Original ContributionSerum sodium correction rate and the outcome in severe hyponatremia
Introduction
Hyponatremia is the most common electrolyte disorder in the Emergency Department (ED) and it represents a serious medical condition that is associated with higher risk of morbidity and mortality [1].
The prevalence of hyponatremia is about 3–10% in the ED [2], [3] and it is more frequent in hot seasons [4].
The serum sodium correction rate in hyponatremia is crucial for the outcome of emergency patients. Excessively fast correction of hyponatremia has been recognized as a major risk factor for the development of the osmotic demyelination syndrome (ODS). In fact, to reduce neurological complications, it has been recommended to avoid overcorrection of hyponatremia > 12 mmol/l in a 24 h period (0.5 mmol/h) [3], [5], [6], [7], [8].
Similarly, Spasovski et al., recommended to avoid an increase in serum sodium concentration rate > 10 meq during the first 24 h (0.4 mmol/h) [9]. Moreover, Verbalis et al., recommended [10] that the minimum goal of serum sodium correction is 4–8 mmol/l day with a maximum limit of 10–12 meq/l (0.4–0.5 mmol/h) in the first 24 h. In particular, Gross et al., [11] observed that, in chronic severe hyponatremia, problems might arise when it is corrected faster than 0.5 mmol/h. In fact, in patients with severe chronic hyponatremia, a maximum increase of 10–12 mmol/l/day (0.5 mmol/h), has been proposed the first day [6], [12].
However, very limited data are reported about the effects of too slow sodium correction rate on the outcome of severe hyponatremic patients in ED.
Thus, in the present study among severe hyponatremic patients at the ED, we report the length of stay and the survival rate of patients with a mean correction rate < 0.3 mmol/h (group A) and with a mean correction rate ≥ 0.3 and < 0.5 mmol/h (group B).
Section snippets
Study design
In this retrospective comparison study we investigated the serum sodium correction rate on both hospital length and survival rate, in patients with severe hyponatremia. All patients were admitted to the ED of Medicine at the Marcianise University Hospital. The study period was from January 1, 2015 until December 31, 2016. The study population included 67 symptomatic hyponatremic patients and the following data were obtained from each ED admission: demographic and clinical characteristics,
Results
During the study period (from January 1st 2015 to December 31st 2016) a total of 67 patients were enrolled. The mean age of patients was 75 ± 3 years, and 36% of patients were male. According to serum sodium correction rate of natremia patients were divided in two groups: group A, which included patients with a sodium correction rate < 0.3 mmol/h, and group B, which included patients with a correction rate between < 0.5 and ≥ 0.3 mmol/h.
The clinical characteristic of patients in groups A and B are
Discussion
In the present study, we reported the mean serum sodium correction rate and its association with both the length of stay at the ED and survival rate in symptomatic chronic hyponatremic patients.
Hyponatremia is the most common electrolyte disorders and it accounts for > 40% of all electrolyte disorders in the Emergency Department [2]. However, the serum sodium correction rate of hyponatremia is still an open issue. Data reported in the literature about the serum sodium levels focused mostly on
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