Frequência e preditores de hipercorreção do sódio sérico em pacientes internados com hiponatremia grave.

Abstract

Introduction: Overcorrection of hyponatremia occurs when the recommended correc- tion rate is exceeded and can be complicated by osmotic demyelination. Data on the frequency and predictors of severe hyponatremia overcorrection are still limited. Objectives: To assess the frequency of severe hyponatremia overcorrection in two Brazilian centers. Methods: Ret- rospective cohort study based on the review of electronic medical records of patients admitted between January 2016 and July 2019 with admission serum sodium < 120 mEq/L (n = 362). Overcorrection was defined as an increase in serum sodium > 8 mEq/L in 24 hours and/or > 18 mEq/L in 48 hours. Overcorrection predictors were identified through multivariate logistic re- gression. Results: The mean age was 75.6 ± 13.6 years, and 65.5% were women. On arrival at the emergency room (ER), the mean initial serum sodium was 113.3 ± 4.9 mEq/L (range 94 to 119). In the ER, 73.2% of patients were treated with 0.9% NaCl, and the average volume was 495 ± 393 ml. The frequency of overcorrection was 38.7% of cases (140 patients). In a multi- variate logistic regression model, admission sodium < 113 mEq/L (OR 2.4; p < 0.001), age < 75 years (OR 1.96; p = 0.005) and receiving ≥ 500 ml of 0.9% NaCl in the ER (OR 2.1; p = 0.007) were associated with an increased chance of overcorrection; having cancer (OR 0.45; p = 0.008) and using furosemide during hospitalization (OR 0.52; p = 0.008) reduced this chance. Conclusions: Overcorrection of severe hyponatremia occurs with high frequency in hospital- ized patients. The volume of 0.9% NaCl administered in the ER is a modifiable risk factor for overcorrection. The more severe the hyponatremia, the more caution should be exercised when trying to correct the disorder. Administering more than 500 ml of 0.9% NaCl in the ER doubled the chance of overcorrection.