Overcorrection of hyponatremia is a medical emergency Richard H. Sterns, John K. Hix  Kidney International  Volume 76, Issue 6, Pages 587-589 (September 2009) DOI: 10.1038/ki.2009.251 Copyright © 2009 International Society of Nephrology Terms and Conditions

Figure 1 Idealized depiction of the recommended approach to unintentional overcorrection of severe hyponatremia. After the initial antidiuresis (urine osmolality 600mOsm/kg) converts to a water diuresis (urine osmolality 80mOsm/kg) as the original cause of the antidiuresis resolves, administration of desmopressin (DDAVP) concentrates the urine (urine osmolality 700mOsm/kg), terminating the water diuresis that has increased the serum sodium by 18mmol/l in less than 24h. A brief infusion of 5% dextrose in water (D5W) re-lowers the serum sodium to a more acceptable level, representing a 10-mmol/l increase in 24h. Continued administration of desmopressin at frequent intervals maintains a concentrated urine (700mOsm/kg), and the concurrent administration of 3% NaCl results in a controlled, predictable, and slow increase in serum sodium concentration until therapeutic goals are reached, maintaining correction rates below therapeutic limits (18mmol/l/48h and 20mmol/l/72h). Kidney International 2009 76, 587-589DOI: (10.1038/ki.2009.251) Copyright © 2009 International Society of Nephrology Terms and Conditions