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Am J Kidney Dis. 2015 Mar;65(3):435-42. doi: 10.1053/j.ajkd.2014.09.021. Epub 2014 Nov 25.

Treatment of hyponatremic encephalopathy with a 3% sodium chloride protocol: a case series.

Author information

1
Renal Consultants of Houston, Houston, TX; Nephrology Division, Hospital Italiano, Buenos Aires, Argentina. Electronic address: carlosayus@yahoo.com.
2
Nephrology Division, Hospital Alejandro Posadas, Buenos Aires, Argentina.
3
Centro de Rehabilitacion Hirsch, Buenos Aires, Argentina.
4
Nephrology Division, Hospital Fernandez, Buenos Aires, Argentina.
5
Pharmacology Division, Universidad de Buenos Aires, Buenos Aires, Argentina.
6
Division of Nephrology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA.

Abstract

BACKGROUND:

3% sodium chloride solution is the accepted treatment for hyponatremic encephalopathy, but evidence-based guidelines for its use are lacking.

STUDY DESIGN:

A case series.

SETTING & PARTICIPANTS:

Adult patients presenting to the emergency department of a university hospital with hyponatremic encephalopathy, defined as serum sodium level < 130 mEq/L with neurologic symptoms of increased intracranial pressure without other apparent cause, and treated with a continuous infusion of 500mL of 3% sodium chloride solution over 6 hours through a peripheral vein.

PREDICTORS:

Hyponatremic encephalopathy defined as serum sodium level < 130 mEq/L with neurologic symptoms of increased intracranial pressure without other apparent cause.

OUTCOMES:

Change in serum sodium level within 48 hours, improvement in neurologic symptoms, and clinical evidence of cerebral demyelination, permanent neurologic injury, or death within 6 months' posttreatment follow-up.

RESULTS:

There were 71 episodes of hyponatremic encephalopathy in 64 individuals. Comorbid conditions were present in 86% of individuals. Baseline mean serum sodium level was 114.1±0.8 (SEM) mEq/L and increased to 117.9±1.3, 121.2±1.2, 123.9±1.0, and 128.3±0.8 mEq/L at 3, 12, 24, and 48 hours following the initiation of 3% sodium chloride solution treatment, respectively. There was a marked improvement in central nervous system symptoms within hours of therapy in 69 of 71 (97%) episodes. There were 12 deaths, all of which occurred following the resolution of hyponatremic encephalopathy and were related to comorbid conditions, with 75% of deaths related to sepsis. No patient developed neurologic symptoms consistent with cerebral demyelination at any point during the 6-month follow-up period.

LIMITATIONS:

Lack of a comparison group and follow-up neuroimaging studies. Number of cases is too small to provide definitive assessment of the safety of this protocol.

CONCLUSIONS:

3% sodium chloride solution was effective in reversing the symptoms of hyponatremic encephalopathy in the emergency department without producing neurologic injury related to cerebral demyelination on long-term follow-up in this case series.

KEYWORDS:

3% sodium chloride; Hyponatremia; cerebral demyelination; electrolyte abnormality; hypertonic saline; hyponatremic encephalopathy; neurologic injury; sodium

PMID:
25465163
DOI:
10.1053/j.ajkd.2014.09.021
[Indexed for MEDLINE]

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