The latest salvo in the hyponatremia wars takes off where Seethapathy left us (NEJM Evidence | NephJC). Last week, Juan Carlos Ayus published his latest study (JAMA Internal Medicine) on hyponatremia, a meta analysis of patient outcomes in the management of hyponatremia pbfluids.com/2024/11/its-... - ThreadSky

kidneyboy.bsky.social • 186 days ago

The latest salvo in the hyponatremia wars takes off where Seethapathy left us (NEJM Evidence | NephJC). Last week, Juan Carlos Ayus published his latest study (JAMA Internal Medicine) on hyponatremia, a meta analysis of patient outcomes in the management of hyponatremia

https://pbfluids.com/2024/11/its-time-for-a-new-paradigm-in-hyponatremia/

Comments

dcharytan.bsky.social•185 days ago

1/nthe issue is that in last 20 years guidelines moved from correction <12 meq/day to 10 then 8 then 6-on the basis of rare cases of cpm with slower rates—ignoring that these cases likely relate to Hyponatremia severity not correction rate and that cpm can also occur with Uber slow correction of <6

dcharytan.bsky.social•185 days ago

2/n-as far as I can tell there was 0 evidence for increased conservativism-but I’ve frequently witnessed residents correcting someone back down because they corrected from 120-128. This leases to prolonged icu stay more blood draws etc ….all based on crap evidence and bad assumptions

dcharytan.bsky.social•185 days ago

3/n that said. I don’t think any of the recent studies address whether it’s safe to abandon slow correction of <10-12/day for eg a sodium of 105 but they are compelling that 4-6 meq day is probably not helpful and may be harmful for a sodium of > 115ish and I’ve never found the argument that

dcharytan.bsky.social•185 days ago

4/n the threshold for very sever hypoNa needs to be 4-6 meq vs the old <12 to make sense based on evidence or pragmatic feasibility

cjchiu.bsky.social•185 days ago

I agree with what you say in you blog. We need good high quality prospective trials. It's crazy we don't for such a relatively common issue that we see.

kidneyboy.bsky.social•185 days ago

The
Most
Common
Electrolyte
Disorder

And we have no compelling studies that guide therapy

sratchley.bsky.social•184 days ago

That
Is
Crazy
Talk

waelhussein.bsky.social•185 days ago

I have been waiting for your guidance, Joel.

Until we have some proper science, what do you do now for 'chronic' hyponatremia? Slow/not slow correction or let it move like it wants?

kidneyboy.bsky.social•185 days ago

I follow the US Expert panel recommendations: 10 in the first 24, unless high risk then shoot for 6, tolerate 8

And I too wait for proper science.

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