Table 4 Summary of recommendations for targets and limits for speed of correction of hyponatremia by included guidance documents
| Â | 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 | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â |
Symptoms | Independent of symptoms | If symptoms | If symptoms | Â | If symptoms | If symptoms | Â | If symptoms | Until seizures resolve or [Na] >125Â mmol/L | Â |
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 | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â |
Symptoms | Independent of symptoms | If no symptoms | Independent of symptoms | Â | Independent of symptoms | Independent of symptoms | Independent of symptoms | If no symptoms | Symptom dependent | Â |
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 |  |  |