Table 2. Risk factors for overcorrection of serum sodium and development of ODS.

ODS, osmotic demyelination syndrome; ADH, antidiuretic hormone; SIADH, syndrome of inappropriate ADH secretion.

Risk factors for overcorrection of serum sodium

Elimination of a cause of SIADH (medication, infection, etc.)

Discontinuation of ADH agonists or treatment with ADH antagonists

Administration of corticosteroids in hyponatremia due to adrenal insufficiency

Discontinuation of thiazide diuretics

Administration of normal saline in fluid depletion

Concurrent correction of hypokalemia

High protein intake in patients with malnutrition

Risk factors for ODS

Severe chronic hyponatremia (<120 mmol/L)

(Too rapid) correction of serum sodium and other forms of osmotic stress

Hypokalemia (irrespective of correction speed)

Chronic alcohol abuse

Malnutrition

Liver disease and liver transplantation