Faster Sodium Correction Linked to Lower Mortality in Severe Hyponatremia: Study

Written By : Dr. Shravani Dali Published On 2026-02-01T21:45:31+05:30 | Updated On 1 Feb 2026 9:45 PM IST

Researchers have found in a new study that among hospitalized adults with severe hyponatremia, medium or fast sodium correction was associated with a lower risk of death and delayed neurologic complications compared with slow correction. Although causality was not established, the findings suggest that current treatment guidelines for severe hyponatremia may need reevaluation and revision.

Slow correction of severe hyponatremia is recommended to prevent osmotic demyelination syndrome but is associated with higher mortality. A study was done to examine the association between sodium correction rates and death or delayed neurologic events. It was a retrospective cohort study. The primary outcome was a composite of 90-day death or delayed neurologic events (new demyelination, paralysis, epilepsy, or altered consciousness between 3 and 90 days from admission). Standardized risk differences (RDs) were generated using targeted maximum likelihood estimation. Heterogeneity of effect was assessed across grades of predicted risk.

Results: 13 988 patients were hospitalized with severe hyponatremia during the study period (median age, 74 years; 63% female). Comorbidities included congestive heart failure (24%), liver disease (18%), alcohol dependence (14%), and metastatic cancer (10%). The primary outcome occurred in 3000 patients (21%); 90-day death occurred in 2554 (18%), and 90-day delayed neurologic events occurred in 587 (4%). Compared with slow 24-hour sodium correction, both medium (RD, −5.6 percentage points [95% CI, −7.1 to −4.0 percentage points]) and fast (RD, −9.0 percentage points [CI, −11.1 to −6.9 percentage points]) correction rates were associated with lower adjusted risk for the primary outcome. Risk differences increased with higher predicted risk, whereas risk ratios remained similar. Faster sodium correction is associated with lower risk for 90-day death or delayed neurologic events. Treatment guidelines should be reexamined.

Reference:

Dustin G. Mark, Mubarika Alavi, Joshua R. Nugent, et al. Sodium Correction Rates and Associated Outcomes Among Patients With Severe Hyponatremia: A Retrospective Cohort Study. Ann Intern Med. [Epub 27 January 2026]. doi:10.7326/ANNALS-25-03676

Keywords:

Dustin G. Mark, Mubarika Alavi, Joshua R. Nugent,Sodium, Correction, Rates, Associated, Outcomes, Among, Patients, Severe Hyponatremia

FasterSodiumCorrectionLinkedLowerMortalitySevereHyponatremiaStudy

Source : Annals of Internal Medicine

Dr. Shravani Dali

Dr. Shravani Dali has completed her BDS from Pravara institute of medical sciences, loni. Following which she extensively worked in the healthcare sector for 2+ years. She has been actively involved in writing blogs in field of health and wellness. Currently she is pursuing her Masters of public health-health administration from Tata institute of social sciences. She can be contacted at editorial@medicaldialogues.in.