods

Patients admitted to Westchester Medical Center via the Emergency Department from 2019 - 2022 with [Na+] ≤125 mmol/L were included. An OCx is defined as a [Na+] correction > 8 mmol/L in 24 hours. Slowing or reversing the OCx is considered a reversal. The use of hypertonic saline (HTS), serum and urine osmolarity (UOs), urine sodium, and the duration were recorded.

Results

477 patients were studied per the inclusion-exclusion criteria. 43% were on HN-associated medications averaging 1.83 (+/- 0.89) per patient with loop diuretics the most common. Cirrhosis was the most common HN-associated chronic disease, and renal consultation was requested in 58% (275/477). OCx occurred in 89 (19%) of patients, with a higher odds ratio (OR) in patients with UOs<300 (OR 3.9) and in whom HTS was administered (OR 4.5). Psychoactive medications were more common in OCx versus diuretics (27 vs 8%) and chronic diseases less likely in OCx (31.5 vs 60%). The rate of OCx was 9.2 +/- 6.1mmol/L in 24 hours. Reversal of treatment was seen in 50% of OCx and risk was increased in patients with UOs <300 (OR 4.3) and HTS (OR 9.4).

Conclusion

OCx is associated with predictors UOs and HTS. Patients presenting with Na<125, on psychoactive medications, and lacking HN-associated chronic diseases should prompt an immediate renal consult to adequately assess HN physiology, underscore the need for UOs, and assess the selection of empiric fluids. While many of these findings are in general associated with HN, this study also highlights their association with OCx.