Written by Mary Marschner
Spoon Feed
This meta-analysis suggests that patients with hypernatremia may have a mortality and length of stay benefit with a faster correction goal than current guidelines.
Is it really an overcorrection?
Treating hypernatremia in the hospital is hard work. It takes providers, nurses, and lab personnel a lot of time and resources. As providers, we have to calculate the correction rate, ensure frequent lab draws are being done and check results, and change type of fluid or rate to ensure no overcorrection within 24hrs. Given resource/time/shift constraints, we have all probably seen many patients who were “overcorrected”, yet often without corresponding adverse events. We need a better look at correction rates and goal correction; this study attempted to see if there was any benefit to correcting sodium faster.
This systematic review and meta-analysis (12 studies; N=10,898) evaluated sodium correction rates in hospitalized adults with hypernatremia. Overall, faster correction (>0.5 mmol/L/h) did not significantly reduce mortality (OR 0.68; 95%CI 0.38–1.24; I²=95%). However, subgroups showed benefit: admission hypernatremia (OR 0.48; CI 0.35–0.68), early correction <24h (OR 0.48; CI 0.31–0.73), and severe hypernatremia ≥155 mmol/L (OR 0.55; CI 0.33–0.92). No major neurologic complications occurred when correction was <1 mmol/L/h. Evidence quality was low to moderate.
This study was very limited. Although they looked at 12 studies, they only used the data from 7, and most of the patients were in only 2 of them, so there is potential for bias. Additionally, the studies did not uniformly agree on what a faster correction rate was. The studies included were observational and retrospective and did not look at other diagnoses that could be contributing to mortality or LOS, which makes the conclusions pretty shaky.
How does this change my practice?
Overall, the study was too weak to change my practice. But I appreciate that it highlights treatment of hypernatremia and the need for more and better studies.
Source
Systematic review and meta-analysis of the treatment of hypernatremia in adult hospitalized patients: impact on mortality, morbidity, and treatment-related side effects. J Crit Care. 2025 Jun;87:155012. doi: 10.1016/j.jcrc.2024.155012. Epub 2025 Jan 6. PMID: 39765195
