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Endocrine Abstracts (2018) 59 P135 | DOI: 10.1530/endoabs.59.P135

SFEBES2018 Poster Presentations Neuroendocrinology and pituitary (25 abstracts)

Bolus 3% saline restores cognitive function more rapidly than traditional slow intravenous infusion of 3% saline in the emergency treatment of SIAD, with symptoms of cerebral irritation

Aoife Garrahy , Rosemary Dineen , Anne Marie Hannon , HM Zia-ul-Hussnain , Martin Cuesta , Mark Sherlock & Chris Thompson


Beaumont Hospital and RCSI, Dublin, Ireland.


Acute hyponatraemia is a medical emergency with high mortality. Recent expert guidelines advocate treatment with intravenous boluses of 3% saline with the aim to reduce cerebral oedema more rapidly than traditional slow intravenous infusion, but there is a poor evidence base for this policy change. We retrospectively audited treatment of symptomatic hyponatraemia due to SIAD (n=57, age 22–76 year), comparing low dose (20 ml/h) and bolus infusion of 3% saline. Bolus 3% saline caused more rapid elevation of plasma sodium at 6 hours, with a concomitant return of GCS to normal. Administration of a 3rd bolus was associated with a greater need for dextrose/DDAVP to reverse 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). Bolus 3% saline delivers faster elevation of plasma sodium, with more effective restoration of GCS, without osmotic demyelination. Frequent electrolyte monitoring is required to prevent overcorrection.

Table 1 Results [expressed as median (min-max)]; pNa, plasma sodium.
Bolus n=22Continuous Infusion n=28P
Baseline
pNa (mmol/l, 133–145) 119 (108–124) 121 (114–125) NS
GCS (3–15)12 (8–14)12 (5–14)NS
Change pNa
6 h6 (2–11) 3 (1–4) <0.0001
24 h10 (6–13)10 (6–12)NS
Change GCS
6 h 3 (1–6) 1 (−2–2) <0.0001
24 h3 (1–7)3 (1–6)NS
Treatment for overcorrection500.008

Volume 59

Society for Endocrinology BES 2018

Glasgow, UK
19 Nov 2018 - 21 Nov 2018

Society for Endocrinology 

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