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Hyponatremia: evaluating the correction factor for hyperglycemia.

T A Hillier1, R D Abbott, E J Barrett

  • 1Department of Internal Medicine, General Clinical Research Center, University of Virginia Health Sciences Center, Charlottesville 22908, USA.

The American Journal of Medicine
|May 4, 1999
PubMed
Summary
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The commonly used correction factor for serum sodium decrease during hyperglycemia is inaccurate. This study found a greater average decrease of 2.4 mEq/L per 100 mg/dL glucose increase, especially above 400 mg/dL.

Area of Science:

  • Endocrinology
  • Nephrology
  • Clinical Chemistry

Background:

  • The standard correction factor for serum sodium decrease in hyperglycemia is 1.6 mEq/L per 100 mg/dL glucose increase.
  • Controlled experimental data validating this factor are lacking.

Purpose of the Study:

  • To experimentally evaluate the hyponatremic response to acute hyperglycemia.
  • To assess the accuracy of the 1.6 mEq/L per 100 mg/dL glucose correction factor.

Main Methods:

  • Six healthy subjects received somatostatin to inhibit insulin secretion.
  • Plasma glucose was raised to over 600 mg/dL using 20% dextrose infusion.
  • Serum sodium and glucose levels were monitored every 10 minutes during glucose infusion and subsequent insulin administration.

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Main Results:

  • The mean serum sodium decrease was 2.4 mEq/L per 100 mg/dL glucose increase, significantly higher than the standard 1.6 factor (P=0.02).
  • The sodium-glucose association was nonlinear, particularly at glucose levels exceeding 400 mg/dL.
  • A correction factor of 4.0 mEq/L per 100 mg/dL glucose was more accurate for glucose concentrations >400 mg/dL.

Conclusions:

  • The physiological decrease in serum sodium during hyperglycemia is greater than the commonly used 1.6 mEq/L per 100 mg/dL glucose correction factor.
  • A revised correction factor of 2.4 mEq/L per 100 mg/dL glucose provides a better overall estimate.
  • The correction factor needs adjustment for glucose concentrations exceeding 400 mg/dL.