Endocrine Abstracts

Background: The European Society of Endocrinology (ESE) published guidelines to standardise intravenous hypertonic saline (HTS) for severe symptomatic hyponatraemia in 2014. Two 150 mL boluses of 3.0% HTS are proposed, one after the other, to achieve an initial sodium rise of 5 mmol/l without waiting for an interval sodium result. ESE guidelines were adopted by our University Hospital in 2017. However, high rates of sodium overcorrection were observed, and the guidelines lacked detailed guidance on overcorrection management.

Objectives: To evaluate the ‘real-world’ safety and efficacy of ESE guidelines for the use of HTS, and to design a bespoke protocol to overcome any identified limitations.

Methods: We conducted a retrospective medical records review of all patients who were administered HTS between 2017-2020 focussing on rates of sodium overcorrection and its management.

Results: In total 112 patients received HTS. Overcorrection rates at 24 hours were 44.9%. There was no reported episode of osmotic demyelination syndrome and HTS administration was not linked to inpatient mortality. 22.6% had overshot the immediate target rise of 5 mmol/l after just one bolus of HTS. Overall, 20% of our cohort received overcorrection treatment but there was heterogeneity in use of overcorrection treatments. Based on these findings, we updated the guideline with a point of care venous blood gas sodium check after the first HTS bolus, and only recommend second bolus if the intended 5 mmol/l rise in sodium has not already been achieved. Further, we adopted use of fixed volume (200 mL) boluses of intravenous dextrose to standardise safe management of sodium overcorrection.

Conclusions: Our data comprise the largest real-world cohort evaluating ESE guidelines. Overcorrection rates were significant prompting a data-driven refinement of ESE guidance for use in our hospital. Our data indicate that a review of ESE guidelines is warranted to amend the current bolus strategy.