Hypertonic Saline for Hyponatremia
2007; Lippincott Williams & Wilkins; Volume: 2; Issue: 6 Linguagem: Inglês
10.2215/cjn.00910207
ISSN1555-905X
AutoresHashim K. Mohmand, Dany Issa, Zubair Ahmad, Joseph D. Cappuccio, Ruth Kouides, Richard H. Sterns,
Tópico(s)Renal function and acid-base balance
ResumoData regarding dosage-response relationships for using hypertonic saline in treatment of hyponatremia are extremely limited. Objectives of this study were to assess adherence to previously published guidelines (limiting correction to <12 mEq/L per d and 12 mEq/L per 24 h and in 9.7% was >18 mEq/L per 48 h. No patient's rate was corrected by >25 mEq/L per 48 h. Among patients with serum sodium <120 mEq/L, the observed increase in sodium exceeded the rise predicted by the Adrogué-Madias formula in 74.2%; the average correction in overcorrectors was 2.4 times the predicted. Inadvertent overcorrection was due to documented water diuresis in 40% of cases.The Adrogué-Madias formula underestimates increase in sodium concentration after hypertonic saline therapy. Unrecognized hypovolemia and other reversible causes of water retention pose a risk for inadvertent overcorrection. Hypertonic saline should be infused at rates lower than those predicted by formulas with close monitoring of serum sodium and urine output.
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