At times of severe hyponatremia, treatment with hypertonic saline may be necessary. We then assess their serum sodium concentration hourly and decide when it is safe to stop monitoring them.
Controlling chronic hyponatremia slowly is essential in order to avoid overcorrection and osmotic demyelination syndrome (ODS). Make sure that urine output, serum osmolality and serum sodium levels are regularly checked.
What is a Hyponatremia Trial?
Hyponatremia is one of the most frequently occurring electrolyte imbalances among hospitalized patients, ranging from mild cognitive test abnormalities and unsteady gait to life-threatening symptoms such as osmotic demyelination syndrome [1, 2]. Treatment goals aim to quickly correct hyponatremia while simultaneously decreasing risks of neurologic sequelae [3, 4].
Tolvaptan, a vasopressin V2-receptor antagonist, promotes aquaresis – or excretion of free water without depletion of electrolytes – among patients suffering from SIADH, improving sodium balance by raising serum sodium concentrations [3, 4]. Real world studies and clinical trials support using tolvaptan in cases ranging from moderately severe to severe symptoms due to SIADH.
In this post-marketing trial, researchers compared the safety and efficacy of tolvaptan administered either through slow continuous infusion (SCI) or rapid intermittent bolus (RIB) regimens for correcting hyponatremia in patients with moderately severe to severe symptoms associated with SIADH. Results demonstrated symptom frequency decline over treatment duration: by each postbaseline assessment time point postbaseline assessments time points there was less than one patient in each group who presented hypernatremia-defining symptoms at each post-baseline assessment time point post baseline assessment time point post baseline assessment time point post baseline assessment time point post baseline assessment time point post baseline assessments time point post baseline assessments time points post baseline assessment time points post baseline assessment time points (compared with baseline assessment time points).
Hyponatremia Trials Overview
Acute hyponatremia is a risk for patients hospitalized for heart failure, often resulting in increased in-hospital mortality and lengthier hospital stays. Fluid restriction alone or combined with sodium chloride administration has proven successful at alleviating symptoms and the incidence of complications; however, to effectively correct hyponatremia the concentration of urine cations such as sodium and potassium must exceed that of serum sodium for successful correction of this condition.
Edematous hyponatremia presents unique challenges. Delayed absorption of infusion saline may worsen symptoms and increase the likelihood of neurologic dysfunction or brain herniation, so a gradual approach should be preferred when correcting levels. Unfortunately, however, this approach may cause an excessive 24-hour increase in serum sodium. Treatment using desmopressin acetate (tolvaptan) may reduce hyponatremia while preventing excess correction – however this medication may lead to significant water diuresis that could delay discharge or require additional hospitalization for reevaluation of patient status before release from hospital care.
Hyponatremia Trials FAQ
Hyponatremia treatment aims to restore serum sodium concentration to levels considered safe for the individual. Initial approaches vary based on factors like its cause, severity of symptoms and likelihood that problems can be corrected.
Hypervolemic Hyponatremia
When people drink too much water without replenishing electrolytes like salt, their bodies lose too much sodium resulting in dilutional hyponatremia – low blood sodium levels caused by drinking too much liquid alone.
At one time, many clinicians treated this type of symptomatic hyponatremia by giving patients normal or 3 percent saline infusions for several days and then giving fluid restriction as preventive therapy. Unfortunately, this method could overcorrect hyponatremia leading to ODS (Osmotic Demyelination Syndrome).
Hyponatremia Trials Research
In most cases, increasing serum sodium concentration by 4 to 6 mEq/L will relieve most severe symptoms of hyponatremia. If more aggressive action are required to correct hyponatremia symptoms, rapid increases could increase herniation risks as well as seizure risks [17].
Plasma sodium values will be regularly assessed as part of standard care. At discharge from hospital, treating physicians will record the final plasma sodium value on each patient chart as part of standardization measures and decide how best to treat any hyponatremia cases that arise.
Chronically hyponatremic patients who are asymptomatic with serum sodium concentrations below 130mEq/L may display subtle impairments to both mental and gait functioning that require further evaluation, including falls and fractures. Chronic treatments like oral urea or furosemide may help normalize serum sodium concentration to minimize these potential risks; however, evidence does not demonstrate their benefits in improving outcomes.
An environmental journalist, specializing in water safety and public health. With a degree in Environmental Science, she writes on water quality issues and sustainable solutions for safe drinking water.