(1347) Is Homeostasis a Joke to You? A Description of Hyponatremia Management

Introduction: Hyponatremia affects 15-20% of emergency hospital admissions and is associated with increased morbidity and mortality. Management of hypotonic hyponatremia is complex and overcorrection of serum sodium may cause osmotic demyelination syndrome and subsequent severe neurologic deficits. Due to the associated risks, correcting serum sodium at an appropriate rate is the mainstay of treatment for chronic hyponatremia. Maintaining this rate of correction, however, is complicated by free water diuresis, and one approach utilized to mitigate this is administering desmopressin (DDAVP). Literature indicates that while DDAVP may be beneficial when used reactively to re-lower serum sodium, proactive administration may prevent overcorrection from occurring.

Methods: This study was conducted at an academic medical center. Patients admitted to medical or surgical critical care services were included if initial serum sodium was < 115 mEq/L with an onset that was chronic (> 48 hours prior) or undetermined. Patients were excluded if they transferred from an outside hospital. The primary outcome was incidence of overcorrection defined as an increase in sodium by > 8 mEq/L in the first 24 hours or by > 6 mEq/L every 24 hours thereafter. Secondary outcomes included DDAVP use patterns. Descriptive statistics were used.

Results: A total of 19 patients were included. The mean age was 62 (+/- 14.8), and 57.9% of patients were female. Mean ICU length of stay was 4.1 (+/- 1.9) days. All patients had symptomatic hyponatremia (21.1% mild, 31.6% moderate, and 47.4% severe). Median initial sodium was 114 mEq/L (108.5-114.5). For the primary outcome, 58% of patients had at least one overcorrection in the 72-hour study period. DDAVP was used in 40% of patients, half of those as a scheduled regimen and half of those as one-time doses. DDAVP was used as a reactive strategy in 10 of the 14 doses given in the study population.

Conclusions: Varied practices for management of hyponatremia were seen and frequent overcorrection was observed. Protocol development may be beneficial to standardize hyponatremia practices.