Eur J Endocrinol. 2023 Jun 12:lvad062. doi: 10.1093/ejendo/lvad062. Online ahead of print.
ABSTRACT
OBJECTIVE: Achieving recommended targets of sodium correction is challenging to physicians treating hyponatraemia. Plasma sodium has to be increased effectively, yet overcorrection must be prevented. This is often hampered by a high variability of responses to treatment. Here, we sought to delineate factors influencing sodium evolution.
DESIGN: We retrospectively analysed 3,460 patients from the multinational Hyponatraemia Registry comprising a wide range of hyponatraemia aetiologies and treatment strategies.
METHODS: Multivariable linear mixed effects models were applied to identify predictors of plasma sodium evolution within the first 24 hours of treatment.
RESULTS: Evolution of sodium levels over time showed a curvilinear pattern with steeper rise at earlier timepoints. Baseline sodium showed the most pronounced impact with an additional increment of 3.12 mEq/L for every 10 mEq/L initial sodium reduction. With sodium increments of 1.9 mEq/L and 1.4 mEq/L per 24 hours, respectively, the entities hypovolaemic and thiazide-associated hyponatraemia were independent factors for sodium evolution. Therapeutic regimens using hypertonic saline (4.6 mEq/L/24 h), tolvaptan (3.4 mEq/L/24 h), or combination therapy (2.6 mEq/L/24 h) were also associated with a significantly larger sodium rise when compared with no active treatment.
CONCLUSIONS: Choice and dosing of active hyponatraemia therapy should be adjusted not only according to aetiology but most importantly to pre-treatment sodium. Although counterintuitive, less aggressive therapy in more profound hyponatraemia might be safer but yet effective at least in less severe cases.
PMID:37307578 | DOI:10.1093/ejendo/lvad062
