Hypertonic saline therapy resulted in sodium increases exceeding the Adrogué-Madias formula prediction in 74.2% of patients, with 11.3% overcorrecting by >12 mEq/L per 24 hours.
Observational (n=62)
No
Does the Adrogué-Madias formula accurately predict the increase in serum sodium concentration following hypertonic saline therapy in adult hyponatremic patients?
The Adrogué-Madias formula underestimates the increase in serum sodium concentration after hypertonic saline therapy, suggesting that hypertonic saline should be infused at lower rates than predicted with close monitoring.
BACKGROUND AND OBJECTIVES: Data regarding dosage-response relationships for using hypertonic saline in treatment of hyponatremia are extremely limited. Objectives of this study were to assess adherence to previously published guidelines (limiting correction to 12 mEq/L per 24 h and in 9.7% was >18 mEq/L per 48 h. No patient's rate was corrected by >25 mEq/L per 48 h. Among patients with serum sodium <120 mEq/L, the observed increase in sodium exceeded the rise predicted by the Adrogué-Madias formula in 74.2%; the average correction in overcorrectors was 2.4 times the predicted. Inadvertent overcorrection was due to documented water diuresis in 40% of cases. CONCLUSIONS: The Adrogué-Madias formula underestimates increase in sodium concentration after hypertonic saline therapy. Unrecognized hypovolemia and other reversible causes of water retention pose a risk for inadvertent overcorrection. Hypertonic saline should be infused at rates lower than those predicted by formulas with close monitoring of serum sodium and urine output.
Mohmand et al. (2007) conducted an observational in Hyponatremia (n=62). Hypertonic saline was evaluated on Observed increase in sodium exceeding the rise predicted by the Adrogué-Madias formula among patients with serum sodium <120 mEq/L. Hypertonic saline therapy resulted in sodium increases exceeding the Adrogué-Madias formula prediction in 74.2% of patients, with 11.3% overcorrecting by >12 mEq/L per 24 hours.