What strategies do you use to prevent overcorrection of serum sodium in patients with severe hyponatremia and adrenal insufficiency when initiating glucocorticoid therapy?

Treatment of hyponatremia due to adrenal insufficiency with glucocorticoid therapy may result in overcorrection of serum sodium due to suppression of ADH and resultant water diuresis. Therefore, serum sodium, urinary osmolality and urinary output should be closely monitored. A brisk water diuresis will result in a significant increase in urinary output, decrease in urinary osmolality and rapid increase in serum sodium level. In this setting, intravenous D5W and/or DDAVP may need to be administered to avoid overcorrection of the serum sodium.