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Continuous versus bolus infusion of hypertonic saline in the treatment of symptomatic hyponatremia due to SIAD

Continuous versus bolus infusion of hypertonic saline in the treatment of symptomatic hyponatremia due to SIAD

Journal of Clinical Endocrinology and Metabolism 2019

Acute hyponatremia is a medical emergency which confers high mortality, attributed primarily to cerebral edema. Expert guidelines advocate the use of intravenous boluses of hypertonic saline, rather than traditional continuous infusion, in order to achieve a faster initial rise in plasma sodium concentration. However, there is a limited evidence base for this recommended policy change. We prospectively assessed the clinical and biochemical outcomes in patients treated for symptomatic hyponatremia due to syndrome of inappropriate antidiuresis (SIAD), in response to intravenous bolus treatment with 3% saline (100ml, repeated up to two more times), and compared the outcomes to retrospective data from patients treated with continuous intravenous infusion of low dose (20ml/hour) 3% saline. Twenty-two patients were treated with bolus infusion and 28 with continuous infusion. Age and gender were similar in both groups. 3% saline bolus caused more rapid elevation of plasma sodium (pNa) at 6 hours (median (range) 6 (2 -11) versus 3 (1 - 4) mmol/l, p <0.0001), with a concomitant improvement in GCS (median (range) 3 (1 - 6) versus 1 (-2 - 2), p < 0.0001) at 6 hours. Median plasma sodium concentration was similar at 24 hours in the two treatment groups. The administration of a 3rd saline bolus was associated with greater need for dextrose/dDAVP to prevent overcorrection (OR 24; p=0.006). There were no cases of osmotic demyelination in either group. Four patients died; all in the infusion group (NS). 3% saline bolus produces faster initial elevation of pNa than continuous infusion of saline, with quicker restoration of GCS, and without osmotic demyelination. Frequent electrolyte monitoring, and judicious intervention with dDAVP is required to prevent overcorrection with bolus therapy.

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Accession: 066600047

Download citation: RISBibTeXText

PMID: 30882872

DOI: 10.1210/jc.2019-00044

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