George JC, et al. - Researchers investigated the incidence, risk factors as well as outcomes of rapid correction of severe hyponatremia. They noted severe hyponatremia was rapidly corrected in 41% of the total patients that presented with severe hyponatremia. They also observed that among those patients who had a documented episode of rapid correction, nearly all had incident osmotic demyelination.

Methods

• Researchers examined a retrospective cohort of 1490 patients admitted with serum sodium <120 mEq/L to seven hospitals in the Geisinger Health System from 2001 to 2017, to determine the incidence and risk factors of rapid correction and osmotic demyelination.
• Serum sodium increase of >8 mEq/L at 24 hours defined rapid correction.
• Manual chart review of all available brain magnetic resonance imaging reports was carried out to determine osmotic demyelination.

Results

• The reported features of study population were: mean age was 66 years old (SD=15), 55% were women, and 67% had prior hyponatremia (last outpatient sodium <135 mEq/L).
• The observed median change in serum sodium at 24 hours was 6.8 mEq/L (interquartile range, 3.4–10.2), and rapid correction was reported in 606 patients (41%) at 24 hours.
• The following were found to be associated with greater risk of rapid correction: younger age, being a woman, schizophrenia, lower Charlson comorbidity index, lower presentation serum sodium, and urine sodium <30 mEq/L.
• Findings demonstrated the association of following with lower risk of rapid correction: prior hyponatremia, outpatient aldosterone antagonist use, and treatment at an academic center.
• Brain magnetic resonance imaging was performed in a total of 295 (20%) patients, on or after admission, with radiologic evidence of osmotic demyelination found in nine (0.6%) patients.
• Incident osmotic demyelination was reported in eight (0.5%) patients, of whom five (63%) had beer potomania, five (63%) had hypokalemia, and seven (88%) had sodium increase >8 mEq/L over a 24-hour period before magnetic resonance imaging.
• Data revealed apparent neurologic recovery in five patients with osmotic demyelination.