Management of Hyponatremia Overcorrection with Dextrose
For hyponatremia overcorrection, 5% dextrose in water (D5W) is the recommended solution to safely re-lower serum sodium levels. 1, 2
Understanding Overcorrection Risk
Overcorrection of hyponatremia is a medical emergency that can lead to osmotic demyelination syndrome (ODS), a rare but severe neurological condition that can result in:
- Parkinsonism
- Quadriparesis
- Death
Safe Correction Rates
- Maximum recommended correction: 8 mEq/L per 24-hour period in high-risk patients with advanced liver disease 3
- Standard recommended correction: 4-8 mEq/L per day, not exceeding 10-12 mEq/L in 24 hours 3
Protocol for Managing Overcorrection
Step 1: Identify Overcorrection
- Monitor serum sodium levels frequently during treatment of hyponatremia
- Overcorrection is defined as exceeding the recommended correction rates
Step 2: Administer D5W
- D5W is the solution of choice as it provides electrolyte-free water 3, 1
- Administration can be via peripheral or central line
Step 3: Dosing and Rate
- Calculate the D5W infusion rate based on the degree of overcorrection
- For peripheral administration, infuse at a controlled rate using an infusion pump 1
Step 4: Consider Adjunctive Therapy
- Desmopressin (DDAVP) can be administered concurrently with D5W to prevent further water diuresis 3, 2
- The combination of desmopressin and D5W is particularly effective for re-lowering serum sodium 2
Special Considerations
Continuous Renal Replacement Therapy (CRRT)
For patients on CRRT with severe hyponatremia:
- D5W can be administered prefilter as preblood pump to prevent overcorrection 1
- This approach allows delivery of recommended effluent volume while preventing rapid sodium correction
Monitoring During Re-Lowering
- Continuous monitoring of vital signs
- Frequent serum sodium measurements (every 2-4 hours)
- Neurological assessments
- Monitor for signs of cerebral edema
Pitfalls to Avoid
- Do not use hypotonic saline (0.45% NaCl) for re-lowering as it contains sodium
- Avoid using D5W with added electrolytes
- Do not administer D5W too rapidly, which can cause cerebral edema
- Do not delay treatment of overcorrection as ODS risk increases with time
The use of D5W for hyponatremia overcorrection is supported by clinical evidence and is considered standard practice in preventing the potentially devastating neurological consequences of overly rapid sodium correction.