Severe hyponatremia - is rapid correction safe?

In view of the continuous controversy about the treatment of hyponatremia (rapid or slow correction), we retrospectively studied 40 patients with severe hyponatremia (serum level of 120 mmol/L and less). Thirteen cases were acute, the remainder (27) were chronic. The mean rate of correction calculated from the rise of serum sodium over the initial 12 hours in both acute and chronic patients, and over the initial 24 hours in the acute and in the majority of the chronic patients was consistent with the definition of rapid correction (increase of serum sodium of >/=0.5 mmol/L/hr). Six of the acute and three of the chronic patients died during follow-up of six months. All deaths were caused by the underlying diseases or by complications not related to the hyponatremia or its treatment. None of the patients (alive or deceased) developed any clinical features of central pontine and extrapontine myelinolysis (CPM). In some of the studies of rapid correction of hyponatremia, chronic alcoholism was felt to be one of the risk factors in the development of CPM. As our patient population, due to religious reasons, abstained from alcohol intake, our results would suggest that in the absence of chronic alcoholism and its attendant malnutrition, rapid correction of severe hyponatremia is probably safe.