Hyponatremia Correction and Osmotic Demyelination Syndrome Risk: A Systematic Review and Meta-Analysis

Abstract

Rationale & Objective: Osmotic demyelination syndrome (ODS) is a rare but severe condition often attributed to the rate of sodium collection. We evaluated the association between the overly rapid sodium correction in adult hospitalized patients with ODS. Study Design: Systematic review and meta-analysis. Setting & Study Populations: Adults hospitalized hyponatremia patients. Selection Criteria for Studies: The studies comparing the incidence of ODS with and without rapid sodium correction inception to January 2024. Data Extraction: Two reviewers independently extracted data and assessed the risk of bias and the certainty of evidence. Analytic Approach: The incidence of ODS following a rapid and nonrapid sodium correction was pooled using the random effects model. Subgroup and meta-regression analyses were performed for the robustness and the source of heterogeneity. Results: Eleven cohort studies were included with 26,710 hospitalized hyponatremia patients. The definition of hyponatremia varied from <116 to <130 mmol/L, and overly rapid sodium correction was defined as >8 to 12 mmol/L within 24 hours. The overall incidence of ODS was 0.23%. The incidence of ODS in rapid and nonrapid sodium correction was 0.73% and 0.10%, respectively. Meta-analysis demonstrated that a rapid rate of sodium correction was associated with a higher incidence of ODS (odds ratio 3.16, 95% CI, 1.54-6.49, I2 = 27%), whereas some patients with hyponatremia developed ODS without rapid sodium level correction. The sensitivity analysis based on the quality of the studies was consistent with the main result. Limitation: Various definition criteria for ODS diagnosis across studies, lack of potential electrolyte and treatment data that may affect the incidence of ODS. Conclusions: The rapid rate of sodium correction had a statistical correlation with a higher incidence of ODS. Among ODS without rapid correction, further studies are recommended to evaluate and comprehend the relationship for better and proper management of hospitalized patients with hyponatremia. Plain Language Summary: Hyponatremia is a common electrolyte disorder that is essential to treat symptoms to prevent further neurologic complications, even from hyponatremia itself or following treatment. This meta-analysis evaluated the association between sodium correction rate and osmotic demyelination syndrome (ODS). The finding demonstrated that rapid correlation >8 mmol/L/24 h had a statistical correlation with a higher risk of ODS. Rapid sodium correction occurred in 21.5% of patients with hyponatremia. The overall incidence of ODS was 0.23% and 0.73% among those with rapid sodium correction. Even without rapid correction, 0.1% of patients with hyponatremia developed ODS. Further studies are needed to comprehend the relationship between hyponatremia and ODS among all individuals, including those without rapid correction, to optimize the management of hyponatremia.