- Initial serum sodium ≤105 meq/L, hypokalaemia (<3.0 meq/L) and alcohol abuse were independently associated with markedly increased ODS risk.
- Fast 24-hour sodium correction was more frequent in ODS cases (43% vs 24%), but adjusted analysis found no significant association.
- Faster sodium correction may be an epiphenomenon of confounding risk factors, suggesting guideline evidence should account for these variables.
Neurocrit Care. 2026 Oct 27. doi: 10.1007/s12028-026-02699-6. Online ahead of print.
ABSTRACT
INTRODUCTION: Clinical guidelines emphasize slow correction of severe hyponatremia to prevent osmotic demyelination syndrome (ODS), though the evidentiary base rarely accounts for confounding factors.
METHODS: A retrospective case-control study of adults with an initial serum sodium concentration ≤ 120 meq/L who were admitted to a 21-hospital-integrated healthcare system between 1 January 2008 and 31 December 2023 was conducted. Maximum 24-h sodium correction rates were defined as slow (< 8 meq/L), moderate (8-12 meq/L), or fast (> 12 meq/L). Adjusted odds ratios (aORs) were estimated using Firth’s penalized logistic regression.
RESULTS: Twenty-three cases of ODS and 9557 non-ODS controls were identified. Compared with controls, ODS cases were more likely to experience fast sodium correction (43% vs. 24%). However, following adjustment for initial serum sodium ≤ 105 meq/L [aOR 10.3, 95% confidence interval (CI) 3.3-32.3], initial serum potassium < 3.0 meq/L (aOR 3.4, 95% CI 1.2-9.3), and history of alcohol abuse (aOR 3.9, 95% CI 1.7-8.8), faster sodium correction rates lacked statistical association with ODS: moderate (aOR 0.6, 95% CI 0.2-2.0) or fast (aOR 1.0, 95% CI 0.3-2.9).
CONCLUSIONS: Faster sodium correction rates in cases of ODS may be, at least in part, epiphenomena of underlying confounding factors.
PMID:42946956 | DOI:10.1007/s12028-026-02699-6
Share Evidence Blueprint
Save to Google Notes
Search Google Scholar
Save as PDF
⭐ My Revision List
