Kidney Week

Abstract: TH-PO0063

Severity of Hyponatremia, Correction Rate, and Risk of Osmotic Demyelination Syndrome: An Epic Cosmos Electronic Health Record (EHR) Database Analysis of Adults with Severe Hyponatremia

Session Information

• Fluid, Electrolyte, and Acid-Base Disorders: Clinical Research
  October 22, 2026 | Location: Exhibit Hall A, 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

• Moritz, Michael L., Akron Children's Hospital, Akron, Ohio, United States

Michael L. Moritz, MD, FASN

• Oravec, Michael, Akron Children's Hospital, Akron, Ohio, United States

Michael Oravec, PhD, MPH

• Pelletier, Jonathan, Akron Children's Hospital, Akron, Ohio, United States

Jonathan Pelletier, MD, MS

• Kaelber, David, MetroHealth Medical Center, Cleveland, Ohio, United States

David Kaelber, MD, PhD, MPH

• Ayus, Juan Carlos, University of California Irvine, Irvine, California, United States

Juan Carlos Ayus, MD, FASN

Background

The relationship between sodium correction rate and osmotic demyelination syndrome (ODS) in severe hyponatremia (≤120 mEq/L) remains controversial, as prior studies have been underpowered.

Methods

We performed a retrospective observational study using Epic Cosmos, a multicenter aggregated electronic health record platform from January 2017 to December 2025. Adult inpatient encounters (≥18 y) with at least one serum sodium ≤120 mEq/L within the first 24 hours of admission and sufficient laboratory data to calculate a 24-hour sodium correction rate were included to assess ODS risk. Correction rate was categorized as slow (<8 mEq/L), medium (8-12 mEq/L), or rapid (>12 mEq/L) over the 24 hours following nadir sodium value. ODS was identified by ICD-10 encounter diagnostic codes. Multivariable regression accounting for patient-level clustering evaluated associations between ODS and age, sex, alcohol use disorder, hypokalemia, liver disease, nadir sodium category, and correction rate.

Results

Among 106,185,726 inpatient admissions, 263,254 adult encounters met criteria for severe hyponatremia without hyperglycemia. ODS was diagnosed in 691 encounters (0.26%). Patients with ODS were younger (median age 54 vs 68 y, p<0.001), more likely to have alcohol use disorder (71% vs 25%, p <0.001) and hypokalemia (< 3.5 mEq/L) (73% vs 41%, p<0.001). ODS incidence rose with worsening nadir sodium (Na) (Table). Alcohol use disorder and hypokalemia were independent predictors of ODS (OR 3.15, 95% CI 2.61–3.81; and OR 2.26, 95% CI 1.90–2.69, respectively). Compared with slow correction (< 8 mEq/L), rapid correction (>12 mEq/L) was not significantly associated with ODS in patients with extreme hyponatremia (Na ≤ 105 mEq/L) (2.0% vs 1.6%) or in the total cohort (OR 1.05, 95% CI 0.85-1.29).

Conclusion

ODS is rare (0.26%) in severe hyponatremia. The major risk factors for ODS are severity of hyponatremia and established risk factors such as alcohol use disorder and hypokalemia. Rapid correction (>12 mEq/L/24h) was not independently associated with ODS.