From the Research
For a patient who has overcorrected sodium by 10 points in 24 hours, I recommend administering desmopressin (DDAVP) 2-4 mcg IV every 6-8 hours until the serum sodium decreases to a safer level, as supported by the most recent study 1. The goal is to lower the sodium correction rate to less than 8 mEq/L per 24 hours to prevent osmotic demyelination syndrome, as suggested by a study published in 2021 2. Alongside desmopressin, administer hypotonic fluids such as D5W or quarter-normal saline to help lower serum sodium. Monitor serum sodium levels every 2-4 hours during this intervention. Desmopressin works as a synthetic analog of vasopressin (antidiuretic hormone) that increases water reabsorption in the kidneys, leading to decreased serum sodium concentration. This intervention is particularly important in patients at high risk for osmotic demyelination syndrome, such as those with chronic hyponatremia, alcoholism, malnutrition, or liver disease, as noted in a study from 2018 3. Some key points to consider in the management of overcorrected hyponatremia include:
- The importance of careful monitoring of serum sodium levels, as emphasized in a study from 2000 4
- The need to adjust the dose and frequency of desmopressin based on the patient's response, as suggested by a study from 2015 5
- The potential benefits of thiamine supplementation in patients with poor dietary intake, as recommended in a study from 2021 2 Once the sodium level has been appropriately lowered, the desmopressin can be tapered while continuing to monitor sodium levels closely.