SFEBES2018 Poster Presentations Neuroendocrinology and pituitary (25 abstracts)
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 2276 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.
Bolus n=22 | Continuous Infusion n=28 | P | |
Baseline | |||
pNa (mmol/l, 133145) | 119 (108124) | 121 (114125) | NS |
GCS (315) | 12 (814) | 12 (514) | NS |
Change pNa | |||
6 h | 6 (211) | 3 (14) | <0.0001 |
24 h | 10 (613) | 10 (612) | NS |
Change GCS | |||
6 h | 3 (16) | 1 (−22) | <0.0001 |
24 h | 3 (17) | 3 (16) | NS |
Treatment for overcorrection | 5 | 0 | 0.008 |