Abstract: FR-PO0582
Nephrology Consultation Timing and Management of Community-Acquired Severe Hyponatremia: Retrospective Cohort Study
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical - 2
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Ali, Mustafa, St Elizabeth's Medical Center, Brighton, Massachusetts, United States
- Alhaddad, Juliano, St Elizabeth's Medical Center, Brighton, Massachusetts, United States
- Balakrishnan, Vaidyanathapuram, St Elizabeth's Medical Center, Brighton, Massachusetts, United States
- Madias, Nicolaos E., St Elizabeth's Medical Center, Brighton, Massachusetts, United States
- Jaber, Bertrand L., St Elizabeth's Medical Center, Brighton, Massachusetts, United States
Background
Community-acquired hyponatremia is the most common electrolyte disorder in hospitalized patients. Severe hyponatremia can be associated with life-threatening complications. We hypothesized that early nephrology consultation improves management by ensuring predictable sodium [Na] correction rates and optimizing resource utilization.
Methods
In this single-center retrospective cohort study, we identified hospitalized adults with severe community-acquired hyponatremia (glucose-corrected serum Na <120 mEq/L) from Jan-2019 to Dec-2023. We extracted data on patient characteristics, hyponatremia-related variables, presence and timing of a nephrology consult, resource utilization (intensive care unit [ICU] and hospital length of stay [LOS]), and patient outcomes.
Results
101 patients were included in the analysis. Mean age was 67 years, and 77% were admitted to the ICU. Among the 50 (50%) patients who received a nephrology consult, 38 (75%) occurred early (within <24 hours [h]). Mean Na on admission, at 24h, at 48h, and at hospital discharge was 116, 123, 127, and 132 mEq/L, respectively. 93% survived the hospitalization. ICU admissions were more common in the consult group (86% vs. 68%; p=0.034). The consult group had a trend toward a lower 24h Na vs. the non-consult group (122±4 vs. 124±5 mEq/L; p=0.096), but the 48h Na was significantly lower (126±4 vs. 128±4 mEq/L; p=0.022). The consult group had significantly higher ICU LOS (5±6 vs. 3±2 days; p=0.01) and was more likely to require use of desmopressin (28% vs. 8%; p=0.018) and urea powder (20% vs. 0%; p=0.001). Early consult was associated with significantly higher use of 3% hypertonic saline (32% vs. 0%; p=0.023), and lower ICU (4±5 vs. 7±8 days; p=0.045) and hospital (10±21 vs. 20±15 days; p=0.01) LOS. No osmotic demyelination syndrome cases were reported.
Conclusion
Among hospitalized adults with severe community-acquired hyponatremia, a nephrology consult was more likely to occur in the ICU but overall did not appear to have an impact on sodium correction rate in the first 48 hours and might have been a proxy for need for overcorrection rescue therapy. However, an early consult was associated with shorter ICU and hospital LOS. The small sample size, potential confounding by indication, and other biases preclude definitive conclusions.