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NEJM EvidenceSevere Hyponatremia Correction, Mortality, and Central Pontine Myelinolysis

Faster Sodium Correction Linked to Lower Mortality and Shorter Hospital Stays

In a recent multicenter observational study, researchers examined the impact of sodium correction rates on mortality, length of hospital stay, and central pontine myelinolysis (CPM) in patients with severe hyponatremia. The findings challenge conventional wisdom on sodium correction rates, suggesting that faster correction may improve patient outcomes.

HCN Medical Memo
This study highlights the need to reevaluate current practices around sodium correction rates in severe hyponatremia. Faster sodium correction may not only reduce mortality but also shorten hospital stays, potentially optimizing healthcare resources. Further research is needed to assess the impact on neurologic complications.

Study Design
  • Multicenter observational study
  • 3,274 patients with severe hyponatremia (admission serum sodium level less than 120 mEq/l) were included
  • Evaluated the association of sodium correction rates with mortality, length of stay, and CPM

Severe hyponatremia occurs in approximately 1-6% of all hospital admissions.

Key Findings
  • 38% had a correction rate of less than 6 mEq/l/24 hours, 29% had 6 to 10 mEq/l/24 hours, and 33% had greater than 10 mEq/l/24 hours
  • Lower correction rates (<6 mEq/l/24 hours) were associated with higher in-hospital mortality
  • Higher correction rates (>10 mEq/l/24 hours) were linked to lower in-hospital mortality and shorter length of stay
  • Seven cases of CPM were identified; most occurred despite low to moderate sodium correction rates and were associated with other conditions like alcohol use disorder and malnutrition

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