Honey, stop what you're doing, new hyponatremia research just dropped!
What's it say?
It looks like slow correction is associated with worse outcomes, like death and length of stay!
Was it just a small study?
No, it was a meta-analysis of almost 12,000 patients!
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2826087
What's it say?
It looks like slow correction is associated with worse outcomes, like death and length of stay!
Was it just a small study?
No, it was a meta-analysis of almost 12,000 patients!
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2826087
Comments
Now can someone use this to get funding for an RCT before anyone goes changing anything?
So the risk of osmotic demyelination syndrome is non-existent? Theoretical? I can't afford JAMA
It’s saying fast is best. That would be quite a large change in practice.
So, that does not mean that we should go FASTER than this !
10 ? 12 ? is it prudent to go faster, this is not addressed here
In a world in which physicians are trying to correct sodium slowly, patients who correct rapidly have a different biology than patients who don’t - and it’s hard to think that wouldn’t impact mortality.
One corrects rapidly if you admit and “continue” rx’d home fluid restriction; other has high risk of HRS & mortality
So can I get a prescription for my Marmite please?
This study mostly rests on previous observational studies, which we have discussed already as @jamiekwillows.bsky.social points out
(& is worse than the included obs studies, though better than the case series the sodium mafia like)
Maybe I’m naive—doesn’t it still justify that we stop aggressively blood letting low-risk patients into hospital acquired anemia until we have better data? Or at least give people that choice? Patients hate it, nurses hate it, and no one gets any sleep
(Thank goodness!!)
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2826087
https://pbfluids.com/2024/11/its-time-for-a-new-paradigm-in-hyponatremia/
Can you provide a plot with ODS directly attributable to the rapid correction of hyponatremia?
https://bsky.app/profile/kidneyboy.bsky.social/post/3lbqxiipzts2h
We have “prevailing wisdom” that rapid correction is bad
Is the published paper enough to change practice?
If not, we need a big definitive RCT.
Practice guidelines after data not the other way around.
As Brendon said in graphical terms - the bias is not eliminated at all by large sample size
Our critique of the last one of these we covered in NephJC 👇 - I imagine this would come to a similar conclusion again?
http://www.nephjc.com/news/hyponatremia-correction
Heavy drinking or viral gastroenteritis. Hard to keep it from shooting up.
It's not only "possible" that the slower correctors had worse diseases, it's a near-certainty imo.