Original Article

Are Salt Tablets Effective in the Treatment of Euvolemic Hyponatremia?

Authors: Ittikorn Spanuchart, MD, Hideaki Watanabe, MD, Thomas Aldan, MD, Dominic Chow, MD, PhD, Roland C.K. Ng, MD

Abstract

Objectives: There is limited evidence for the use of salt tablets in the treatment of hyponatremia. This retrospective study evaluated the effectiveness of salt tablet administration in euvolemic hyponatremia.

Methods: This was a single-center, retrospective cohort study. Information on patients’ demographics, clinical characteristics, and laboratory data were collected for retrospective review. Treatment for hyponatremia, including the amount of salt tablets, fluid restriction, and diuretics was collected. We compared hyponatremic patients with those who received salt tablets versus those who did not receive salt tablets. The primary outcome of interest was the change in serum sodium at 48 hours between the two groups.

Results: A total of 1258 medical records were initially screened with inclusion and exclusion criteria. After screening, there were 83 patients included in the study. Forty-two patients received salt tablets and 41 patients were in the group that did not receive salt tablets. Patients treated with salt tablets were older, more often female, and had lower body weight and lower initial serum sodium. The change in serum sodium after 48 hours was higher in the salt tablet group (5.2 mEq/L) than the non-salt tablet group (3.1 mEq/L; P < 0.001). This difference in serum sodium between the two groups remained statistically significant when adjusted for age, sex, weight, and initial serum sodium.

Conclusions: The use of salt tablets in the treatment of euvolemic hyponatremia is associated with a small but significant improvement in serum sodium compared with patients who did not receive such therapy, even after adjusting for age, sex, weight, and initial serum sodium. This study supports the effectiveness of salt tablets in the treatment of euvolemic hyponatremia in medical patients.
Posted in: Endocrinology, Diabetes, and Metabolism10

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References

1. Corona G, Giuliani C, Parenti G, et al. The economic burden of hyponatremia: systematic review and meta-analysis. Am J Med 2016;129:823-835.e4.
2. Amin A, Deitelzweig S, Christian R, et al. Evaluation of incremental healthcare resource burden and readmission rates associated with hospitalized hyponatremic patients in the US. J Hosp Med 2012;7:634-639.
3. Wald R, Jaber BL, Price LL, et al. Impact of hospital-associated hyponatremia on selected outcomes. Arch Intern Med 2010;170:294-302.
4. Liamis G, Rodenburg EM, Hofman A, et al. Electrolyte disorders in community subjects: prevalence and risk factors. Am J Med 2013;126:256-263.
5. Mohan S, Gu S, Parikh A, et al. Prevalence of hyponatremia and association with mortality: results from NHANES. Am J Med 2013;126:1127-1137.e1.
6. Corona G, Giuliani C, Verbalis JG, et al. Hyponatremia improvement is associated with a reduced risk of mortality: evidence from a meta-analysis. PLoS One 2015;10:e0124105.
7. Verbalis JG, Goldsmith SR, Greenberg A, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med 2013;126:S1-S42.
8. Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant 2014;29(suppl 2):i1-i39.
9. Hoorn EJ, Zietse R. Diagnosis and treatment of hyponatremia: compilation of the guidelines. J Am Soc Nephrol 2017;28:1340-1349.
10. Decaux G, Waterlot Y, Genette F, et al. Inappropriate secretion of antidiuretic hormone treated with frusemide. Br Med J (Clin Res Ed) 1982;285:89-90.
11. Jahangiri A, Wagner J, Tran MT, et al. Factors predicting postoperative hyponatremia and efficacy of hyponatremia management strategies after more than 1000 pituitary operations. J Neurosurg 2013;119:1478-1483.
12. Barber SM, Liebelt BD, Baskin DS. Incidence, etiology and outcomes of hyponatremia after transsphenoidal surgery: experience with 344 consecutive patients at a single tertiary center. J Clin Med 2014;3:1199-1219.
13. Human T, Cook AM, Anger B, et al. Treatment of hyponatremia in patients with acute neurological injury. Neurocrit Care 2017;27:242-248.
14. Kerns E, Patel S, Cohen DM. Hourly oral sodium chloride for the rapid and predictable treatment of hyponatremia. Clin Nephrol 2014;82:397-401.