From the Guidelines
The appropriate dose of dextrose for overcorrection of hyponatremia is not explicitly stated in the provided evidence, however, the goal rate of increase of serum sodium is 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 (ODS) 1.
Key Considerations
- The treatment of hyponatremia in cirrhotic ascites depends on etiology, chronicity, severity, and urgency 1.
- For hypovolemic hyponatremia, treatment is the discontinuation of diuretics and/or laxatives and providing fluid resuscitation, typically with 5% IV albumin or crystalloid (preferentially lactated Ringer’s) solution 1.
- In cases of hypervolemic hyponatremia, discontinuation of intravenous fluid therapy and free water restriction should be considered 1.
- The use of hypertonic saline is reserved for short-term treatment of patients with symptomatic or severe hyponatremia or those with imminent LT 1.
Important Details
- Frequent monitoring is necessary when correcting the serum sodium concentration to avoid overcorrection and mitigate the risk of ODS 1.
- The administration of hypertonic sodium chloride allows a temporary elevation in the serum sodium concentration and symptom relief after administration, but this treatment requires close attention because edema and ascites can be worsened 1.
- Vasopressin receptor antagonists can be used to raise serum sodium during treatment, but they should be used with caution only for a short term (≤30 days) 1.
From the FDA Drug Label
For peripheral vein administration: Injection of the solution should be made slowly. The maximum rate at which dextrose can be infused without producing glycosuria is 0.5 g/kg of body weight/hour. In insulin-induced hypoglycemia, intravenous injection of 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose) is usually adequate.
The appropriate dose of dextrose for overcorrection of hyponatremia is not directly stated in the label.
- The label provides dosing information for insulin-induced hypoglycemia and total parenteral nutrition, but not for overcorrection of hyponatremia.
- The label does mention a maximum infusion rate of 0.5 g/kg of body weight/hour to avoid glycosuria, but this is not specific to overcorrection of hyponatremia. 2
From the Research
Dextrose Dosing for Overcorrection of Hyponatremia
- The appropriate dose of dextrose for overcorrection of hyponatremia is not explicitly stated in the provided studies, but it is mentioned that administering 5% dextrose in water can help to cautiously re-lower the serum sodium concentration when therapeutic limits have been exceeded 3.
- In patients receiving continuous renal replacement therapy (CRRT), a calculated amount of dextrose 5% solution (D5W) prefilter can be used to prevent overcorrection of hyponatremia, with the goal of keeping the rate of sodium correction below 8 mEq/day 4.
- The use of desmopressin and 5% dextrose in water can be given concurrently to re-lower the serum sodium concentration when therapeutic limits have been exceeded, highlighting the importance of careful monitoring and adjustment of treatment 3.
Prevention of Overcorrection
- To prevent overcorrection of hyponatremia, it is recommended to limit the correction of serum sodium level to no more than 10-12 mEq/L in any 24-hour period and/or 18 mEq/L in any 48-hour period 5, 6.
- Frequent monitoring of serum sodium concentration and urine output is mandatory to avoid overcorrection, and administration of desmopressin can be an effective strategy to avoid or reverse overcorrection 6, 5.
Treatment of Hyponatremia
- The treatment of hyponatremia should be tailored to the underlying cause and the patient's fluid volume status, with the goal of correcting the serum sodium level while avoiding overcorrection 7, 6.
- Hypertonic saline can be used to treat severely symptomatic hyponatremia, but it should be used with caution and careful monitoring to avoid overcorrection 7, 5.