{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:58:29Z","timestamp":1790841509169,"version":"4.1.0"},"reference-count":112,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Hyponatremia is the most common electrolyte disorder encountered in clinical practice. Its management is challenging because treatment must balance the risk of cerebral edema in acute hyponatremia against the risk of osmotic demyelination syndrome (ODS) from overly rapid correction of chronic hyponatremia. Recent observational studies have questioned current correction limits, prompting renewed debate regarding optimal management. This narrative review presents a physiology-based approach to the evaluation and treatment of hyponatremia. Acute hyponatremia may cause life-threatening cerebral edema because cerebral adaptation is incomplete, whereas chronic hyponatremia is characterized by the loss of intracellular electrolytes and organic osmolytes that limit brain swelling but increase vulnerability to osmotic injury during correction. Because the duration of hyponatremia is often uncertain, management should be guided primarily by neurological manifestations rather than duration alone. We propose a systematic treatment approach based on neurological severity, the duration of hyponatremia when definitively known, and the patient\u2019s risk of neurological injury, balancing the immediate danger of cerebral edema against the risk of ODS. We critically review the evidence underlying current correction limits and recent observational studies reporting that ODS is uncommon, inconsistently associated with overly rapid correction, and that slower correction has been associated with higher mortality. We conclude that, until higher-quality evidence becomes available, conservative correction limits for management of chronic hyponatremia remain appropriate, with correction not exceeding 10 mmol\/l in 24 h (18 mmol\/l in 48 h) in average-risk patients, targeting a rise of 4\u20138 mmol\/l\/day, and 8 mmol\/l in 24 h in patients at high risk for ODS, targeting a rise of 4\u20136 mmol\/l\/day.<\/jats:p>","DOI":"10.1093\/ckj\/sfag288","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:40:16Z","timestamp":1787841616000},"source":"Crossref","is-referenced-by-count":0,"title":["Managing hyponatremia: fast or slow? Why, when, how, and controversies"],"prefix":"10.1093","volume":"19","author":[{"given":"Kamel S","family":"Kamel","sequence":"first","affiliation":[{"name":"Renal Division, St Michael\u2019s Hospital and the University of Toronto, Toronto, Canada"},{"name":"Keenan Research Center in the Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziv","family":"Harel","sequence":"additional","affiliation":[{"name":"Renal Division, St Michael\u2019s Hospital and the University of Toronto, Toronto, Canada"},{"name":"Keenan Research Center in the Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Schreiber","sequence":"additional","affiliation":[{"name":"Renal Division, St Michael\u2019s Hospital and the University of Toronto, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"2026100103171907800_bib1","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1159\/000493234","article-title":"Etiology and epidemiology of hyponatremia","volume-title":"Disorders of Fluid and Electrolyte Metabolism: Focus on Hyponatremia","author":"Burst","year":"2019"},{"key":"2026100103171907800_bib2","doi-asserted-by":"publisher","first-page":"1320","DOI":"10.1016\/j.mayocp.2015.08.013","article-title":"Hyponatremia management: walking the tightrope without a net","volume":"90","author":"Albright","year":"2015","journal-title":"Mayo Clin Proc"},{"key":"2026100103171907800_bib3","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1038\/ki.1990.78","article-title":"Treating hyponatremia: damned if we do and damned if we don\u2019t","volume":"37","author":"Berl","year":"1990","journal-title":"Kidney Int"},{"key":"2026100103171907800_bib4","volume-title":"Fluid, Electrolytes, and Acid-Base Physiology. A Problem-Based Approach","author":"Kamel","year":"2026"},{"key":"2026100103171907800_bib5","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1113\/jphysiol.2002.020818","article-title":"Aquaporin water channels\u2014from atomic structure to clinical medicine","volume":"542","author":"Agre","year":"2002","journal-title":"J Physiol"},{"key":"2026100103171907800_bib6","doi-asserted-by":"publisher","first-page":"7309","DOI":"10.1074\/jbc.R700042200","article-title":"Intracellular organic osmolytes: function and regulation","volume":"283","author":"Burg","year":"2008","journal-title":"J Biol Chem"},{"key":"2026100103171907800_bib7","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1001\/archinte.159.4.333","article-title":"Hyponatremia, hyposmolality, and hypotonicity: tables and fables","volume":"159","author":"Oster","year":"1999","journal-title":"Arch Intern Med"},{"key":"2026100103171907800_bib8","doi-asserted-by":"publisher","first-page":"1581","DOI":"10.1056\/NEJM200005253422107","article-title":"Hyponatremia","volume":"342","author":"Adrogu\u00e9","year":"2000","journal-title":"N Engl J Med"},{"key":"2026100103171907800_bib9","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.3390\/jcm12051714","article-title":"Adaptation of the brain to hyponatremia and its clinical implications","volume":"12","author":"Gankam\u00a0Kengne","year":"2023","journal-title":"J Clin Med"},{"key":"2026100103171907800_bib10","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/0002-9343(82)90825-7","article-title":"Neurogenic disorders of osmoregulation","volume":"72","author":"Robertson","year":"1982","journal-title":"Am J Med"},{"key":"2026100103171907800_bib11","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1016\/j.tins.2013.08.004","article-title":"Central regulation of body-fluid homeostasis","volume":"36","author":"Noda","year":"2013","journal-title":"Trends Neurosci"},{"key":"2026100103171907800_bib12","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1056\/NEJMra1812053","article-title":"New neuroscience of homeostasis and drives for food, water, and salt","volume":"380","author":"Lowell","year":"2019","journal-title":"N Engl J Med"},{"key":"2026100103171907800_bib13","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1111\/apha.12487","article-title":"The median preoptic nucleus: front and centre for the regulation of body fluid, sodium, temperature, sleep and cardiovascular homeostasis","volume":"214","author":"McKinley","year":"2015","journal-title":"Acta Physiol"},{"key":"2026100103171907800_bib14","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1056\/NEJMc1505505","article-title":"Molecular physiology of water balance","volume":"373","author":"Knepper","year":"2015","journal-title":"N Engl J Med"},{"key":"2026100103171907800_bib15","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1038\/nrneph.2017.149","article-title":"The neural basis of homeostatic and anticipatory thirst","volume":"14","author":"Gizowski","year":"2018","journal-title":"Nat Rev Nephrol"},{"key":"2026100103171907800_bib16","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1111\/joim.12645","article-title":"Vasopressin: physiology, assessment and osmosensation","volume":"282","author":"Bankir","year":"2017","journal-title":"J Intern Med"},{"key":"2026100103171907800_bib17","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1159\/000493233","article-title":"Physiology and pathophysiology of water homeostasis","volume-title":"Disorders of Fluid and Electrolyte Metabolism: Focus on Hyponatremia","author":"Rondon-Berrios","year":"2019"},{"key":"2026100103171907800_bib18","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1006\/frne.1994.1007","article-title":"Baroreceptor regulation of vasopressin and renin secretion: low-pressure versus high-pressure receptors","volume":"15","author":"Thrasher","year":"1994","journal-title":"Front Neuroendocrinol"},{"key":"2026100103171907800_bib19","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1016\/j.jacc.2014.12.010","article-title":"Hyponatremia in acute decompensated heart failure: depletion versus dilution","volume":"65","author":"Verbrugge","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"2026100103171907800_bib20","doi-asserted-by":"publisher","first-page":"1499","DOI":"10.1056\/NEJMcp2210411","article-title":"The syndrome of inappropriate antidiuresis","volume":"389","author":"Adrogu\u00e9","year":"2023","journal-title":"N Engl J Med"},{"key":"2026100103171907800_bib21","doi-asserted-by":"crossref","first-page":"5810","DOI":"10.3390\/jcm11195810","article-title":"Pathophysiology of drug-induced hyponatremia","volume":"11","author":"Kim","year":"2022","journal-title":"J Clin Med"},{"key":"2026100103171907800_bib22","doi-asserted-by":"publisher","first-page":"106261","DOI":"10.1016\/j.biocel.2022.106261","article-title":"AQP2 trafficking in health and diseases: an updated overview","volume":"149","author":"Centrone","year":"2022","journal-title":"Int J Biochem Cell Biol"},{"key":"2026100103171907800_bib23","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1007\/s00424-008-0498-1","article-title":"Physiology and pathophysiology of the vasopressin-regulated renal water reabsorption","volume":"456","author":"Boone","year":"2008","journal-title":"Pflugers Arch Eur J Physiol"},{"key":"2026100103171907800_bib24","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.1172\/JCI103712","article-title":"Interrelations between serum sodium concentration, serum osmolarity and total exchangeable sodium, total exchangeable potassium and total body water","volume":"37","author":"Edelman","year":"1958","journal-title":"J Clin Invest"},{"key":"2026100103171907800_bib25","doi-asserted-by":"publisher","first-page":"1981","DOI":"10.1056\/NEJMra2030212","article-title":"Insights into salt handling and blood pressure","volume":"385","author":"Ellison","year":"2021","journal-title":"N Engl J Med"},{"key":"2026100103171907800_bib26","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1159\/000515726","article-title":"Can changes in the plasma sodium concentration be predicted based on the mass balance of sodium, potassium, and water in the face of osmotically inactive sodium storage?","volume":"145","author":"Nguyen","year":"2021","journal-title":"Nephron"},{"key":"2026100103171907800_bib27","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1001\/archinte.1986.00360140159023","article-title":"Postoperative hyponatremia. A prospective study","volume":"146","author":"Chung","year":"1986","journal-title":"Arch Intern Med"},{"key":"2026100103171907800_bib28","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1093\/bja\/aei279","article-title":"Fluid absorption in endoscopic surgery","volume":"96","author":"Hahn","year":"2006","journal-title":"Br J Anaesth"},{"key":"2026100103171907800_bib29","doi-asserted-by":"crossref","first-page":"121","DOI":"10.2165\/00023210-199707020-00004","article-title":"Polydipsia-hyponatraemia syndrome : epidemiology, clinical features and treatment","volume":"7","author":"Vieweg","year":"1997","journal-title":"CNS Drug"},{"key":"2026100103171907800_bib30","first-page":"1432","article-title":"Statement of the 3rd International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California","volume-title":"Br J Sports Med","author":"Hew-Butler","year":"2015"},{"key":"2026100103171907800_bib31","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s12882-017-0464-2","article-title":"\u201cBowel prep hyponatremia\u201d\u2014a state of acute water intoxication facilitated by low dietary solute intake: case report and literature review","volume":"18","author":"Windpessl","year":"2017","journal-title":"BMC Nephrol"},{"key":"2026100103171907800_bib32","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1210\/endrev\/bnad010","article-title":"Syndrome of inappropriate antidiuresis: from pathophysiology to management","volume":"44","author":"Warren","year":"2023","journal-title":"Endocr Rev"},{"key":"2026100103171907800_bib33","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1681\/ASN.0000000588","article-title":"Syndrome of inappropriate antidiuresis","volume":"36","author":"Rosner","year":"2025","journal-title":"J Am Soc Nephrol"},{"key":"2026100103171907800_bib34","doi-asserted-by":"publisher","first-page":"2064","DOI":"10.1056\/NEJMcp066837","article-title":"Clinical practice. The syndrome of inappropriate antidiuresis","volume":"356","author":"Ellison","year":"2007","journal-title":"N Engl J Med"},{"key":"2026100103171907800_bib35","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1053\/j.ajkd.2019.07.011","article-title":"Thiazide-associated hyponatremia: clinical manifestations and pathophysiology","volume":"75","author":"Filippone","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"2026100103171907800_bib36","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1053\/ajkd.1998.v31.pm9631849","article-title":"\u201cBeer potomania\u201d in non-beer drinkers: effect of low dietary solute intake","volume":"31","author":"Thaler","year":"1998","journal-title":"Am J Kidney Dis"},{"key":"2026100103171907800_bib37","first-page":"61","article-title":"Beer potomania: two cases and review of the literature","volume":"45","author":"Fenves","year":"1996","journal-title":"Clin Nephrol"},{"key":"2026100103171907800_bib38","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1093\/ndt\/gfr790","article-title":"The importance of distal delivery of filtrate and residual water permeability in the pathophysiology of hyponatremia","volume":"27","author":"Kamel","year":"2012","journal-title":"Nephrol Dial Transplant"},{"key":"2026100103171907800_bib39","first-page":"F554","article-title":"Regulation of collecting duct water permeability independent of cAMP-mediated AVP response","volume":"261","author":"Lankford","year":"1991","journal-title":"Am J Physiol"},{"key":"2026100103171907800_bib40","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1152\/physrev.00053.2006","article-title":"Mouse models and the urinary concentrating mechanism in the new millennium","volume":"87","author":"Fenton","year":"2007","journal-title":"Physiol Rev"},{"key":"2026100103171907800_bib41","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1016\/S0188-4409(02)00353-3","article-title":"Mechanisms counteracting swelling in brain cells during hyponatremia","volume":"33","author":"Pasantes-Morales","year":"2002","journal-title":"Arch Med Res"},{"key":"2026100103171907800_bib42","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1056\/NEJMra1404489","article-title":"Disorders of plasma sodium\u2014causes, consequences, and correction","volume":"372","author":"Sterns","year":"2015","journal-title":"N Engl J Med"},{"key":"2026100103171907800_bib43","doi-asserted-by":"publisher","first-page":"1916","DOI":"10.1172\/JCI105882","article-title":"Factors that limit brain volume changes in response to acute and sustained hyper- and hyponatremia","volume":"47","author":"Holliday","year":"1968","journal-title":"J Clin Invest"},{"key":"2026100103171907800_bib44","first-page":"F661","article-title":"Volume regulatory loss of Na, Cl, and K from rat brain during acute hyponatremia","volume":"252","author":"Melton","year":"1987","journal-title":"Am J Physiol"},{"key":"2026100103171907800_bib45","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1016\/0006-8993(91)90806-7","article-title":"Hyponatremia causes large sustained reductions in brain content of multiple organic osmolytes in rats","volume":"567","author":"Verbalis","year":"1991","journal-title":"Brain Res"},{"key":"2026100103171907800_bib46","doi-asserted-by":"publisher","first-page":"S12","DOI":"10.1016\/j.amjmed.2006.05.003","article-title":"Brain volume regulation in response to hypo-osmolality and its correction","volume":"119","author":"Sterns","year":"2006","journal-title":"Am J Med"},{"key":"2026100103171907800_bib47","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1002\/iub.406","article-title":"Naturally occurring organic osmolytes: from cell physiology to disease prevention","volume":"62","author":"Khan","year":"2010","journal-title":"IUBMB Life"},{"key":"2026100103171907800_bib48","doi-asserted-by":"publisher","first-page":"3490","DOI":"10.1007\/s11064-017-2397-3","article-title":"Betaine in the brain: characterization of betaine uptake, its influence on other osmolytes and its potential role in neuroprotection from osmotic stress","volume":"42","author":"Knight","year":"2017","journal-title":"Neurochem Res"},{"key":"2026100103171907800_bib49","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1172\/JCI115292","article-title":"Study of brain electrolytes and organic osmolytes during correction of chronic hyponatremia. Implications for the pathogenesis of central pontine myelinolysis","volume":"88","author":"Lien","year":"1991","journal-title":"J Clin Invest"},{"key":"2026100103171907800_bib50","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/0006-8993(93)91564-9","article-title":"Rapid correction of hyponatremia produces differential effects on brain osmolyte and electrolyte reaccumulation in rats","volume":"606","author":"Verbalis","year":"1993","journal-title":"Brain Res"},{"key":"2026100103171907800_bib51","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.1126\/science.7466381","article-title":"Rapid correction of hyponatremia causes demyelination: relation to central pontine myelinolysis","volume":"211","author":"Kleinschmidt-DeMasters","year":"1981","journal-title":"Science"},{"key":"2026100103171907800_bib52","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1002\/ana.410130303","article-title":"Central pontine myelinolysis following rapid correction of hyponatremia","volume":"13","author":"Laureno","year":"1983","journal-title":"Ann Neurol"},{"key":"2026100103171907800_bib53","doi-asserted-by":"publisher","first-page":"57","DOI":"10.7326\/0003-4819-126-1-199701010-00008","article-title":"Myelinolysis after correction of hyponatremia","volume":"126","author":"Laureno","year":"1997","journal-title":"Ann Intern Med"},{"key":"2026100103171907800_bib54","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1038\/ki.2009.254","article-title":"Re-induction of hyponatremia after rapid overcorrection of hyponatremia reduces mortality in rats","volume":"76","author":"Gankam\u00a0Kengne","year":"2009","journal-title":"Kidney Int"},{"key":"2026100103171907800_bib55","doi-asserted-by":"publisher","first-page":"1535","DOI":"10.1056\/NEJM198606123142402","article-title":"Osmotic demyelination syndrome following correction of hyponatremia","volume":"314","author":"Sterns","year":"1986","journal-title":"N Engl J Med"},{"key":"2026100103171907800_bib56","doi-asserted-by":"publisher","first-page":"1834","DOI":"10.1681\/ASN.2010111127","article-title":"Astrocytes are an early target in osmotic demyelination syndrome","volume":"22","author":"Gankam\u00a0Kengne","year":"2011","journal-title":"J Am Soc Nephrol"},{"key":"2026100103171907800_bib57","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1016\/0306-4522(93)90233-6","article-title":"Neuronal-glial exchange of taurine during hypo-osmotic stress: a combined immunocytochemical and biochemical analysis in rat cerebellar cortex","volume":"54","author":"Nagelhus","year":"1993","journal-title":"Neuroscience"},{"key":"2026100103171907800_bib58","doi-asserted-by":"publisher","first-page":"1143","DOI":"10.1046\/j.1471-4159.1994.63031143.x","article-title":"Potassium and taurine release are highly correlated with regulatory volume decrease in neonatal primary rat astrocyte cultures","volume":"63","author":"Vitarella","year":"1994","journal-title":"J Neurochem"},{"key":"2026100103171907800_bib59","doi-asserted-by":"publisher","first-page":"1802","DOI":"10.1681\/ASN.2016050509","article-title":"Osmotic stress-induced defective glial proteostasis contributes to brain demyelination after hyponatremia treatment","volume":"28","author":"Gankam-Kengne","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"2026100103171907800_bib60","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1006\/exnr.2000.7474","article-title":"Blood-brain barrier disruption and complement activation in the brain following rapid correction of chronic hyponatremia","volume":"165","author":"Baker","year":"2000","journal-title":"Exp Neurol"},{"key":"2026100103171907800_bib61","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1002\/glia.23268","article-title":"Regional oligodendrocytopathy and astrocytopathy precede myelin loss and blood-brain barrier disruption in a murine model of osmotic demyelination syndrome","volume":"66","author":"Bouchat","year":"2018","journal-title":"Glia"},{"key":"2026100103171907800_bib62","doi-asserted-by":"publisher","first-page":"2090","DOI":"10.1681\/ASN.2010040438","article-title":"Minocycline prevents osmotic demyelination syndrome by inhibiting the activation of microglia","volume":"21","author":"Suzuki","year":"2010","journal-title":"J Am Soc Nephrol"},{"key":"2026100103171907800_bib63","doi-asserted-by":"publisher","first-page":"1443","DOI":"10.1111\/ene.12571","article-title":"Central pontine and extrapontine myelinolysis: a systematic review","volume":"21","author":"Singh","year":"2014","journal-title":"Euro J Neurol"},{"key":"2026100103171907800_bib64","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1001\/jama.2022.11176","article-title":"Diagnosis and management of hyponatremia: a review","volume":"328","author":"Adrogu\u00e9","year":"2022","journal-title":"JAMA"},{"key":"2026100103171907800_bib65","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1053\/crad.2002.0977","article-title":"MRI findings in osmotic myelinolysis","volume":"57","author":"Chua","year":"2002","journal-title":"Clin Radiol"},{"key":"2026100103171907800_bib66","doi-asserted-by":"publisher","first-page":"767470","DOI":"10.3389\/fneur.2021.767470","article-title":"Cerebral microcirculation, perivascular unit, and glymphatic system: role of aquaporin-4 as the gatekeeper for water homeostasis","volume":"12","author":"Szczygielski","year":"2021","journal-title":"Front Neurol"},{"key":"2026100103171907800_bib67","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.1227\/01.NEU.0000359533.16214.04","article-title":"Hypertonic saline and its effect on intracranial pressure, cerebral perfusion pressure, and brain tissue oxygen","volume":"65","author":"Rockswold","year":"2009","journal-title":"Neurosurgery"},{"key":"2026100103171907800_bib68","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1007\/s12028-013-9907-1","article-title":"Safety and efficacy of repeated doses of 14.6 or 23.4 % hypertonic saline for refractory intracranial hypertension","volume":"20","author":"Lewandowski-Belfer","year":"2014","journal-title":"Neurocrit Care"},{"key":"2026100103171907800_bib69","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1212\/01.wnl.0000304042.05557.60","article-title":"Reversal of transtentorial herniation with hypertonic saline","volume":"70","author":"Koenig","year":"2008","journal-title":"Neurology"},{"key":"2026100103171907800_bib70","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1016\/j.amjmed.2013.07.006","article-title":"Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations","volume":"126","author":"Verbalis","year":"2013","journal-title":"Am J Med"},{"key":"2026100103171907800_bib71","doi-asserted-by":"publisher","first-page":"i1","DOI":"10.1093\/ndt\/gfu040","article-title":"Clinical practice guideline on diagnosis and treatment of hyponatraemia","volume":"29","author":"Spasovski","year":"2014","journal-title":"Nephrol Dial Transplant"},{"key":"2026100103171907800_bib72","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.amjms.2023.04.025","article-title":"The safety of intravenous peripheral administration of 3% hypertonic saline: a systematic review and meta-analysis","volume":"366","author":"Madieh","year":"2023","journal-title":"Am J Med Sci"},{"key":"2026100103171907800_bib73","doi-asserted-by":"publisher","first-page":"1340","DOI":"10.1681\/ASN.2016101139","article-title":"Diagnosis and Treatment of Hyponatremia: compilation of the Guidelines","volume":"28","author":"Hoorn","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"2026100103171907800_bib74","doi-asserted-by":"publisher","first-page":"656","DOI":"10.7326\/0003-4819-107-5-656","article-title":"Severe symptomatic hyponatremia: treatment and outcome. A study of 64 cases","volume":"107","author":"Sterns","year":"1987","journal-title":"Ann Intern Med"},{"key":"2026100103171907800_bib75","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1111\/jgs.13325","article-title":"Symptoms and characteristics of individuals with profound hyponatremia: a prospective multicenter observational study","volume":"63","author":"Nigro","year":"2015","journal-title":"J Am Geriatr Soc"},{"key":"2026100103171907800_bib76","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1111\/j.1523-1755.2005.67117.x","article-title":"Defining conditions that lead to the retention of water: the importance of the arterial sodium concentration","volume":"67","author":"Shafiee","year":"2005","journal-title":"Kidney Int"},{"key":"2026100103171907800_bib77","doi-asserted-by":"publisher","first-page":"20","DOI":"10.7326\/0003-4819-126-1-199701010-00003","article-title":"Postoperative hyponatremia despite near-isotonic saline infusion: a phenomenon of desalination","volume":"126","author":"Steele","year":"1997","journal-title":"Ann Intern Med"},{"key":"2026100103171907800_bib78","doi-asserted-by":"publisher","first-page":"891","DOI":"10.7326\/0003-4819-117-11-891","article-title":"Postoperative hyponatremic encephalopathy in menstruant women","volume":"117","author":"Ayus","year":"1992","journal-title":"Ann Intern Med"},{"key":"2026100103171907800_bib79","doi-asserted-by":"publisher","first-page":"F619","DOI":"10.1152\/ajprenal.00502.2007","article-title":"Brain cell volume regulation in hyponatremia: role of sex, age, vasopressin, and hypoxia","volume":"295","author":"Ayus","year":"2008","journal-title":"Am J Physiol Renal Physiol"},{"key":"2026100103171907800_bib80","doi-asserted-by":"publisher","first-page":"331","DOI":"10.2215\/CJN.03190807","article-title":"DDAVP is effective in preventing and reversing inadvertent overcorrection of hyponatremia","volume":"3","author":"Perianayagam","year":"2008","journal-title":"Clin J Am Soc Nephro"},{"key":"2026100103171907800_bib81","doi-asserted-by":"publisher","first-page":"1362.e15","DOI":"10.1016\/j.amjmed.2015.04.040","article-title":"Desmopressin to prevent rapid sodium correction in severe hyponatremia: a systematic review","volume":"128","author":"MacMillan","year":"2015","journal-title":"Am J Med"},{"key":"2026100103171907800_bib82","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1002\/ana.410270110","article-title":"Central pontine myelinolysis and pontine lesions after rapid correction of hyponatremia: a prospective magnetic resonance imaging study","volume":"27","author":"Brunner","year":"1990","journal-title":"Ann Neurol"},{"key":"2026100103171907800_bib83","first-page":"349","article-title":"High incidence of neurologic complications following rapid correction of severe hyponatremia in polydipsic patients","volume":"55","author":"Tanneau","year":"1994","journal-title":"J Clin Psychiatry"},{"key":"2026100103171907800_bib84","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1093\/oxfordjournals.qjmed.a069024","article-title":"Severe hyponatraemia: complications and treatment","volume":"88","author":"Ellis","year":"1995","journal-title":"QJM"},{"key":"2026100103171907800_bib85","doi-asserted-by":"publisher","first-page":"128","DOI":"10.3810\/hp.2009.12.266","article-title":"Patients presenting with severe hypotonic hyponatremia: etiological factors, assessment, and outcomes","volume":"37","author":"Vu","year":"2009","journal-title":"Hosp Pract"},{"key":"2026100103171907800_bib86","doi-asserted-by":"publisher","first-page":"1348","DOI":"10.1016\/j.mayocp.2015.07.014","article-title":"Sodium correction practice and clinical outcomes in profound hyponatremia","volume":"90","author":"Geoghegan","year":"2015","journal-title":"Mayo Clin Proc"},{"key":"2026100103171907800_bib87","doi-asserted-by":"publisher","first-page":"984","DOI":"10.2215\/CJN.13061117","article-title":"Risk factors and outcomes of rapid correction of severe hyponatremia","volume":"13","author":"George","year":"2018","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026100103171907800_bib88","doi-asserted-by":"publisher","first-page":"1140","DOI":"10.1681\/ASN.2012020128","article-title":"The challenge of hyponatremia","volume":"23","author":"Adrogu\u00e9","year":"2012","journal-title":"J Am Soc Nephrol"},{"key":"2026100103171907800_bib89","doi-asserted-by":"publisher","first-page":"641","DOI":"10.2215\/CJN.10440917","article-title":"Treatment of severe hyponatremia","volume":"13","author":"Sterns","year":"2018","journal-title":"CJASN"},{"key":"2026100103171907800_bib90","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.34067\/KID.0004402021","article-title":"Osmotic demyelination syndrome following correction of hyponatremia by &lt;\/=10 mEq\/L per day","volume":"2","author":"Tandukar","year":"2021","journal-title":"Kidney360"},{"key":"2026100103171907800_bib91","volume-title":"Overview of the treatment of hyponatremia in adults","author":"Sterns","year":"2025"},{"key":"2026100103171907800_bib92","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1016\/S0272-6386(12)80274-5","article-title":"Treatment of hyponatremia: a quantitative analysis","volume":"21","author":"Kamel","year":"1993","journal-title":"Am J Kidney Dis"},{"key":"2026100103171907800_bib93","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1053\/j.ajkd.2009.12.024","article-title":"A patient with severe hyponatremia and hypokalemia: osmotic demyelination following potassium repletion","volume":"55","author":"Berl","year":"2010","journal-title":"Am J Kidney Dis"},{"key":"2026100103171907800_bib94","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1053\/j.ajkd.2012.11.032","article-title":"Hypertonic saline and desmopressin: a simple strategy for safe correction of severe hyponatremia","volume":"61","author":"Sood","year":"2013","journal-title":"Am J Kidney Dis"},{"key":"2026100103171907800_bib95","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1159\/000503773","article-title":"Urea for chronic hyponatremia","volume":"49","author":"Rondon-Berrios","year":"2020","journal-title":"Blood Purif"},{"key":"2026100103171907800_bib96","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1111\/cen.13930","article-title":"Urea treatment in fluid restriction-refractory hyponatraemia","volume":"90","author":"Lockett","year":"2019","journal-title":"Clin Endocrinol"},{"key":"2026100103171907800_bib97","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1136\/bmj.285.6335.89","article-title":"Inappropriate secretion of antidiuretic hormone treated with frusemide","volume":"285","author":"Decaux","year":"1982","journal-title":"BMJ"},{"key":"2026100103171907800_bib98","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1681\/ASN.2009080857","article-title":"Oral tolvaptan is safe and effective in chronic hyponatremia","volume":"21","author":"Berl","year":"2010","journal-title":"J Am Soc Nephrol"},{"key":"2026100103171907800_bib99","doi-asserted-by":"publisher","first-page":"2207","DOI":"10.1056\/NEJMra1403672","article-title":"Vasopressin antagonists","volume":"372","author":"Berl","year":"2015","journal-title":"N Engl J Med"},{"key":"2026100103171907800_bib100","doi-asserted-by":"publisher","first-page":"5483","DOI":"10.3390\/jcm12175483","article-title":"Safety and efficacy of vaptans in the treatment of hyponatremia from syndrome of inappropriate antidiuretic hormone secretion (SIADH): a systematic review and meta-analysis","volume":"12","author":"Krisanapan","year":"2023","journal-title":"J Clin Med"},{"key":"2026100103171907800_bib101","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1016\/j.eprac.2025.04.012","article-title":"Low-dose tolvaptan for the treatment of syndrome of inappropriate antidiuretic hormone-associated hyponatremia: a systematic review, meta-analysis, and meta-regression analysis of clinical effectiveness and safety","volume":"31","author":"Lewellyn","year":"2025","journal-title":"Endocr Pract"},{"key":"2026100103171907800_bib102","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1681\/ASN.2019090944","article-title":"A randomized trial of empagliflozin to increase plasma sodium levels in patients with the syndrome of inappropriate antidiuresis","volume":"31","author":"Refardt","year":"2020","journal-title":"J Am Soc Nephrol"},{"key":"2026100103171907800_bib103","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1681\/ASN.2022050623","article-title":"Treatment effect of the SGLT2 inhibitor empagliflozin on chronic syndrome of inappropriate antidiuresis: results of a randomized, double-blind, placebo-controlled, crossover trial","volume":"34","author":"Refardt","year":"2023","journal-title":"J Am Soc Nephrol"},{"key":"2026100103171907800_bib104","doi-asserted-by":"publisher","first-page":"EVIDoa2200215","DOI":"10.1056\/EVIDoa2200215","article-title":"Osmotic demyelination syndrome in patients hospitalized with hyponatremia","volume":"2","author":"MacMillan","year":"2023","journal-title":"NEJM Evidence"},{"key":"2026100103171907800_bib105","doi-asserted-by":"publisher","first-page":"EVIDe2300014","DOI":"10.1056\/EVIDe2300014","article-title":"Hyponatremia treatment guidelines\u2014have they gone too far?","volume":"2","author":"Ayus","year":"2023","journal-title":"NEJM Evidence"},{"key":"2026100103171907800_bib106","doi-asserted-by":"publisher","first-page":"129","DOI":"10.2215\/CJN.0000000000000244","article-title":"Treatment guidelines for hyponatremia: stay the course","volume":"19","author":"Sterns","year":"2024","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026100103171907800_bib107","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1111\/ane.13150","article-title":"Incidence of osmotic demyelination syndrome in Sweden: a nationwide study","volume":"140","author":"Aegisdottir","year":"2019","journal-title":"Acta Neurol Scand"},{"key":"2026100103171907800_bib108","doi-asserted-by":"publisher","first-page":"EVIDoa2300107","DOI":"10.1056\/EVIDoa2300107","article-title":"Severe hyponatremia correction, mortality, and central pontine myelinolysis","volume":"2","author":"Seethapathy","year":"2023","journal-title":"NEJM Evidence"},{"key":"2026100103171907800_bib109","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1001\/jamainternmed.2024.5981","article-title":"Correction rates and clinical outcomes in hospitalized adults with severe hyponatremia: a systematic review and meta-analysis","volume":"185","author":"Ayus","year":"2025","journal-title":"JAMA Intern Med"},{"key":"2026100103171907800_bib110","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1053\/j.ajkd.2025.07.015","article-title":"Revisiting new data on the mortality benefit of rapid correction of hyponatremia: deja vu all over again","volume":"87","author":"Sterns","year":"2026","journal-title":"Am J Kidney Dis"},{"key":"2026100103171907800_bib111","doi-asserted-by":"publisher","first-page":"610","DOI":"10.34067\/KID.0000000000000414","article-title":"Hyponatremia correction rates and mortality: causality or epiphenomenon?","volume":"5","author":"Rondon-Berrios","year":"2024","journal-title":"Kidney360"},{"key":"2026100103171907800_bib112","doi-asserted-by":"publisher","first-page":"e70158","DOI":"10.1111\/acem.70158","article-title":"Severe hyponatremia in the emergency department incidence of cerebral edema and risk of osmotic demyelination syndrome","volume":"33","author":"Burst","year":"2026","journal-title":"Acad Emerg Med"}],"container-title":["Clinical Kidney Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ckj\/advance-article-pdf\/doi\/10.1093\/ckj\/sfag288\/70819673\/sfag288.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/19\/10\/sfag288\/70819673\/sfag288.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/19\/10\/sfag288\/70819673\/sfag288.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:17:28Z","timestamp":1790839048000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ckj\/article\/doi\/10.1093\/ckj\/sfag288\/8771872"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":112,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ckj\/sfag288","relation":{},"ISSN":["2048-8505","2048-8513"],"issn-type":[{"value":"2048-8505","type":"print"},{"value":"2048-8513","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,8,27]]},"article-number":"sfag288"}}