Treatment Guidelines for Hyponatremia: Stay the Course

Authors

Richard H. Sterns, Rochester Regional HealthFollow
Helbert Rondon-Berrios, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Horacio J. Adrogué, Baylor College of Medicine , Houston, Texas.
Tomas Berl, University of Colorado Aschutz School of Medicine, Aurora, Colorado.
Volker Burst, University of Cologne Faculty of Medicine, Cologne , Germany.
David M. Cohen, Oregon Health and Science University, Portland, Oregon.
Mirjam Christ-Crain, University of Basel, Basel, Switzerland.
Martin Cuesta, Hospital Clinico San Carlos , Madrid, Spain.
Guy Decaux, Erasmus University Hospital , Brussels, Belgium.
Michael Emmett, Baylor University Medical Center, Dallas, Texas.
Aoife Garrahy, Tallaght University Hospital , Dublin, Ireland.
Fabrice Gankam-Kengne, EpiCura Hospital , Ath, Belgium.
John K. Hix, Rochester Regional HealthFollow
Ewout J. Hoorn, Erasmus Medical Center , Rotterdam, The Netherlands.
Kamel S. Kamel, University of Toronto, Toronto, Ontario, Canada.
Nicolaos E. Madias, Tufts University School of Medicine, Boston, Massachusetts.
Alessandro Peri, University of Florence School of Medicine , Florence, Italy.
Julie Refardt, University of Basel, Basel, Switzerland.
Mitchell H. Rosner, University of Virginia School of Medicine, Charlottesville, Virginia.
Mark Sherlock, RCSI School of Medicine , Dublin, Ireland.
Stephen Silver MD, Rochester Regional HealthFollow
Alain Soupart, Erasmus University Hospital , Brussels, Belgium.
Chris J. Thompson, RCSI School of Medicine , Dublin, Ireland.
Joseph G. Verbalis, G eorgetown University Medical Center, Washington, DC.

Department

Medicine

Additional Department

Nephrology

Document Type

Article

Publication Title

Clinical Journal of the American Society of Nephrology

Abstract

International guidelines designed to minimize the risk of complications that can occur when correcting severe hyponatremia have been widely accepted for a decade. On the basis of the results of a recent large retrospective study of patients hospitalized with hyponatremia, it has been suggested that hyponatremia guidelines have gone too far in limiting the rate of rise of the serum sodium concentration; the need for therapeutic caution and frequent monitoring of the serum sodium concentration has been questioned. These assertions are reminiscent of a controversy that began many years ago. After reviewing the history of that controversy, the evidence supporting the guidelines, and the validity of data challenging them, we conclude that current safeguards should not be abandoned. To do so would be akin to discarding your umbrella because you remained dry in a rainstorm. The authors of this review, who represent 20 medical centers in nine countries, have all contributed significantly to the literature on the subject. We urge clinicians to continue to treat severe hyponatremia cautiously and to wait for better evidence before adopting less stringent therapeutic limits.

First Page

129

Last Page

135

DOI

10.2215/CJN.0000000000000244

Volume

19

Issue

1

Publication Date

1-1-2024

Medical Subject Headings

Hyponatremia (therapy, blood, diagnosis); Humans; Practice Guidelines as Topic; Sodium (blood); Severity of Illness Index

PubMed ID

37379081

Recommended Citation

Sterns, R. H., Rondon-Berrios, H., Adrogué, H. J., Berl, T., Burst, V., Cohen, D. M., Christ-Crain, M., Cuesta, M., Decaux, G., Emmett, M., Garrahy, A., Gankam-Kengne, F., Hix, J. K., Hoorn, E. J., Kamel, K. S., Madias, N. E., Peri, A., Refardt, J., Rosner, M. H., Sherlock, M., Silver, S., Soupart, A., Thompson, C. J., & Verbalis, J. G. (2024). Treatment Guidelines for Hyponatremia: Stay the Course. Clinical Journal of the American Society of Nephrology, 19 (1), 129-135. https://doi.org/10.2215/CJN.0000000000000244