Beck Julia, Arshad Muhammad Fahad, Iqbal Ahmed, Christ-Crain Mirjam
Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, 4031 Basel, Switzerland.
Department of Clinical Research, University of Basel, 4031 Basel, Switzerland.
Eur J Endocrinol. 2025 May 30;192(6):754-762. doi: 10.1093/ejendo/lvaf115.
For the treatment of severe symptomatic hyponatremia, the European Society of Endocrinology (ESE) guidelines (2014) recommend a bolus-wise strategy using hypertonic saline (HTS). However, there are recent controversies regarding the risk of overcorrection and osmotic demyelination syndrome (ODS), leading to significant heterogeneity in practice. The aim of this survey was to evaluate clinical practices and perspectives of endocrinologists across Europe in managing severe symptomatic hyponatremia.
A web-based anonymous cross-sectional survey (REDCap®), endorsed by ESE, was disseminated from 06, 2024 to 02, 2025. Data were analyzed using R-Studio.
A total of 662 responses were received. After excluding incomplete and non-European responses, 439 responses from 36 countries were analyzed. Most responses were received from university hospitals (68.6%) and senior clinicians (68.1%). Thirty-one percent of clinicians had experience using both bolus and continuous infusions in managing severe symptomatic hyponatremia, while sole bolus or continuous infusion therapy was preferred by 32% and 23%, respectively. Preferred bolus dosage and strength were 3% 100 mL (28%) and 3% 150 mL (19%), while 5% preferred a weight-based dosage. Most (84%) clinicians preferred one bolus infusion followed by a blood test before repeating a second. Thirty-four percent of respondents had encountered ≥1patient with suspected or confirmed ODS in their practice, with 55% reported ODS being associated with sodium overcorrection.
This is the first European survey on the management of severe symptomatic hyponatremia, offering valuable insights into real-life clinical practice. Our findings highlight ongoing uncertainties in treatment strategies and underscore the need for future research and evidence-based review of the ESE guidelines.
对于重度症状性低钠血症的治疗，欧洲内分泌学会（ESE）指南（2014年）推荐采用高渗盐水（HTS）的推注策略。然而，近期关于过度纠正风险和渗透性脱髓鞘综合征（ODS）存在争议，导致实践中存在显著异质性。本调查的目的是评估欧洲内分泌学家在管理重度症状性低钠血症方面的临床实践和观点。
由ESE认可的基于网络的匿名横断面调查（REDCap®）于2024年6月至2025年2月进行。使用R-Studio分析数据。
共收到662份回复。排除不完整和非欧洲回复后，分析了来自36个国家的439份回复。大多数回复来自大学医院（68.6%）和资深临床医生（68.1%）。31%的临床医生在管理重度症状性低钠血症时有使用推注和持续输注两种方法的经验，而分别有32%和23%的医生更倾向于单纯推注或持续输注治疗。首选的推注剂量和浓度分别为3% 100 mL（28%）和3% 150 mL（19%），而5%的医生更倾向于基于体重的剂量。大多数（84%）临床医生倾向于一次推注输注，然后在重复第二次之前进行血液检查。34%的受访者在其临床实践中遇到过≥1例疑似或确诊ODS的患者，其中55%报告ODS与钠过度纠正有关。
这是首次关于重度症状性低钠血症管理的欧洲调查，为现实临床实践提供了有价值的见解。我们的研究结果凸显了治疗策略中持续存在的不确定性，并强调了未来对ESE指南进行研究和循证审查的必要性。
