NaCl 3% Bolus Therapy as Emergency Treatment for Severe Hyponatremia: Comparison of 100 mL vs 250 mL.

Autor:	Massop K; Department of Internal Medicine, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands., Haverkort DA; Department of Internal Medicine, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands., Bech AP; Department of Internal Medicine, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands., de Boer H; Department of Internal Medicine, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands.
Jazyk:	angličtina
Zdroj:	The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2023 Jul 14; Vol. 108 (8), pp. e521-e526.
DOI:	10.1210/clinem/dgad080
Abstrakt:	Context: The aim of initial treatment of severe hyponatremia is to rapidly increase serum sodium to reduce the complications of cerebral edema. The optimal strategy to achieve this goal safely is still under debate. Objective: To compare the efficacy and safety of 100 and 250 mL NaCl 3% rapid bolus therapy as initial treatment of severe hypotonic hyponatremia. Methods: Retrospective analysis of patients admitted to a teaching hospital in The Netherlands between 2017 and 2019. The patients were 130 adults with severe hypotonic hyponatremia, defined as serum sodium ≤ 120 mmol/L. A bolus of either 100 mL (n = 63) or 250 mL (n = 67) NaCl 3% was the initial treatment. Successful treatment was defined as a rise in serum sodium ≥ 5 mmol/L within the first 4 hours after bolus therapy. Overcorrection of serum sodium was defined as an increase of more than 10 mmol/L in the first 24 hours. Results: The percentage of patients with a rise in serum sodium ≥5 mmol/L within 4 hours was 32% and 52% after a bolus of 100 and 250 mL, respectively (P = .018). Overcorrection of serum sodium was observed after a median of 13 hours (range 9-17 hours) in 21% of patients in both treatment groups (P = .971). Osmotic demyelination syndrome did not occur. Conclusion: Initial treatment of severe hypotonic hyponatremia is more effective with a NaCl 3% bolus of 250 mL than of 100 mL and does not increase the risk of overcorrection. (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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