title: Sodium Correction Practice and Clinical Outcomes in Profound Hyponatremia.
abstract: OBJECTIVE
  To assess the epidemiology of nonoptimal hyponatremia correction and to identify associated morbidity and in-hospital mortality.
  
  
  METHODS
  An electronic medical record search identified all patients admitted with profound hyponatremia (sodium <120 mmol/L) from January 1, 2008, through December 31, 2012. Patients were classified as having optimally or nonoptimally corrected hyponatremia at 24 hours after admission. Optimal correction was defined as sodium correction in 24 hours of 6 through 10 mmol/L. We investigated the association between sodium correction and demographic and outcome variables, including occurrence of osmotic demyelination syndrome (ODS). Baseline characteristics by correction outcome categories were compared using the Kruskal-Wallis test for continuous variables and the χ(2) test for categorical variables. Odds ratios for in-hospital mortality between groups were assessed using logistic regression. Adjusted differences in hospital length of stay (LOS) and intensive care unit (ICU) LOS were assessed using the Dunnett 2-tailed t test.
  
  
  RESULTS
  A total of 412 patients satisfied inclusion criteria of whom 174 (42.2%) were admitted to the ICU. A total of 211 (51.2%) had optimal correction of their hyponatremia at 24 hours, 87 (21.1%) had undercorrected hyponatremia, and 114 (27.9%) had overcorrected hyponatremia. Both patient factors and treatment factors were associated with nonoptimal correction. There was a single case of ODS. Overcorrection was not associated with in-hospital mortality or ICU LOS. When adjusted for patient factors, undercorrection of profound hyponatremia was associated with an increase in hospital LOS (9.3 days; 95% CI, 1.9-16.7 days).
  
  
  CONCLUSIONS
  Nonoptimal correction of profound hyponatremia is common. Fortunately, nonoptimal correction is associated with serious morbidity only infrequently.
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN. Electronic address: geoghep@tcd.ie.
authors.forename: Pierce
authors.initials: P
authors.lastname: Geoghegan
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN; Medical Scientist Training Program, Mayo Clinic, Rochester, MN.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Harrison
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN.
authors.forename: Charat
authors.initials: C
authors.lastname: Thongprayoon
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN; Department of Anesthesiology, Mayo Clinic, Rochester, MN.
authors.forename: Rahul
authors.initials: R
authors.lastname: Kashyap
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN; Wichita Falls Family Practice Residency Program, North Central Texas Medical Foundation, Wichita Falls.
authors.forename: Adil
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Yue
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
authors.forename: Kianoush B
authors.initials: KB
authors.lastname: Kashani
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
mesh_terms: D000368:Aged; D004334:Drug Administration Schedule; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D012189:Retrospective Studies; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage / Q000009:adverse effects; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States
chemical_list: D012462:Saline Solution, Hypertonic