Endocrine Abstracts

JOINT977

Background: The European Society of Endocrinology (ESE) guidelines (2014) recommend a bolus-wise strategy using hypertonic saline (HTS) for treatment of severe symptomatic hyponatraemia. The aim of treatment is to raise serum sodium by ≤10 mmol/l in first 24 hours⁽¹⁾. However, there are recent controversies regarding risk of overcorrection and osmotic demyelination syndrome (ODS)⁽²⁾, leading to significant heterogeneity in practice⁽³⁾.

Aim: To evaluate the clinical practices and perspectives of endocrinologists across Europe in managing severe symptomatic hyponatraemia.

Methods: A web-based anonymous cross-sectional survey, endorsed by ESE, was disseminated to ESE members between 28/06/24 and 31/12/24 via email, newsletter and social media. The survey consisted of 13 multiple-choice questions and was developed using REDCap®. Data was analysed using R-Studio (version 4.4.2).

Results: A total of 642 responses were received. After excluding incomplete and non-European responses, 422 responses form 36 countries were analysed. 79.4% (n=335) responses were from endocrinology followed by Internal Medicine (10.9%) and emergency medicine (6.2%). Most responses were received from university hospitals (70.9%) and by senior clinicians i.e. professors/consultants (66.8%). Most clinicians (32%) had experience using both bolus and continuous infusions in managing severe symptomatic hyponatraemia while sole bolus or continuous infusion therapy was preferred by 29.9% and 23.7%, respectively. For those with experience of bolus therapy (n=113), preferred volumes of infusions were 100 mL (26.8%) and 150 mL (19.2%), while 4.5% preferred a weight-based dosage. 24-hour target sodium rise was defined as ≤8 mmol/l and ≤10 mmol/l by 38% and 37.8% of the respondents, respectively. In absence of seizures, most (83.9%) clinicians preferred one bolus infusion followed by a blood test before repeating a second, while 85.8% had at least some experience with using venous blood gas sodium with HTS use. 34.3% respondents had encountered ≧1patient with suspected or confirmed ODS in their practice, while 54.9% reported association of ODS with sodium overcorrection.

Conclusion: This is the first European survey on severe symptomatic hyponatraemia management, offering insights into real-life practice. Our survey underlines that first, there is significant variation in practice, second, most clinicians prefer a more cautious approach than recommended by guidelines, and third, 1/3rd of clinicians have encountered ODS in their clinical practice. The survey results call for future research and an evidence-based review of ESE guidelines.

References:: 1. Spasovski et al., Eur J Endocrinol. (2014), doi: 10.1530/EJE-13-1020.

2. McMillan et al., NEJM Evidence (2023), doi: 10.1056/EVIDoa2200215.

3. Arshad et al., Endocrine (2023), doi: 10.1007/s12020-023-03322-w.