Treatment Guidelines for Hyponatremia

What is it about?

Hyponatremia (a low sodium concentration of the blood) is a common disorder. If the blood sodium concentration is raised too fast, it can cause brain damage-- a disorder called "osmotic demyelination syndrome" (ODS). For this reason, international guidelines designed to minimize the risk of complications that can occur when correcting severe hyponatremia have been widely accepted for a decade. Thankfully as physicians have adopted these guidelines, ODS has become much less common than it was 40 years ago, when the risks of rapid correction of hyponatremia were first recognized. Based on the results of a recent large retrospective study of patients hospitalized with hyponatremia, it has been suggested that hyponatremia guidelines have gone too far in limiting the rate of rise of sodium concentration; the need for therapeutic caution and frequent monitoring of blood samples has been questioned. These assertions are reminiscent of a controversy that began many years ago. After reviewing the history of that controversy, the evidence supporting the guidelines, and the validity of data challenging them, we conclude that current safeguards should not be abandoned. To do so would be akin to discarding your umbrella because you remained dry in a rainstorm.

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