December 2024
GAZETTE
Until now, clinical practice guidelines recommended rapid correction of the levels of this mineral. According to a new paper published in JAMA Internal Medicine, rapid correction for hospitalized adults is a safe and effective measure. See infographic here
Low blood sodium, or hyponatremia, is a relatively common phenomenon in hospitalized patients that, in severe cases, can cause fatigue, confusion, seizures, coma, and death. However, Clinical guidelines recommend that blood sodium correction be done slowly to prevent the onset of a rare neurological complication, “osmotic demyelinating syndrome” or ODS. Now, a review of published studies and an analysis of the progress of more than 2.000 patients admitted to a Buenos Aires hospital confirm that, like a Formula One racer, speed is an ally of success.: Rapid correction of hyponatremia saves lives, without increasing the risk of SDO.
“These findings are very significant: they force us to rethink the recommendations of the guidelines and should change clinical practice,” One of the review's authors said, Dr. Agustín Ciapponi, family physician and doctor in public health, director of the Cochrane Argentina Center of the Institute for Clinical and Health Effectiveness (IECS), an institution affiliated with the Faculty of Medicine of the UBA.
The new review was published in the scientific journal JAMA Internal Medicine and arose from an initial observation by Dr. Juan Carlos Ayus, a nephrologist at the University of California in Irvine, United States, who suspected that the “cautious” approach of the guidelines was unfounded and that rapid correction of hyponatremia could produce better clinical results. See publication here.
To answer that question, Dr. Ayus, Dr. Ciapponi and colleagues from Canada, the United States and Argentina used a methodology, the systematic review with meta-analysis, which groups and synthesizes the findings of different studies published in the medical literature, which allows the sample to be expanded and the effects of an intervention to be observed that in smaller isolated studies go unnoticed or do not achieve statistical significance.
The The results of the review were eloquent. From an analysis of 16 studies published over the past decade involving more than 11.800 patients, the research team found that rapid correction of severe hyponatremia was associated with 32 and 221 fewer in-hospital deaths per 1000 patients treated compared with slow and very slow correction, respectively. The approach also reduced 30-day mortality and shortened hospital stay by 1 to 3 days, with no increase in ODS.
“Physicians have always been taught to avoid rapid and excessive correction of [blood] sodium levels, but these data suggest that the greater concern should be treating patients with hyponatremia too slowly,” said in the influential NEJM Journal Watch Dr. Neil Winawer, professor in the Department of Medicine at Emory University in Atlanta, United States.
In a related study presented in late October at the American Society of Nephrology Annual Meeting (Kidney Week), conducted in San Diego, United States, Dr. Ayus conducted a retrospective analysis on data from 2.037 patients hospitalized with severe hyponatremia at the Hospital Italiano in Buenos Aires between 2010 and 2023. The results were in line with the review findings: rapid correction of blood sodium levels reduced the respective risk of in-hospital and 41-day mortality by 34% and 30% compared with slow correction. And the incidence of SDO was very low (0,14%) and was not associated with the speed of correction.
“In medicine, there are many practices that are carried out out of habit or out of atavistic fears, even when there are no solid foundations and they can be harmful or counterproductive. The evidence we are providing now is a warning sign and a call to carry out more research to confirm the need to modify the strategy adopted for this very common complication in hospitalized patients,” concluded Dr. Ciapponi.
ABOUT IECS:
The IECS is an independent academic institution dedicated to research, education and technical cooperation in health. Founded in 2002, it is an institution affiliated with the Faculty of Medicine of the University of Buenos Aires (UBA) that is home to a CONICET executing unit, a WHO Collaborating center and a Cochrane Center.
The mission of the IECS is “to contribute to improving global health, generating and promoting the application of the best scientific evidence.”
In 2018, the IECS was honored by the WHO for its work against the tobacco pandemic in Latin America. See here
See institutional video here Visit institutional website at: www.iecs.org.ar
IECS PRESS CONTACT: Lic. Mariana Comolli, mcomolli@iecs.org.ar