Significantly higher risk of overcorrection in hyponatraemic patients with standard bolus infusion

The ‘one size fits all’ approach regarding the use of bolus infusion of hypertonic saline with fixed volumes leads to a significantly higher risk of overcorrection in patients with a low BMI [1].

A Dutch study presented by Dr Anissa Pelouto (Erasmus Medical Center, Rotterdam, the Netherlands) aimed to determine whether the standard (guideline recommended) bolus administration of hypertonic saline (150 or 100 mL) for hyponatraemia leads to overcorrection, especially in people with a lower BMI, as overcorrection in chronic hyponatraemia patients can be harmful. Correction of symptomatic hyponatraemia is a delicate balance; it must occur quickly enough to prevent cerebral oedema but slowly enough to prevent osmotic demyelination syndrome.  Data was analysed from 183 patients who had received a bolus dose for hyponatremia at Erasmus MC between July 2017 and July 2021. Overcorrection was defined as an increase in the serum sodium level by greater than 12 or 18 mmol/L within 24 or 48 hours, respectively.  Overcorrection occurred in 20% of patients; the overcorrection rate was significantly higher in patients with low BMI compared to patients without low BMI (37% vs 14%; P<0.001). “We also found that BMI was independently associated with overcorrection,” Dr Pelouto added. She concluded by recommending volume adjustments in patients with low BMI [1].

1. Pelouto A, et al. One Size Does Not Fit All: Real World Data on the Safety of Bolus Hypertonic Saline for Symptomatic Hyponatremia. FR-OR49,ASN Kidney Week 2022, 3–6 Nov.

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