Use of hypertonic saline in severe symptomatic hyponatraemia; results from a national survey of endocrinologists in the United Kingdom.

IF 3 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Pub Date : 2024-12-01 Epub Date: 2024-06-15 DOI:10.1007/s12020-024-03927-9

Muhammad Fahad Arshad, Ahmed Iqbal

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引用次数: 0

Abstract

Background: Severe symptomatic hyponatraemia is potentially life-threatening and hypertonic saline (HTS) is effective at rapidly correcting serum sodium. Several clinical guidelines have aimed to standardise the administration of HTS. However, evidence supporting the guidelines is limited, and concerns have been raised regarding the potential for overcorrection.

Objective: To assess the practices and perceptions surrounding HTS use in severe symptomatic hyponatraemia among United Kingdom (UK) endocrinologists and trainees.

Methods: An anonymous online survey was disseminated to Society for Endocrinology (UK) clinical members between 24/10/2023 and 30/11/2023 using a web-based multiple-choice questionnaire.

Results: We received 133 responses with a survey response rate of 8.3% (60.1% consultants, 33.1% trainees, 6.8% others). 85% of respondents employed bolus treatment with HTS only, with 9.8% using both bolus and continuous infusions. Most (53.2%) preferred 150 mL boluses, followed by 100 mL boluses (19.8%), while 5.5% of respondents used weight-based dosage. Commonly used HTS strengths were 2.7% (45.1%), followed by 1.8% (31.6%), while the 3% HTS strength recommended in guidelines was used by 21.8%. Contrary to guidelines, 78.6% did not administer a second bolus without waiting for the sodium result after the first bolus. Moreover, 86% have experience using venous blood gas sodium readings for monitoring. Overcorrection targets defined by 10 and 8 mmol/24 h cut-offs were used by 48.9% and 39.9%, respectively. For definite or anticipated overcorrection, 75.9% preferred 5% dextrose, while 40.6% had experience with desmopressin.

Conclusion: Significant variation exists in HTS use for severe symptomatic hyponatraemia in the UK. Most clinicians prefer a more cautious approach in administering HTS. These data offer insight into real-life care and call for future research.

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在严重症状性低钠血症中使用高渗盐水；英国内分泌专家全国调查的结果。

背景：严重的无症状低钠血症可能会危及生命，而高渗盐水 (HTS) 能有效快速纠正血清钠。一些临床指南旨在规范高渗盐水的施用。然而，支持这些指南的证据有限，而且人们对过度纠正的可能性表示担忧：目的：评估英国（UK）内分泌专家和受训人员对严重症状性低钠血症使用 HTS 的做法和看法：方法：在 2023 年 10 月 24 日至 2023 年 11 月 30 日期间，使用基于网络的多项选择问卷向英国内分泌学会的临床会员进行匿名在线调查：我们收到了 133 份回复，调查回复率为 8.3%（60.1% 为顾问，33.1% 为受训人员，6.8% 为其他人员）。85%的受访者仅使用 HTS 栓注治疗，9.8%的受访者同时使用栓注和持续输注。大多数受访者（53.2%）首选 150 毫升栓剂，其次是 100 毫升栓剂（19.8%），5.5% 的受访者使用基于体重的剂量。常用的 HTS 浓度为 2.7%（45.1%），其次是 1.8%（31.6%），而 21.8% 的受访者使用了指南推荐的 3% HTS 浓度。与指南相反，78.6% 的人在第一次给药后没有等待钠结果就进行了第二次给药。此外，86% 的人有使用静脉血气钠读数进行监测的经验。分别有 48.9% 和 39.9% 的人使用 10 和 8 mmol/24 h 临界值定义的过度纠正目标。对于明确或预期的过度纠正，75.9% 的人首选 5%葡萄糖，而 40.6% 的人有使用去氨加压素的经验：结论：在英国，对严重症状性低钠血症使用 HTS 的情况存在很大差异。大多数临床医生在使用 HTS 时更倾向于采取更为谨慎的方法。这些数据有助于深入了解现实生活中的护理情况，并呼吁开展未来研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Endocrine ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

5.40%

发文量

295

审稿时长

1.5 months

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.