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Risk Factors and Total Sodium Dose Associated With Hyponatremia Overcorrection: A Retrospective Cohort Study
Ji-Yun Im1, Jai Won Chang1, Chan-Young Jung1
1Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
The Journal of Emergency Medicine
|August 10, 2026
Summary
Hyponatremia overcorrection, a risk for neurologic impairment, is linked to low urine osmolality and high sodium doses. Calculating total sodium dose can help prevent overcorrection in patients with hyponatremia.
Area of Science:
- Nephrology
- Internal Medicine
- Emergency Medicine
Background:
- Hyponatremia overcorrection poses a risk of irreversible neurologic damage.
- Existing research on hyponatremia risk factors and treatments yields inconsistent findings.
- Current guidelines lack patient-specific considerations for hyponatremia management.
Purpose of the Study:
- Identify risk factors for hyponatremia overcorrection.
- Evaluate the correlation between administered sodium dose and serum sodium level changes.
Main Methods:
- Retrospective cohort study of 212 emergency department patients with hyponatremia.
- Primary outcome: Hyponatremia overcorrection (>12 mEq/L increase in serum sodium at 12h).
- Secondary outcome: Hyponatremia overcorrection (>8 mEq/L increase in serum sodium at 12h).
Main Results:
- Overcorrection occurred in 18.4% (>8 mEq/L) and 7.5% (>12 mEq/L) of patients.
- Low urine osmolality (<150 mOsm/kg) and sodium dose (>4.6 mEq/kg/12h) were significant risk factors.
- Higher sodium doses (>4.6 mEq/kg/12h) resulted in significantly greater serum sodium increases (9.4 vs. 5.1 mEq/L).
Conclusions:
- Low urine osmolality and sodium doses exceeding 4.6 mEq/kg/12h are key risk factors for hyponatremia overcorrection.
- Calculating total sodium dose is crucial for preventing overcorrection.
- Findings emphasize the need for individualized hyponatremia treatment strategies.