Has your management of severe hyponatremia changed after a recent observational study described higher in-hospital mortality for sodium correction of <6 mEq/L compared to 6-10 mEq/L in the first 24 hours?

In short, no. I think the recent studies tell me two things:

1. We need to better discriminate correction rates based on the risk of osmotic demyelination (ODS).
2. Perhaps, do not worry so much about over-correction.

They do not tell me to start rapidly correcting patients, and I guess I will summarize m...

For me, this is deja vu. The rate of correction of hyponatremia was hotly debated in the 1980s but eventually settled with all guidelines recommended slower correction of about 6 mEq/L in the first 24 hours. Now the controversy is back as a result of the publication of several observational studies ...

I think that the key question is whether the higher mortality is related to the lower rate of correction of hyponatremia per se or is the higher mortality a reflection of the disease states underlying the defect in urinary free water excretion. Patients with a reversible defect in urinary free water...

From my modest experience, the correction rate of 8-10 mEq/L within 24 hours and 18 mEq/L in the first 48 hours was safe and practical with less blood withdrawal, and fewer days in the hospital especially if the nurses stick to the schedule of the blood draw and IVF administration. Even if the nurse...

In my experience, hyponatremia requires bladder dysfunction. A Foley catheter for megacystis can correct serum sodium better than infusing IV fluids.

Moskowitz, PMID 1593698