{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T08:35:36Z","timestamp":1793176536348,"version":"4.5.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R21DK122023"],"award-info":[{"award-number":["R21DK122023"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2021,9]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Osmotic demyelination syndrome (ODS) can occur despite adherence to current hyponatremia correction guidelines, especially in patients with serum sodium <115 mEq\/L.<\/jats:p>\n <\/jats:list-item>\n \n Limit the rate of correction of serum sodium <8 mEq\/L in any 24-hour period in these patients to minimize the risk of ODS.<\/jats:p>\n <\/jats:list-item>\n \n Thiamine supplementation should be considered for any patient with hyponatremia whose dietary intake has been poor.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Overly rapid correction of chronic hyponatremia may lead to osmotic demyelination syndrome. European guidelines recommend a correction to \u226410 mEq\/L in 24 hours to prevent this complication. However, osmotic demyelination syndrome may occur despite adherence to these guidelines.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We searched the literature for reports of osmotic demyelination syndrome with rates of correction of hyponatremia \u226410 mEq\/L in 24 hours. The reports were reviewed to identify specific risk factors for this complication.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We identified 19 publications with a total of 21 patients that were included in our analysis. The mean age was 52 years, of which 67% were male. All of the patients had community-acquired chronic hyponatremia. Twelve patients had an initial serum sodium <115 mEq\/L, of which seven had an initial serum sodium \u2264105 mEq\/L. Other risk factors identified included alcohol use disorder (\n n<\/jats:italic>\n =11), hypokalemia (\n n<\/jats:italic>\n =5), liver disease (\n n<\/jats:italic>\n =6), and malnutrition (\n n<\/jats:italic>\n =11). The maximum rate of correction in patients with serum sodium <115 mEq\/L was at least 8 mEq\/L in all but one patient. In contrast, correction was <8 mEq\/L in all but two patients with serum sodium \u2265115 mEq\/L. Among the latter group, osmotic demyelination syndrome developed before hospital admission or was unrelated to hyponatremia overcorrection. Four patients died (19%), five had full recovery (24%), and nine (42%) had varying degrees of residual neurologic deficits.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Osmotic demyelination syndrome can occur in patients with chronic hyponatremia with a serum sodium <115 mEq\/L, despite rates of serum sodium correction \u226410 mEq\/L in 24 hours. In patients with severe hyponatremia and high-risk features, especially those with serum sodium <115 mEq\/L, we recommend limiting serum sodium correction to <8 mEq\/L. Thiamine supplementation is advisable for any patient with hyponatremia whose dietary intake has been poor.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0004402021","type":"journal-article","created":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T14:40:18Z","timestamp":1625755218000},"page":"1415-1423","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":56,"title":["Osmotic Demyelination Syndrome following Correction of Hyponatremia by \u226410 mEq\/L per Day"],"prefix":"10.34067","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3745-7533","authenticated-orcid":false,"given":"Srijan","family":"Tandukar","sequence":"first","affiliation":[{"name":"Willis-Knighton Medical Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard H.","family":"Sterns","sequence":"additional","affiliation":[{"name":"School of Medicine and Dentistry, University of Rochester, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7109-146X","authenticated-orcid":false,"given":"Helbert","family":"Rondon-Berrios","sequence":"additional","affiliation":[{"name":"Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,9,30]]},"reference":[{"issue":"Suppl 1","key":"B1-20250825","doi-asserted-by":"crossref","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":"B2-20250825","doi-asserted-by":"crossref","first-page":"i1","DOI":"10.1093\/ndt\/gfu040","article-title":"Clinical practice guideline on diagnosis and treatment of 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