Editorial in New England Journal of Medicine Evidence – Michael Moritz, MD, Comments on Recent Hyponatremia/Osmotic Demyelination Syndrome Study

Results from a recent multicenter study published in New England Journal of Medicine Evidence in March 2023 report on “Osmostic Demyelination Syndrome in Patients Hospitalized With Hyponatremia,” by MacMillan et al.

The study explores what, if any correlation exists between osmotic demyelination syndrome (ODS) and rapid correction of hyponatremia in a large cohort of hospitalized patients. The prevailing sentiment is that rapid correction of chronic hyponatremia results in ODS and that a slow correction can prevent its development.

However, the results from the new study show a different conclusion, that ODS is exceedingly rare, and that rapid serum sodium correction is not associated with the development of ODS.

Accompanying the new paper is an editorial discussing its impact and importance co-authored by Michael L. Moritz, MD, clinical director of the Division of Pediatric Nephrology at UPMC Children’s Hospital of Pittsburgh, and Juan C. Ayus, MD, from the University of California Irvine, with whom Dr. Moritz frequently collaborates on research.

The editorial, “Hyponatremia Treatment Guidelines – Have They Gone Too Far?” comments on study’s findings and importance relative to treating hospitalized patients experiencing hyponatremia.

“The findings of this study are very important because they demonstrate that ODS is an infrequent complication of hyponatremia with no relationship between rate of correction of hyponatremia and the development of ODS, with the majority of patients developing ODS having slow correction,” says Dr. Moritz “The misconception that patients with chronic hyponatremia are at significant risk for developing ODS and that slow correction can prevent it has resulted in fear in the treatment of hyponatremia. There can be significant benefits of treating hyponatremia more rapidly with hypertonic saline via an intermittent bolus approach that can stave off neurological complications from hyponatremia.”

Drs. Moritz and Ayus advocate for more liberal treatment guidelines around the rate of correction in light of the study’s new findings, and from their own past and ongoing research into best practices for treating hyponatremia in hospitalized pediatric patients.

Read the new study by MacMillan et al, and the accompanying editorial.

Reference

Ayus JC, Moritz ML. Hyponatremia Treatment Guidelines – Have They Gone too Far? NEJM Evid. 2023; 2(4).

More About Dr. Moritz

Michael L. Moritz, MD, FASN, is professor of pediatrics and clinical director of the Division of Pediatric Nephrology at UPMC Children’s Hospital of Pittsburgh. He also is the associate vice-chair of Clinical Affairs for Ambulatory Care and Innovation in the Department of Pediatrics at the University of Pittsburgh School of Medicine.

Dr. Moritz is an internationally respected researcher and expert in the fields of sodium disorders and water metabolism and leads many of the Division’s ongoing clinical trials.

In addition to his role as clinical director in the Division, Dr. Moritz also is the Director of Pediatric Dialysis at UPMC Children’s.

Dr. Moritz is one of the country's leading researchers and experts in sodium and water metabolism, and dysnatremias in general. He has done seminal work in these fields, pointing out the dangers of using hypotonic fluids in hospitalized children as it has resulted in numerous cases of iatrogenic death or permanent neurological injury.

Dr. Moritz was the first to recommend the use of 0.9% sodium chloride in maintenance fluids in hospitalized children as prophylaxis against developing hospital-acquired hyponatremia. Dr. Moritz also introduced the concept of using repeated 3% sodium chloride boluses to treat hyponatremic encephalopathy, which has now become the accepted therapy.

Some of his more recent published research deals with the safety of 3% NaCl administration via peripheral line.

Learn more about Dr. Moritz.