Division of General Internal Medicine, University Health Network, Toronto, ON, Canada; Division of General Internal Medicine, Department of Medicine, University of Toronto, ON, Canada; HoPingKong Centre for Excellence in Education and Practice, University Health Network, Toronto, ON, Canada.
Division of General Internal Medicine, University Health Network, Toronto, ON, Canada; Division of General Internal Medicine, Department of Medicine, University of Toronto, ON, Canada; HoPingKong Centre for Excellence in Education and Practice, University Health Network, Toronto, ON, Canada.
Am J Med. 2018 Mar;131(3):317.e1-317.e10. doi: 10.1016/j.amjmed.2017.09.048. Epub 2017 Oct 20.
Overcorrection of plasma sodium in severe hyponatremia is associated with osmotic demyelination syndrome. Desmopressin (DDAVP) can prevent overcorrection of plasma sodium in hyponatremia. The objective of this study was to compare outcomes in hyponatremia according to DDAVP usage.
This was a retrospective observational study including all admissions to internal medicine with hyponatremia (plasma sodium concentration <123 mEq/L) from 2004 to 2014 at 2 academic hospitals in Toronto, Canada. The primary outcome was safe sodium correction (≤12 mEq/L in any 24-hour and ≤18 mEq/L in any 48-hour period).
We identified 1450 admissions with severe hyponatremia; DDAVP was administered in 254 (17.5%). Although DDAVP reduced the rate of change of plasma sodium, fewer patients in the DDAVP group achieved safe correction (174 of 251 [69.3%] vs 970 of 1164 [83.3%]); this result was driven largely by overcorrection occurring before DDAVP administration in the rescue group. Among patients receiving DDAVP, most received it according to a reactive strategy, whereby DDAVP was given after a change in plasma sodium within correction limits (174 of 254 [68.5%]). Suspected osmotic demyelination syndrome was identified in 4 of 1450 admissions (0.28%). There was lower mortality in the DDAVP group (3.9% vs 9.4%), although this is likely affected by confounding. Length of stay in hospital was longer in those who received DDAVP according to a proactive strategy.
Although observational, these data support a reactive strategy for using DDAVP in patients at average risk of osmotic demyelination syndrome, as well as a more stringent plasma sodium correction limit of 8 mEq/L in any 24-hour period for high-risk patients. Further studies are urgently needed on DDAVP use in treating hyponatremia.
严重低钠血症中血浆钠的过度纠正与渗透性脱髓鞘综合征有关。去氨加压素（DDAVP）可防止低钠血症中血浆钠的过度纠正。本研究的目的是比较根据 DDAVP 使用情况在低钠血症中的结果。
这是一项回顾性观察性研究，包括 2004 年至 2014 年在加拿大多伦多的 2 所学术医院因低钠血症（血浆钠浓度 <123mEq/L）而住院的所有患者。主要结局是安全的钠纠正（任何 24 小时内≤12mEq/L，任何 48 小时内≤18mEq/L）。
我们确定了 1450 例严重低钠血症患者；其中 254 例（17.5%）使用了 DDAVP。尽管 DDAVP 降低了血浆钠的变化率，但 DDAVP 组达到安全纠正的患者较少（251 例中的 174 例[69.3%]与 1164 例中的 970 例[83.3%]）；这一结果主要是由于在抢救组中，DDAVP 给药前发生了过度纠正。在接受 DDAVP 的患者中，大多数根据反应性策略接受治疗，即在纠正范围内的血浆钠发生变化后给予 DDAVP（254 例中的 174 例[68.5%]）。在 1450 例入院患者中，有 4 例（0.28%）疑似发生渗透性脱髓鞘综合征。DDAVP 组的死亡率较低（3.9%比 9.4%），尽管这可能受到混杂因素的影响。根据主动策略接受 DDAVP 的患者住院时间较长。
尽管这是一项观察性研究，但这些数据支持在平均存在渗透性脱髓鞘综合征风险的患者中采用反应性策略使用 DDAVP，以及对高危患者在任何 24 小时内将血浆钠纠正限制在 8mEq/L 更严格的限制。急需进一步研究 DDAVP 在治疗低钠血症中的应用。
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