Capsule Commentary on Woodfine et. al., Criteria for Hyponatremic Overcorrection: Systematic Review and Cohort Study of Emergently Ill Patients

Excerpt

Although hyponatremia is common in hospitalized patients and is associated with prolonged lengths of stay and increased morbidity and mortality,¹ it is potentially reversible. Indeed, hospital physicians devote a great deal of their time to calculating sodium deficits and choosing intravenous infusion rates. Until reading this interesting study by Woodfine and van Walraven, we did not realize the degree of potential variation in making these decisions: 9 different formulae for calculating sodium correction rates have been published, with surprisingly low correlations between each (as described in Woodfine’s Tables 4 and 6), and there are 14 different definitions for “overly fast correction” in the literature, most based on studies of less than 75 patients. When these 14 definitions were retrospectively applied to a cohort of 624 patients treated for serum sodium less than 116 mmol/L, Woodfine and van Walraven found that there was an elevenfold difference in the frequency of “overcorrection” (from 8.5 to 89.9%)! As the authors point out, this has implications both medico-legally and for quality of care.² …