Evaluation of Severe Hyponatremia Management Care Pathway in Critically Ill Patients

Sunday, March 22, 2026

2:30 PM - 3:30 PM Central Time

Location: Connections Central - RST 06

CO

Catherine E. O'Rourke, PharmD, MPH

Connecticut

Disclosure(s): No relevant financial relationship(s) to disclose.
MA

Mahmoud Ammar, PharmD, MBA, BCPS, BCCCP, FCCM

Senior Critical Care Pharmacy Specialist
Yale New Haven Hospital

Disclosure information not submitted.
CF

Claudia Florian, PharmD, BCPS, BCCP

Clinical Pharmacist
Yale New Haven Hospital

Disclosure information not submitted.
NS

Nancy Scarpelli, PharmD, BCPS

Clinical Pharmacist
Greenwich Hospital

Disclosure information not submitted.
PA

Paul Ahearn, PharmD, BCPS, BCCCP

Clinical Pharmacy Specialist
Bridgeport Hospital

Disclosure information not submitted.
JS

Jonathan Siner, MD

Associate Chief Patient Safety Officer
Yale School of Medicine

Disclosure information not submitted.
Jennifer Johnson, APRN

Yale New Haven Health, Connecticut

Disclosure(s): No relevant financial relationship(s) to disclose.

Introduction: Severe hyponatremia treatment variability across large health systems makes maintaining an institutional care standard demanding. The primary purpose is to evaluate the impact of a system-wide Severe Hyponatremia Care Pathway integrated into the electronic health record on resource utilization, as measured in 3% hypertonic saline (HTS) utilization in adult patients with severe hyponatremia.

Methods: Electronic health record data were used to retrospectively identify patients aged 18 years or older admitted to a hospital within the Yale New Haven Health System between October 1, 2023, and February 28, 2025, who experienced severe hyponatremia, defined as a serum sodium level of < 120 mEq/L. Patients were stratified based on whether the provider activated the Severe Hyponatremia Care Pathway. The primary outcome was the frequency of 3% HTS bolus administrations. Other outcomes include the frequency of desmopressin (DDAVP) and dextrose 5% (D5) administrations. Hospital and intensive care unit (ICU) length of stay (LOS), in-hospital mortality, and disposition were also evaluated. A sub-group analysis for patients admitted to an ICU was performed. Descriptive analyses were reported.

Results: Of 412 total patients, 181 (44%) had provider activation of the Severe Hyponatremia Care Pathway (pathway group), and 231 (56%) did not (no-pathway group). ICU patients in the pathway group were more likely to receive 3% HTS (49% vs. 19%, p < 0.001), have shorter ICU LOS (4.8 vs. 7.6 days), and better mortality rates (6% vs. 22%, p< 0.001). Correction agents (DDAVP and D5) had mixed results with pathway patients more likely to receive DDAVP (31% vs 16%, p< 0.001), but D5 more likely for non-pathway patients (32% vs. 22%, p=0.03).

Conclusions: While this study has several limitations and barriers, the results suggest that utilizing a health system-based Care Pathway may be associated with optimized pharmacologic treatment, lower in-hospital mortality rates, and shorter hospital and ICU LOS in patients with severe hyponatremia.