In this episode, I’ll discuss animal data on the rate of correction for acute hypernatremia.
Acute hypernatremia is a common occurrence in ICU patients. Whenever there is an acute and significant change in sodium levels – whether high or low – there is concern about the safe speed of correction to avoid adverse neurological effects. However, directly investigating the safe speed of correction in patients would not be permitted by any institutional review board, so case reports or animal data represent the best available information for making decisions on the rate of correction that should be used.
To add to the available knowledge on this subject a group of authors published in the journal Critical Care a study looking at the impact of different rates of sodium reduction on the central nervous system in acute hypernatremia in rabbits.
The study included four groups of rabbits given acute hypernatremia with different target sodium reduction rates: 1 mEq/L/hr (The slow group), 2 mEq/L/hr (The middle group), 3 mEq/L/hr (The fast group), and a sham surgery group. Central venous pressure and intracranial pressure were monitored, and after sodium reduction, brain tissue was extracted for pathological examination.
Comparing intracranial pressure before and after sodium correction, the middle and fast rate groups had significant increases in intracranial pressure. Likewise, after correction, pathological findings showed increased brain edema and disorganized brain tissue in the cerebral cortex and brainstem in the middle and fast groups.
The authors concluded:
For acute hypernatremia that develops within 48 h, sodium reduction rates exceeding 1 mEq/L/h are associated with greater increases in ICP and more severe brain edema. Therefore, for managing acute hypernatremia,our result prompted that sodium reduction rates might not exceed 1 mEq/L/h.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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