Evaluation of Serum Sodium Correction Rates for Management of Hyponatremia in Hospitalized Patients.

BACKGROUND: Appropriate correction of hyponatremia can reduce complications such as osmotic demyelination syndrome (ODS). OBJECTIVE: To evaluate rates of serum sodium correction in hyponatremic hospitalized patients and identify factors associated with higher rates of overcorrection. METHODS: This is an institutional review board-approved single-center, retrospective chart review of patients ≥18 years of age with at least 1 serum sodium <130 mEq/L during hospitalization. The primary end point was percentage of patients appropriately corrected for hyponatremia. Appropriate correction was defined as a sodium change ≤12 mEq/L over 24 hours and 18 mEq/L over 48 hours, and overcorrection was defined as an increase in serum sodium exceeding these cutoffs. Secondary end points included incidence of ODS, poor neurological outcome, intensive care unit (ICU) and hospital lengths of stay (LOSs), and in-hospital mortality. RESULTS: Of 234 patients evaluated, 100 were included. Mean age was 72 ± 16 years, and 47% were male. Overcorrection occurred in 14 patients. There was no incidence of ODS. Rates of poor neurological outcome (P = 0.77), ICU (P = 0.09) and hospital LOS (P = 0.13), and in-hospital mortality (P = 0.20) were similar between appropriately corrected and overcorrected patients. Using a logistic regression analysis, severe hyponatremia (serum sodium < 120 mEq/L; P = 0.0122) and history of alcohol use disorder (P < 0.001) were risk factors found to be associated with overcorrection. CONCLUSION AND RELEVANCE: Overcorrection of hyponatremia occurred in 14% of patients in this study. To minimize this risk, further caution should be taken when managing patients presenting with identified risk factors.

Phenobarbital Monotherapy for the Management of Alcohol Withdrawal Syndrome in Surgical-Trauma Patients.

BACKGROUND: Benzodiazepine is first-line therapy for alcohol withdrawal syndrome (AWS), and phenobarbital is an alternative therapy. However, its use has not been well validated in the surgical-trauma patient population. OBJECTIVE: To describe the use of fixed-dose phenobarbital monotherapy for the management of patients at risk for AWS in the surgical-trauma intensive care unit. METHODS: Surgical-trauma critically ill patients who received phenobarbital monotherapy, loading dose followed by a taper regimen, for the management of AWS were included in this evaluation. The effectiveness of phenobarbital monotherapy to treat AWS and prevent development of AWS-related complications were evaluated. Safety end points assessed included significant hypotension, bradycardia, respiratory depression, and need for invasive mechanical ventilation. RESULTS: A total of 31 patients received phenobarbital monotherapy; the majority of patients were at moderate risk for developing AWS (n = 20; 65%) versus high risk (n = 11; 35%). None of the patients developed AWS-related complications; all patients were successfully managed for their AWS. Nine patients (29%) received nonbenzodiazepine adjunct therapy for agitation post-phenobarbital initiation. Three patients (10%) experienced hypotension, and 3 (10%) were intubated. None of the patients had clinically significant bradycardia or respiratory depression. CONCLUSION AND RELEVANCE: Fixed-dose phenobarbital monotherapy appears to be well tolerated and effective in the management of AWS. Further evaluation is needed to determine the extent of benefit with the use of phenobarbital monotherapy for management of AWS.