REBEL EM - May 06, 2021 - By Salim Rezaie
Paper: Baek SH et al. Risk of Overcorrection in Rapid Intermittent Bolus vs Slow Continuous Infusion Therapies of Hypertonic Saline for Patients with Symptomatic Hyponatremia: The SALSA Randomized Clinical Trial. JAMA Intern Med 2021. PMID: 33104189 [Access on Read by QxMD]
“Clinical Question: What is the risk of overcorrection with hypertonic saline (3%) in rapid intermittent bolus (RIB) vs slow continuous infusion (SCI) therapies in patients with symptomatic hyponatremia?
Author Conclusion: “This randomized clinical trial found that both RIB and SIC therapies of hypertonic saline for treating hyponatremia were effective and safe, with no difference in the overcorrection risk. However, RIB had a lower incidence of therapeutic relowering treatment and tended to have a better efficacy in achieving sNa within 1 hour than SCI. RIB could be suggested as the preferred treatment of symptomatic hyponatremia, which is consistent with the current consensus guidelines.”
Clinical Take Home Point: In this small RCT, both RIB and SCI therapy were effective and safe with no statistically significant differences in overcorrection of sodium (A 7% difference wasn’t statistically significant, but this could be an issue of the study simply being underpowered). However, RIB therapy was more effective in achieving the target correction rate in the 1st hour after treatment initiation, didn’t increase the risk of overcorrection, and is user-friendly (no calculations required) compared to SCI. Until better evidence is available RIB therapy is the treatment of choice in patients with symptomatic hyponatremia.”