Dutta Deep, Kumar Manoj, Joshi Ameya, Sharma Meha
Department of Endocrinology, Center for Endocrinology, Diabetes, Arthritis and Rheumatism Superspeciality Healthcare, New Delhi, India.
Department of Endocrinology, Maharishi Markandeshwar Institute of Medical Sciences, Ambala, Haryana, India.
Ann Afr Med. 2025 Apr 1;24(2):431-437. doi: 10.4103/aam.aam_249_24. Epub 2025 Mar 7.
Three percent hypertonic saline (3NS) is an established treatment for severe hyponatremia. The optimal regimen for administering 3NS for severe hyponatremia, with the aim to minimize side effects is not known. This systematic review and meta-analysis aimed to evaluate the safety profile of rapid intermittent bolus (RIB) versus slow continuous infusion (SCI) of 3NS for managing symptomatic severe hyponatremia.
Databases were searched for studies evaluating the use of RIB versus SCI/conventional therapy of 3NS for managing symptomatic severe hyponatremia. The primary outcome was to evaluate the occurrence of overcorrection of hyponatremia. Secondary outcomes were to evaluate the need for relowering therapy, duration of hospital stay, changes in sodium levels, osmotic demyelination syndrome (ODS), and mortality.
Data from three studies (290 patients) with severe hyponatremia was analyzed. Patients receiving RIB had a similar occurrence of overcorrection (relative risk [RR]: 1.59 [0.40, 6.35]; I2 = 61%; P = 0.51), need for relowering treatment to bring down serum sodium back to the normal range (RR: 2.53 [0.32, 20.20]; I2 = 81%; P = 0.38), ODS (RR: 2.24 [0.09, 57.18]; P = 0.63) and mortality (RR: 0.51 [0.08, 3.30]; I2 = 31%; P = 0.48), as compared to those receiving SCI. Patients receiving RIB had a marginally higher duration of hospital stay, which approached statistical significance (mean difference: 3.71 days [-0.18, 7.59]; I2 = 0%; P = 0.06).
Both RIB and SCI of hypertonic saline were safe and effective for managing severe symptomatic hyponatremia. The reduced duration of hospital stay with SCI of hypertonic saline may suggest this may be the optimal way of administering hypertonic saline.
3%高渗盐水（3NS）是治疗严重低钠血症的既定疗法。对于严重低钠血症，旨在将副作用降至最低的3NS最佳给药方案尚不清楚。本系统评价和荟萃分析旨在评估3NS快速间歇性推注（RIB）与缓慢持续输注（SCI）治疗症状性严重低钠血症的安全性。
检索数据库中评估RIB与3NS的SCI/传统疗法治疗症状性严重低钠血症的研究。主要结局是评估低钠血症过度纠正的发生率。次要结局是评估再次降低治疗的必要性、住院时间、钠水平变化、渗透性脱髓鞘综合征（ODS）和死亡率。
分析了三项严重低钠血症研究（290例患者）的数据。与接受SCI的患者相比，接受RIB的患者在过度纠正发生率（相对风险[RR]：1.59[0.40，6.35]；I2 = 61%；P = 0.51）、使血清钠恢复正常范围所需的再次降低治疗（RR：2.53[0.32，20.20]；I2 = 81%；P = 0.38）、ODS（RR：2.24[0.09，57.18]；P = 0.63）和死亡率（RR：0.51[0.08，3.30]；I2 = 31%；P = 0.48）方面相似。接受RIB的患者住院时间略长，接近统计学显著性（平均差异：3.71天[-0.18，7.59]；I2 = 0%；P = 0.06）。
高渗盐水的RIB和SCI治疗症状性严重低钠血症均安全有效。高渗盐水SCI缩短住院时间可能表明这可能是高渗盐水的最佳给药方式。
