Hyponatraemia Correction Rate ODS Prevention — ESENeph MCQ

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ModerateElectrolyte DisordersHyponatraemia Correction Rate ODS PreventionESENeph

A 42-year-old woman develops severe hyponatraemia (Na+ 108 mmol/L) with confusion and a seizure. She was on desmopressin for central diabetes insipidus and increased her water intake during a heatwave. She weighs 60 kg. What is the maximum rate of sodium correction in the first 24 hours?

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Correct answer: D — 6-8 mmol/L in 24 hours

For severe chronic hyponatraemia with neurological symptoms, expert guidelines recommend sodium correction of no more than 6-8 mmol/L in the first 24 hours (and no more than 8 mmol/L in any 24-hour period, maximum 18 mmol/L in 48 hours). Overcorrection risks osmotic demyelination syndrome (ODS, formerly central pontine myelinolysis), which causes devastating irreversible neurological damage (quadriplegia, pseudobulbar palsy, locked-in syndrome) 2-6 days after overcorrection. Initial management of seizures: 100 mL of 3% hypertonic saline bolus over 10 minutes (may repeat x2). Desmopressin should be held, and electrolytes checked every 2-4 hours. If overcorrection occurs, desmopressin can be given to re-lower sodium.

Reference: Sterns et al 2010 – Osmotic Demyelination Prevention; Verbalis et al 2013 – Hyponatraemia Guidelines