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.
| Bolus n=22 | Continuous Infusion n=28 | P | |
| 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 h | 6 (2–11) | 3 (1–4) | <0.0001 |
| 24 h | 10 (6–13) | 10 (6–12) | NS |
| Change GCS | |||
| 6 h | 3 (1–6) | 1 (−2–2) | <0.0001 |
| 24 h | 3 (1–7) | 3 (1–6) | NS |
| Treatment for overcorrection | 5 | 0 | 0.008 |
Article tools
My recent searches
My recently viewed abstracts
Authors
Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more