Rates of osmotic demyelination after rapid correction of sodium in hyponatremia, a multicenter cohort study of patients hospitalized with hyponatremia

Author:

MacMillan Thomas E,Shin Saeha,Topf Joel,Kwan Janice,Weinerman Adina,Tang Terence,Raissi Afsaneh,Koppula Radha,Razak Fahad,Verma Amol A,Fralick Michael

Abstract

ABSTRACTBackgroundOsmotic demyelination syndrome (ODS) is a rare but devastating complication of rapid correction of hyponatremia. Current guidelines recommend limiting the sodium correction rate to no more than 8 mmol/L per 24 hours, but this is based on expert opinion and small observational studies.MethodsWe conducted a multicenter cohort study of patients admitted into hospital with hyponatremia at five academic hospitals in Toronto between April 1, 2010 and December 31, 2019. We identified all adult patients with hyponatremia (sodium <130 mmol/L) based on their initial serum sodium measured on presentation to the emergency department. The primary outcome was the rate of ODS. ODS cases were identified using medical record review and neuroimaging results. The secondary outcome was the rate of rapid correction of sodium (>8 mmol/L in any 24-hour period).ResultsOur cohort included 21182 hospitalizations with hyponatremia. Approximately 50% were women, the average age was 68 years, and mean initial sodium was 124.6 mmol/L (SD 4.6) including 13.1% with sodium <120 mmol/L. Overall, rapid correction of sodium occurred in 3438 (17.9%) admissions. Despite the fact that 3438 experienced rapid correction, there were only 12 cases of ODS among our 21182 hospitalizations with hyponatremia. Cases of ODS had a markedly lower initial serum sodium (110.7 vs. 124.6 mmol/L), were younger (50 years vs 68 years), were more likely to have alcohol use disorder, and were more likely to have hypokalemia (58% vs 14%) compared to those without ODS.ConclusionsIn the large multicenter study of patients with hyponatremia, “rapid” overcorrection was common (N=3438, 17.9%) but ODS was rare (N=12, 0.06%). The initial serum sodium was markedly lower for those with ODS compared to those without. Taken together, these results suggest that the severity of hyponatremia is a more important risk factor for ODS then the rate of correction.

Publisher

Cold Spring Harbor Laboratory

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3