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Table 4 Summary of recommendations for targets and limits for speed of correction of hyponatremia by included guidance documents

From: Diagnosis and treatment of hyponatremia: a systematic review of clinical practice guidelines and consensus statements

  Guideline Organization/Societies
Criteria/categories NIV NHS GAIN AEEH EHN ERBP/ESE/ESICM UF HEP RCHM EAH-ICD
[16] [17] [22] [23] [25] [20] [18] [19] [21] [24]
Targets [Na] increase           
Symptoms Independent of symptoms If symptoms If symptoms   If symptoms If symptoms   If symptoms Until seizures resolve or [Na] >125 mmol/L  
Acute onset (<48 h) 1–2 mmol/L/h initially Until [Na] >120 mmol/L independent of onset 1–2 mmol/L/h first 2–3 h   1–6 mmol/L first 2 h 5 mmol/L first h   4–6 mmol/L urgently Independent of onset  
Chronic onset (>48 h)    0.5–1 mmol/L/h first 2–3 h   1–6 mmol/L first 2 h 5 mmol/L first h   If seizures or coma 4–6 mmol/L urgently, otherwise 4–6 mmol/L per 24 h   
Limits [Na] increase           
Symptoms Independent of symptoms If no symptoms Independent of symptoms   Independent of symptoms Independent of symptoms Independent of symptoms If no symptoms Symptom dependent  
Acute onset (<48 h) If no risk of ODS ≤10 mmol/L per 24 h ≤18 mmol/L per 48 h If risk of ODS <8 mmol/L per 24 h ≤8–12 mmol/L per 24 h ≤18 mmol/L per 48 h <12 mmol/L per 24 h   If no risk of ODS ≤10 mmol/L per 24 h ≤18 mmol/L per 48 h If risk of ODS <8 mmol/L per 24 h ≤10 mmol/L first 24 h ≤8 mmol/L every 24 h thereafter ≤10 mmol/L per 24 h No limits ≤8 mmol/L per 24 h after seizures resolve, Independent of onset  
Chronic onset (>48 h) <8 mmol/L per 24 h ≤8–12 mmol/L per 24 h ≤18 mmol/L per 48 h <12 mmol/L per 24 h   <8–12 mmol/L per 24 h <18 mmol/L per 48 h ≤10 mmol/L first 24 h ≤8 mmol/L every 24 h thereafter ≤10 mmol/L per 24 h <8–12 mmol/L per 24 h <18 mmol/L per 48 h   
  1. [Na] – Serum sodium concentration.
  2. NIV, Nederlandse Internisten Vereniging [16]; NHS, National Health Service [17]; GAIN, Guidelines and Audit Implementation Network [22]; AEEH, La Asociación Española para el Estudio del Hígado [23]; EHN, European Hyponatremia Network [25]; ERBP, European Renal Best Practice; ESE, European Society of Endocrinology; ESICM, European Society of Intensive Care Medicine [20]; UF, University of Florida [18]; HEP, Hyponatremia Expert Panel [19]; RCH Melbourne, the Royal Children’s Hospital Melbourne [21]; EAH-ICD, International Exercise-Associated Hyponatremia Consensus Development Conference [24].