Abstract: TH-OR024
Efficacy and Safety of Rapid Intermittent Bolus Compared with Slow Continuous Correction in Patients with Severe Hypernatremia (SALSA II Trial)
Session Information
- Fluids and Electrolytes: Bench and Bedside
November 06, 2025 | Location: Room 361A, Convention Center
Abstract Time: 05:20 PM - 05:30 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Kim, Sejoong, Seoul National University Bundang Hospital Department of Internal Medicine, Seongnam-si, Gyeonggi-do, Korea (the Republic of)
- Yun, Giae, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Korea (the Republic of)
- Lee, Jeonghwan, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Dongjak-gu, Seoul, Korea (the Republic of)
- Joo, Kwon Wook, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Baek, Seon Ha, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Korea (the Republic of)
Background
Severe hypernatremia (serum sodium [sNa] ≥155 mmol/L) is associated with high mortality, yet the optimal correction strategy remains unclear due to the complexity of electrolyte-free water clearance calculations. This study evaluated the efficacy and safety of rapid intermittent bolus (RIB) versus slow continuous infusion (SCI) of electrolyte-free water in patients with severe hypernatremia.
Methods
This prospective, multicenter, randomized controlled trial enrolled patients from three hospitals in Korea between June 2021 and January 2025. Patients were randomly assigned to receive either RIB or SCI therapy. The primary outcome was achieving rapid sodium correction, defined as a decrease in sNa of ≥6 mmol/L within 24 hours or reaching sNa ≤150 mmol/L. Secondary outcomes included 28-day survival, sNa changes at 6 hours, and total 5% dextrose water volume over 48 hours. Additional outcomes included the incidence of target correction and the overcorrection rate.
Results
Among 178 patients (mean age 75.8 ± 12.8 years, 51.1% male, mean baseline sNa 160.4 ± 6.2 mmol/L), rapid sodium correction was achieved in 91.0% (RIB) vs. 88.8% (SCI) (p=0.62). The RIB group exhibited a greater sNa decrease within 6 hours (-4.7 ± 2.6 vs. -3.6 ± 2.6 mmol/L, p = 0.004) and required less total fluid over 48 hours (1976.0 ± 1285.3 vs. 2505.6 ± 1704.8 mL, p = 0.04). Both groups achieved high target correction rates (95.2% vs. 95.3%, p=1.00) with no significant differences in overcorrection rates (16.5% vs. 14.1%, p=0.67) or 28-day survival (9.1% vs. 12.4%, p=0.48).
Conclusion
Both RIB and SCI effectively corrected sNa with no significant differences in primary or safety outcomes. However, RIB achieved faster initial sodium reduction with lower fluid volume, potentially reducing fluid overload risk. This trial suggests the feasibility of a simplified correction protocol, incorporating ongoing losses, offering a more practical approach without requiring complex electrolyte-free water clearance calculations.
Funding
- Government Support – Non-U.S.