Risk Factors and Outcomes of Rapid Correction of Severe Hyponatremia

Background and objectives Rapid correction of severe hyponatremia can result in serious neurologic complications, including osmotic demyelination. Few data exist on incidence and risk factors of rapid correction or osmotic demyelination. Design, setting, participants, & measurements In a retrospective cohort of 1490 patients admitted with serum sodium 8 mEq/L at 24 hours. Osmotic demyelination was determined by manual chart review of all available brain magnetic resonance imaging reports. Results Mean age was 66 years old (SD=15), 55% were women, and 67% had prior hyponatremia (last outpatient sodium 8 mEq/L over a 24-hour period before magnetic resonance imaging. Five patients with osmotic demyelination had apparent neurologic recovery. Conclusions Among patients presenting with severe hyponatremia, rapid correction occurred in 41%; nearly all patients with incident osmotic demyelination had a documented episode of rapid correction. Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_06_05_CJASNPodcast_18_7_G.mp3