Management of severe hyponatremia in non-ICU settings was safe, with similar rates of sodium overcorrection compared to ICU management (28.1% vs 31.8%, p=0.3823) and less iatrogenic hypernatremia.
Cohort (n=1,048)
No
Does management of severe hyponatremia in non-ICU settings compared to ICU settings result in similar safety and complication rates in adults?
Severe hyponatremia can be safely managed in non-ICU settings without increased complications, potentially preserving ICU resources.
Absolute Event Rate: 28.1% vs 31.8%
p-value: p=0.3823
Abstract Rationale Severe hyponatremia (sodium ≤125 mEq/L) is a common and dangerous electrolyte disturbance linked to high morbidity and mortality. Traditionally, these patients are managed in the ICU due to the need for close monitoring during sodium correction, yet no studies have evaluated the safety of treating severe hyponatremia outside the ICU. This retrospective study compares treatment strategies and complications of severe hyponatremia management between ICU and non-ICU settings. Methods This IRB-approved retrospective study analyzed adults admitted to Kaiser Moanalua (2018-2023) with ICD-10-coded hyponatremia and admission sodium 125 mEq/L. Chronic baseline cases were excluded. EHR data included admission location, sodium trends, demographics, Charlson comorbidity index (CCI), clinical complications, including osmotic demyelination syndrome (ODS), and over-correction (8 mEq/24h). Manual chart review confirmed etiology, treatment strategy, use of D5W/desmopressin (DDAVP). Statistical analysis was conducted in SAS using parametric, nonparametric, and generalized linear models (alpha = 0.05). Results Of 1,048 admissions, 129 (14%) were ICU admissions. There was no difference in CCI between patients cared for in the ICU or non-ICU settings. ICU hypertonic (3%) saline use was higher (12.4% vs 2.9%, p 0.0001), though a numerically higher number of non-ICU patients received it (16 vs 27 in non-ICU). Overcorrection occurred in 31.8% of ICU and 28.1% of non-ICU patients (p = 0.3823) with no confirmed ODS cases or related complications. Iatrogenic hypernatremia was more frequent in ICU (7.8% vs 0.9%, p 0.0001). Treatment with D5W or desmopressin was more frequent in the ICU versus non-ICU (32.6% vs 8.6%, p 0.0001). ICU patients had a longer median length of stay (8 vs 4 days, p 0.0001) and a longer median time to sodium normalization (82 vs 64 hours, p = 0.0068). Conclusions This study supports the safety of managing severe hyponatremia outside the ICU, noting 86% of total severe hyponatremia admissions were successfully managed on non-ICU floors without increased complications. Hypertonic saline was frequently and safely administered outside the ICU. Sodium overcorrection was higher in the ICU, suggesting more conservative correction practices outside the ICU. No cases of ODS or treatment-related complications occurred in any setting. Other markers of overtreatment: iatrogenic hypernatremia, D5W/DDAVP use, and prolonged hospitalization were all significantly more frequent in ICU patients. These findings indicate that patients meeting criteria for severe hyponatremia were safely managed outside the ICU in our study with fewer complications, supporting the potential as a standard approach to preserve ICU resources. This abstract is funded by: None
Kircher et al. (Fri,) conducted a cohort in Severe hyponatremia (n=1,048). Non-ICU management vs. ICU management was evaluated on Sodium overcorrection (>8 mEq/24h) (p=0.3823). Management of severe hyponatremia in non-ICU settings was safe, with similar rates of sodium overcorrection compared to ICU management (28.1% vs 31.8%, p=0.3823) and less iatrogenic hypernatremia.