Publication Date
1-1-2024
Journal
Clinical Journal of the American Society of Nephrology
DOI
10.2215/CJN.0000000000000244
PMID
37379081
PMCID
PMC10843202
PubMedCentral® Posted Date
6-28-2023
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
Hyponatremia, Humans, Practice Guidelines as Topic, Sodium, Severity of Illness Index, complications, hypernatremia, hypokalemia, hyponatremia, malnutrition, mortality risk, osmolality, outcomes, risk factors, water–electrolyte balance
Abstract
International guidelines designed to minimize the risk of complications that can occur when correcting severe hyponatremia have been widely accepted for a decade. On the basis of the results of a recent large retrospective study of patients hospitalized with hyponatremia, it has been suggested that hyponatremia guidelines have gone too far in limiting the rate of rise of the serum sodium concentration; the need for therapeutic caution and frequent monitoring of the serum sodium concentration has been questioned. These assertions are reminiscent of a controversy that began many years ago. After reviewing the history of that controversy, the evidence supporting the guidelines, and the validity of data challenging them, we conclude that current safeguards should not be abandoned. To do so would be akin to discarding your umbrella because you remained dry in a rainstorm. The authors of this review, who represent 20 medical centers in nine countries, have all contributed significantly to the literature on the subject. We urge clinicians to continue to treat severe hyponatremia cautiously and to wait for better evidence before adopting less stringent therapeutic limits.
Included in
Diseases Commons, Internal Medicine Commons, Medical Sciences Commons, Nephrology Commons