Table 4.
Summary of recommendations for targets and limits for speed of correction of hyponatremia by included guidance documents
| Guideline Organization/Societies | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Criteria/categories | NIV | NHS | GAIN | AEEH | EHN | ERBP/ESE/ESICM | UF | HEP | RCHM | EAH-ICD |
| [16] | [17] | [22] | [23] | [25] | [20] | [18] | [19] | [21] | [24] | |
| Targets [Na] increase | ||||||||||
| Symptoms | Independent of symptoms | If symptoms | If symptoms | If symptoms | If symptoms | If symptoms | Until seizures resolve or [Na] >125 mmol/L | |||
| Acute onset (<48 h) | 1–2 mmol/L/h initially | Until [Na] >120 mmol/L independent of onset | 1–2 mmol/L/h first 2–3 h | 1–6 mmol/L first 2 h | 5 mmol/L first h | 4–6 mmol/L urgently | Independent of onset | |||
| Chronic onset (>48 h) | 0.5–1 mmol/L/h first 2–3 h | 1–6 mmol/L first 2 h | 5 mmol/L first h | If seizures or coma 4–6 mmol/L urgently, otherwise 4–6 mmol/L per 24 h | ||||||
| Limits [Na] increase | ||||||||||
| Symptoms | Independent of symptoms | If no symptoms | Independent of symptoms | Independent of symptoms | Independent of symptoms | Independent of symptoms | If no symptoms | Symptom dependent | ||
| Acute onset (<48 h) | If no risk of ODS ≤10 mmol/L per 24 h ≤18 mmol/L per 48 h If risk of ODS <8 mmol/L per 24 h | ≤8–12 mmol/L per 24 h ≤18 mmol/L per 48 h | <12 mmol/L per 24 h | If no risk of ODS ≤10 mmol/L per 24 h ≤18 mmol/L per 48 h If risk of ODS <8 mmol/L per 24 h | ≤10 mmol/L first 24 h ≤8 mmol/L every 24 h thereafter | ≤10 mmol/L per 24 h | No limits | ≤8 mmol/L per 24 h after seizures resolve, Independent of onset | ||
| Chronic onset (>48 h) | <8 mmol/L per 24 h | ≤8–12 mmol/L per 24 h ≤18 mmol/L per 48 h | <12 mmol/L per 24 h | <8–12 mmol/L per 24 h <18 mmol/L per 48 h | ≤10 mmol/L first 24 h ≤8 mmol/L every 24 h thereafter | ≤10 mmol/L per 24 h | <8–12 mmol/L per 24 h <18 mmol/L per 48 h | |||
[Na] – Serum sodium concentration.
NIV, Nederlandse Internisten Vereniging [16]; NHS, National Health Service [17]; GAIN, Guidelines and Audit Implementation Network [22]; AEEH, La Asociación Española para el Estudio del Hígado [23]; EHN, European Hyponatremia Network [25]; ERBP, European Renal Best Practice; ESE, European Society of Endocrinology; ESICM, European Society of Intensive Care Medicine [20]; UF, University of Florida [18]; HEP, Hyponatremia Expert Panel [19]; RCH Melbourne, the Royal Children’s Hospital Melbourne [21]; EAH-ICD, International Exercise-Associated Hyponatremia Consensus Development Conference [24].