Introduction: Hyponatremia is a condition that requires prompt evaluation and treatment to avoid serious toxicities. One potential complication of treatment is overcorrection of hyponatremia. The optimal strategy for treatment of overcorrection is unknown, with limited evidence for agents including desmopressin (DDAVP) and hypotonic fluids. It is hypothesized that initial treatment with hypotonic fluids will result in more episodes of overcorrection compared to initial treatment with DDAVP.
Methods: This was a single-center, retrospective chart review. Patients admitted between January 2018 and January 2023 who received treatment for the overcorrection of hyponatremia were screened. The primary outcome was the number of patients who had multiple episodes of overcorrection based on their initial treatment strategy. Secondary outcomes included the difference in hospital length of stay (LOS) based on initial treatment strategy, time to appropriate sodium level after overcorrection, and LOS for patients who had one overcorrection episode compared to those who had multiple episodes.
Results: Twenty-one patients were included, who experienced a total of 38 episodes of overcorrection. Seven patients had more than one episode of overcorrection during admission. Five (31%) patients who initially received hypotonic fluids experienced multiple overcorrection episodes versus one (20%) patient who initially used DDAVP. The median correction time in the DDAVP group was 5.4 hours (IQR 2.3-8.5) from treatment versus 8.4 hours (IQR 3.7-14) in the hypotonic fluids group. The median hospital LOS was 4.2 days (IQR 3.8-5) for patients with 1 episode of overcorrection and 8.8 days (IQR 8.8-9.9) for patients who had more than 1 episode.
Conclusions: DDAVP given as the initial agent for the overcorrection of hyponatremia is associated with fewer episodes of overcorrection. This may be due to the longer duration of effect compared to hypotonic fluids and the variation in dosing of hypotonic fluids. Providers should consider the use of DDAVP for the initial treatment of overcorrection.
