SALSA RCT – Hypertonic Saline Bolus vs Infusion for Hyponatremia

Written by Vivian Lei

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Intermittent boluses of hypertonic saline for treatment of moderate-to-severe hyponatremia has similar efficacy to a continuous infusion and may be easier to administer with less risk of overcorrection.



Why does this matter?
Correcting symptomatic hyponatremia with hypertonic saline requires balancing treatment goals with risk of overcorrection. While a continuous infusion is typically used, this study investigates whether fixed dose boluses of hypertonic saline may potentially have similar efficacy with the added benefits of safety and ease of implementation.

A hot salty SALSA trial
This was a prospective, randomized controlled trial performed at 3 hospitals in South Korea in which 178 patients (ED and inpatient) age 18 and older with moderate to severe symptomatic hyponatremia (Na ≤ 125 mmol/L) were randomized to receive a protocol of slow continuous infusion (SCI) of hypertonic saline or rapid intermittent bolus (RIB) therapy. Sodium was assessed every 6 hours and relowering therapy with 5% dextrose in water and/or desmopressin was given if sodium had been overcorrected in either group. The incidence of overcorrection was not significantly different, occurring in 17.2% in the RIB group vs. 24.2% in the SCI group. The RIB group had a lower incidence of requiring relowering treatment as well as a higher proportion of patients achieving target correction rate within 1 hour. No cases of osmotic demyelination syndrome occurred in either group.

Source
Risk of Overcorrection in Rapid Intermittent Bolus vs Slow Continuous Infusion Therapies of Hypertonic Saline for Patients With Symptomatic Hyponatremia: The SALSA Randomized Clinical Trial. JAMA Intern Med. 2021 Jan 1;181(1):81-92. doi: 10.1001/jamainternmed.2020.5519.

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