Friday, July 8, 2022

Hyponatremia correction

emDOCs - July 7th, 2022 - By Sarah Mongold; Brannon Inman
Reviewed by: Alex Koyfman; Brit Long
Take away:
  • No difference in achieving correction goal at 48 hours. Trend toward over correction in SCI (P=0.26). Relowering more common in SCI group (P=0.04).
  • Rates of achieving target correction in 1st hour higher in the RIB group.
  • This study asks an important clinical question and is the first prospective RCT evaluating RIB and SCI.
  • Groups were similar at baseline.
  • Unfortunately, the outcomes are not patient centered, and the 95% CIs were wide for overcorrection incidence.
  • A significant number of patients were excluded because of protocol violations, and the exclusion criteria are complicated.
My take:
  • I find RIB more feasible in the stressful environment of the ED, and it achieved target correction rate in the 1st hour at higher rates compared to SCI. When I think management of symptomatic hyponatremia is needed in the ED, I will be doing RIB.
  • However, both RIB and SCIR therapy were safe and effective, and further RCTs are needed evaluating this question.