{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:03:12Z","timestamp":1790254992139,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Kaohsiung J of Med Scie"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Hyponatremia is a common electrolyte disorder in the emergency department (ED), but its clinical burden is not evenly distributed across the sodium spectrum. We conducted a retrospective observational cohort study of adult ED encounters at a tertiary referral hospital between July 2019 and July 2024 to identify a data\u2010driven threshold for extreme hyponatremia and evaluate its association with 28\u2010day mortality. Encounters with simultaneous sodium and glucose measurements were included, and sodium values were corrected for hyperglycemia. Kernel density estimation identified a distinct local minimum defining distribution\u2010derived extreme hyponatremia (DDEH). Propensity score matching based on age and sex was used to compare DDEH with nonextreme hyponatremia and normonatremia. Among 227,027 eligible ED patients, density modeling identified an inflection point at 110\u2009mmol\/L. Sixty\u2010one patients (0.027%) met criteria for DDEH. In matched analyses (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200961 per group), 28\u2010day mortality was highest in the DDEH group (36.1%), compared with nonextreme hyponatremia (18.0%) and normonatremia (6.6%) (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Kaplan\u2013Meier analysis showed significantly reduced survival in patients with DDEH (log\u2010rank\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). A distribution\u2010derived sodium threshold of 110\u2009mmol\/L identified a rare but high\u2010risk phenotype of extreme hyponatremia in ED patients. This cohort\u2010derived boundary identified a rare extreme\u2010tail phenotype associated with systemic physiological vulnerability and increased short\u2010term mortality risk, but external validation is required before broader clinical implementation.\n                  <\/jats:p>","DOI":"10.1002\/kjm2.70291","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T12:26:12Z","timestamp":1790252772000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Data\u2010Driven Threshold for Extreme Hyponatremia in the Emergency Department and Its Association With 28\u2010Day Mortality"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8530-8607","authenticated-orcid":false,"given":"Yalcin","family":"Golcuk","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine Mu\u011fla S\u0131tk\u0131 Ko\u00e7man University  Mu\u011fla T\u00fcrkiye"},{"name":"Department of Health of the Elderly, Institute of Health Sciences Mu\u011fla S\u0131tk\u0131 Ko\u00e7man University  Mu\u011fla T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4476-7989","authenticated-orcid":false,"given":"\u00d6mer\u2010Faruk","family":"Karakoyun","sequence":"additional","affiliation":[{"name":"Emergency Medicine Service Mu\u011fla Training and Research Hospital  Mu\u011fla T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7018-7187","authenticated-orcid":false,"given":"Fulden","family":"Canta\u015f\u2010T\u00fcrki\u015f","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Faculty of Medicine Mu\u011fla S\u0131tk\u0131 Ko\u00e7man University  Mu\u011fla T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9502-5574","authenticated-orcid":false,"given":"\u0130smail","family":"K\u0131rl\u0131","sequence":"additional","affiliation":[{"name":"Department of Health of the Elderly, Institute of Health Sciences Mu\u011fla S\u0131tk\u0131 Ko\u00e7man University  Mu\u011fla T\u00fcrkiye"},{"name":"Department of Internal Medicine, Faculty of Medicine Mu\u011fla S\u0131tk\u0131 Ko\u00e7man University  Mu\u011fla T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2097-0296","authenticated-orcid":false,"given":"Satuk\u2010Bu\u011fra","family":"Y\u0131ld\u0131r\u0131m","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine Mu\u011fla S\u0131tk\u0131 Ko\u00e7man University  Mu\u011fla T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2493-1806","authenticated-orcid":false,"given":"Bekir","family":"Baran","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine Mu\u011fla S\u0131tk\u0131 Ko\u00e7man University  Mu\u011fla T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2293-697X","authenticated-orcid":false,"given":"Burcu","family":"Kaymak\u2010Golcuk","sequence":"additional","affiliation":[{"name":"Clinical Biochemistry Service Mu\u011fla Training and Research Hospital  Mu\u011fla T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1080\/1354750X.2024.2361074","article-title":"Hyponatremia in the Emergency Department: An Overview of 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