From the Guidelines
For the management of overcorrection of hyponatremia, the rate of D5W infusion is not explicitly stated in the provided evidence, but the goal is to prevent osmotic demyelination syndrome by not exceeding a correction rate of 8 mEq/L per 24-hour period 1. To manage overcorrection of hyponatremia, the following steps can be taken:
- Infuse D5W to provide free water and dilute serum sodium concentration
- Administer DDAVP (desmopressin) to prevent further water excretion
- Monitor serum sodium levels frequently to adjust the treatment as needed The provided evidence recommends a goal rate of increase of serum sodium of 4-6 mEq/L per 24-hour period, not to exceed 8 mEq/L per 24-hour period to ameliorate the risk of osmotic demyelination syndrome in patients with cirrhosis 1. Key considerations in the management of overcorrection of hyponatremia include:
- Frequent monitoring of serum sodium levels
- Adjusting the treatment to prevent excessive correction
- Using a combination of D5W infusion and DDAVP administration to safely lower serum sodium levels
- Continuing treatment until the sodium correction rate is slowed to the safe range of 6-8 mEq/L per 24 hours.
From the Research
Rate of D5W for Overcorrection of Hyponatremia
- The rate of D5W (5% dextrose in water solution) for overcorrection of hyponatremia is not explicitly stated in the provided studies as a standard rate applicable to all cases.
- However, a study 2 presents a case series where a calculated amount of D5W prefilter was used to prevent overcorrection of hyponatremia in patients receiving continuous renal replacement therapy (CRRT), with the rate of sodium correction not exceeding 8 mEq/day.
- The study 2 also mentions a simplified equation to determine the D5W rate depending on the prescribed effluent volume, but the specifics of this equation are not provided in the text.
- Other studies 3, 4, 5, 6 discuss the management and correction of hyponatremia, emphasizing the importance of avoiding overcorrection to prevent osmotic demyelination syndrome (ODS) and other neurological complications, but do not provide a specific rate for D5W administration in this context.