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.