Downloaded from http://journals.lww.com/cjasn by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1A
Authors: Sterns, RH; Rondon-Berrios, H; Adrogue, HJ; Berl, T; Burst, V; Cohen, DM; Christ-
Crain, M; Cuesta, M; Decaux, G; Emmett, M; Garrahy, A; Gankam-Kengne, F; Hix, JK; Hoorn,
WnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 06/28/2023
EJ; Kamel, KS; Madias, NE; Peri, A; Refardt, J; Rosner, MH; Sherlock, M; Silver, SM; Soupart,
A; Thompson, CJ; Verbalis, JG
Title: Treatment Guidelines for Hyponatremia: Stay the Course
Manuscript Type: Review
Manuscript Category: Complications
Funders:
Disclosures:
Author Contributions:
Study Group/Organization Name:
Study Group Members’ Names:
Clinical Trial Registry Name and Registration Number:
Data Sharing Statement:
Abstract:
International guidelines designed to minimize the risk of complications that can occur when
correcting severe hyponatremia have been widely accepted for a decade. Based on the results of
a recent large retrospective study of patients hospitalized with hyponatremia, it has been
suggested that hyponatremia guidelines have gone too far in limiting the rate of rise of the serum
sodium concentration; the need for therapeutic caution and frequent monitoring of the serum
sodium concentration has been questioned. These assertions are reminiscent of a controversy
that began many years ago. After reviewing the history of that controversy, the evidence
supporting the guidelines, and the validity of data challenging them, we conclude that current
safeguards should not be abandoned. To do so would be akin to discarding your umbrella
because you remained dry in a rainstorm. The authors of this review, who represent 20 medical
centers in 9 countries, have all contributed significantly to the literature on the subject. We urge
clinicians to continue to treat severe hyponatremia cautiously and to wait for better evidence
before adopting less stringent therapeutic limits.
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
,Clinical Journal of the American Society of Nephrology
Doi:10.2215/CJN.0000000000000244
Treatment Guidelines for Hyponatremia: Stay the Course
Richard H. Sterns1,2, Helbert Rondon-Berrios3, Horacio J. Adrogue4, Tomas Berl5, Volker Burst6,
David M. Cohen7, Mirjam Christ-Crain8, Martin Cuesta9, Guy Decaux10, Michael Emmett11, Aoife
Garrahy12, Fabrice Gankam-Kengne13, John K. Hix2, Ewout J. Hoorn14, Kamel S. Kamel15, Nicolaos
E. Madias16, Alessandro Peri17, Julie Refardt8, Mitchell H. Rosner18, Mark Sherlock19, Stephen M.
Silver2, Alain Soupart10, Chris J. Thompson19, Joseph G. Verbalis20, on behalf of PRONATREOUS
Investigators
1
University of Rochester School of Medicine and Dentistry, USA; 2Rochester General Hospital,
USA; 3University of Pittsburgh School of Medicine, USA; 4Baylor College of Medicine, USA;
5
University of Colorado School of Medicine, USA;6University of Cologne Faculty of Medicine,
Germany; 7Oregon Health and Science University, USA; 8University of Basel, Switzerland;
9
Hospital Clinico San Carlos, Spain; 10Erasmus University Hospital Belgium; 11Baylor University
Medical Center, USA; 12Tallaght University Hospital, Ireland; 13EpiCura Hospital, Belgium;
14
Erasmus Medical Center, the Netherlands; 15University of Toronto, Canada; 16Tufts University
School of Medicine, USA; 17University of Florence School of Medicine, Italy; 18University of
Virginia School of Medicine, USA; 19RCSI School of Medicine, Ireland; 20Georgetown University
Medical Center, USA
Corresponding Author:
Richard H. Sterns, MD
Professor, Emeritus
University of Rochester
School of Medicine and Dentistry
Rochester, NY
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
, PRONATREOUS Investigators: Richard H. Sterns, Helbert Rondon-Berrios, Horacio J. Adrogue,
Tomas Berl, Volker Burst, David M. Cohen, Mirjam Christ-Crain, Martin Cuesta, Guy Decaux,
Michael Emmett, Aoife Garrahy, Fabrice Gankam-Kengne, John K. Hix, Ewout J. Hoorn, Kamel S.
Kamel, Nicolaos E. Madias, Alessandro Peri, Julie Refardt, Mitchell H. Rosner, Mark Sherlock,
Stephen M. Silver, Alain Soupart, Chris J. Thompson, Joseph G. Verbalis
Abstract
International guidelines designed to minimize the risk of complications that can occur when
correcting severe hyponatremia have been widely accepted for a decade. Based on the results
of a recent large retrospective study of patients hospitalized with hyponatremia, it has been
suggested that hyponatremia guidelines have gone too far in limiting the rate of rise of the
serum sodium concentration; the need for therapeutic caution and frequent monitoring of the
serum sodium concentration has been questioned. These assertions are reminiscent of a
controversy that began many years ago. After reviewing the history of that controversy, the
evidence supporting the guidelines, and the validity of data challenging them, we conclude that
current safeguards should not be abandoned. To do so would be akin to discarding your
umbrella because you remained dry in a rainstorm. The authors of this review, who represent
20 medical centers in 9 countries, have all contributed significantly to the literature on the
subject. We urge clinicians to continue to treat severe hyponatremia cautiously and to wait for
better evidence before adopting less stringent therapeutic limits.
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
Authors: Sterns, RH; Rondon-Berrios, H; Adrogue, HJ; Berl, T; Burst, V; Cohen, DM; Christ-
Crain, M; Cuesta, M; Decaux, G; Emmett, M; Garrahy, A; Gankam-Kengne, F; Hix, JK; Hoorn,
WnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 06/28/2023
EJ; Kamel, KS; Madias, NE; Peri, A; Refardt, J; Rosner, MH; Sherlock, M; Silver, SM; Soupart,
A; Thompson, CJ; Verbalis, JG
Title: Treatment Guidelines for Hyponatremia: Stay the Course
Manuscript Type: Review
Manuscript Category: Complications
Funders:
Disclosures:
Author Contributions:
Study Group/Organization Name:
Study Group Members’ Names:
Clinical Trial Registry Name and Registration Number:
Data Sharing Statement:
Abstract:
International guidelines designed to minimize the risk of complications that can occur when
correcting severe hyponatremia have been widely accepted for a decade. Based on the results of
a recent large retrospective study of patients hospitalized with hyponatremia, it has been
suggested that hyponatremia guidelines have gone too far in limiting the rate of rise of the serum
sodium concentration; the need for therapeutic caution and frequent monitoring of the serum
sodium concentration has been questioned. These assertions are reminiscent of a controversy
that began many years ago. After reviewing the history of that controversy, the evidence
supporting the guidelines, and the validity of data challenging them, we conclude that current
safeguards should not be abandoned. To do so would be akin to discarding your umbrella
because you remained dry in a rainstorm. The authors of this review, who represent 20 medical
centers in 9 countries, have all contributed significantly to the literature on the subject. We urge
clinicians to continue to treat severe hyponatremia cautiously and to wait for better evidence
before adopting less stringent therapeutic limits.
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
,Clinical Journal of the American Society of Nephrology
Doi:10.2215/CJN.0000000000000244
Treatment Guidelines for Hyponatremia: Stay the Course
Richard H. Sterns1,2, Helbert Rondon-Berrios3, Horacio J. Adrogue4, Tomas Berl5, Volker Burst6,
David M. Cohen7, Mirjam Christ-Crain8, Martin Cuesta9, Guy Decaux10, Michael Emmett11, Aoife
Garrahy12, Fabrice Gankam-Kengne13, John K. Hix2, Ewout J. Hoorn14, Kamel S. Kamel15, Nicolaos
E. Madias16, Alessandro Peri17, Julie Refardt8, Mitchell H. Rosner18, Mark Sherlock19, Stephen M.
Silver2, Alain Soupart10, Chris J. Thompson19, Joseph G. Verbalis20, on behalf of PRONATREOUS
Investigators
1
University of Rochester School of Medicine and Dentistry, USA; 2Rochester General Hospital,
USA; 3University of Pittsburgh School of Medicine, USA; 4Baylor College of Medicine, USA;
5
University of Colorado School of Medicine, USA;6University of Cologne Faculty of Medicine,
Germany; 7Oregon Health and Science University, USA; 8University of Basel, Switzerland;
9
Hospital Clinico San Carlos, Spain; 10Erasmus University Hospital Belgium; 11Baylor University
Medical Center, USA; 12Tallaght University Hospital, Ireland; 13EpiCura Hospital, Belgium;
14
Erasmus Medical Center, the Netherlands; 15University of Toronto, Canada; 16Tufts University
School of Medicine, USA; 17University of Florence School of Medicine, Italy; 18University of
Virginia School of Medicine, USA; 19RCSI School of Medicine, Ireland; 20Georgetown University
Medical Center, USA
Corresponding Author:
Richard H. Sterns, MD
Professor, Emeritus
University of Rochester
School of Medicine and Dentistry
Rochester, NY
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
, PRONATREOUS Investigators: Richard H. Sterns, Helbert Rondon-Berrios, Horacio J. Adrogue,
Tomas Berl, Volker Burst, David M. Cohen, Mirjam Christ-Crain, Martin Cuesta, Guy Decaux,
Michael Emmett, Aoife Garrahy, Fabrice Gankam-Kengne, John K. Hix, Ewout J. Hoorn, Kamel S.
Kamel, Nicolaos E. Madias, Alessandro Peri, Julie Refardt, Mitchell H. Rosner, Mark Sherlock,
Stephen M. Silver, Alain Soupart, Chris J. Thompson, Joseph G. Verbalis
Abstract
International guidelines designed to minimize the risk of complications that can occur when
correcting severe hyponatremia have been widely accepted for a decade. Based on the results
of a recent large retrospective study of patients hospitalized with hyponatremia, it has been
suggested that hyponatremia guidelines have gone too far in limiting the rate of rise of the
serum sodium concentration; the need for therapeutic caution and frequent monitoring of the
serum sodium concentration has been questioned. These assertions are reminiscent of a
controversy that began many years ago. After reviewing the history of that controversy, the
evidence supporting the guidelines, and the validity of data challenging them, we conclude that
current safeguards should not be abandoned. To do so would be akin to discarding your
umbrella because you remained dry in a rainstorm. The authors of this review, who represent
20 medical centers in 9 countries, have all contributed significantly to the literature on the
subject. We urge clinicians to continue to treat severe hyponatremia cautiously and to wait for
better evidence before adopting less stringent therapeutic limits.
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
