HDCN Abstract:  ASN Annual Meeting -- San Diego  

Yi J, Han S, Kim H.

The Effectiveness of Barsoum-Levine Formula for Predicting the Initial Saline Infusion Rates in Severe Hyponatremia greater than or equal to 125 mEq/L).

ASN Annual Meeting -- San Diego
J Am Soc Nephrol (Nov) 20:428A 2009

The best method to guide an initial rate of saline infusion in correcting serum sodium levels in severe hyponatremic patients still remains as an issue. This study aimed to compare the efficiency of 3 suggested formulas - Adrogue-Madias (AM), Barsoum-Levine (BL), and simplified Barsoum-Levine (sBL) equations - for its rates through isotonic saline load test (ISLT). Eighteen consecutive patients (M:F, 7:11, 759 yrs) were enrolled in emergency room (ER), who showed severe hyponatremia (serum NaSD, 1146.6 mEq/L; 102-125 mEq/L) without edema or renal diseases. ISLT at 83 ml/hr for 12 to 24 hrs was performed on the first day of admission to ICU via ER. Actual changes in serum Na from baseline (Act-[Na]) were compared to its predicted changes (Pre-[Na]) calculated by 3 formulas.

The volume of urine was measured during the first 4 hrs for BL and sBL. Based on clinical data including ISLT, out of 18 patients, 12 were assessed as hypovolemia (67%) and 6 as euvolemia (33%). The mean correction rate of serum Na was 0.300.18 mEq/L/hr during 24 hrs with no significant difference between the first and the second 12 hrs. At 12 hrs, Act-[Na] was 54.4 mEq/L while Pre-[Na] was 1.90.8 mEq/L by AM (p<0.05 vs Act-[Na]), 3.33.7 mEq/L by BL (p=NS), and 2.92.0 mEq/L by sBL (p=NS), respectively. At 24 hrs, Act-[Na] was 74.3 mEq/L while Pre- [Na] was 3.81.7 mEq/L by AM (p<0.05), 7.35.5 mEq/L by BL (p=NS), and 2.92.0 mEq/L by sBL (p=NS), respectively.

Also, correlation analysis between Act- [Na] and Pre-[Na] showed no significance in AM at all (r=- 0.2, p=0.93 at 12 hrs, r=0.2, p=0.45 at 24 hrs), but it was significant in both BL and sBL, more in the latter (BL, r=0.51, p=0.03 at 12 hrs, r=0.62, p=0.02 at 24 hrs; sBL, r=0.50, p=0.04 at 12 hrs, r=0.81, p=0.001 at 24 hrs). All patients tolerated ISLT well and discharged with normalized serum Na. In conclusion, Barsoum-Levine formulas, preferably the simplified one, could be recommended as an optimal guide for the initial management with saline infusion for the severe hyponatremic patients admitted via ER, who revealed high prevalence of hypovolemia.

© Copyright 2009-2010 American Society of Nephrology.Reproduced with permission.
Until September of 2010 all ASN abstracts from the 2009 Annual Meeting are available at this link.

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