Evidence map›Paper›PMID 41069084›Full record

Trial reportAcademic emergency medicine : official journal of the Society for Academic Emergency Medicine2026

Severe Hyponatremia in the Emergency Department Incidence of Cerebral Edema and Risk of Osmotic Demyelination Syndrome.

Volker Burst, Ramon Rabii, Julian Peto-Madew, Thorsten Persigehl, Stefan Haneder, Matthias Johannes Hackl, Christoph Hüser, Moritz Trappe, Sadrija Cukoski, Kathrin Möllenhoff and 1 more

Erratum issuedAbstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Severe Hyponatremia in the Emergency Department Incidence of Cerebral Edema and Risk of Osmotic Demyelination Syndrome.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026
    Trial
  2. Review
  3. Article
  4. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors.

Volker BurstEmergency Department, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Ramon RabiiEmergency Department, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Julian Peto-MadewEmergency Department, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Thorsten PersigehlDepartment of Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany.
Stefan HanederDepartment of Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany.
Matthias Johannes HacklEmergency Department, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Christoph HüserEmergency Department, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Moritz TrappeEmergency Department, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.ORCID 0000-0002-6696-9709
Sadrija CukoskiEmergency Department, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Kathrin MöllenhoffInstitute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University of Cologne, Cologne, Germany.
Victor SuárezEmergency Department, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

STUDY

objectiveTreatment strategies in severe hyponatremia aim at rapid sodium correction to prevent or treat cerebral edema but limit sodium rise to prevent osmotic demyelination syndrome (ODS). The true risk of edema or ODS in ED patients is unknown.

methodsWe performed a retrospective study of patients admitted to the ED of a tertiary hospital from January 2013 to December 2018 with plasma sodium ≤ 125 mmol/L. The rate of cerebral edema at presentation and the rate of ODS that developed during the stay were determined based on imaging studies and clinical evaluation. Secondary analyses looked at the association between overly rapid sodium correction (> 8 mmol/L) at 24 h, ODS risk, mortality, and length of stay.

resultsThe primary analysis group comprised 852 patients; 318 (37%) of these presented with severe symptoms. Four patients (0.5%) with cerebral edema and 11 patients (1.3%) with ODS were detected. Alcoholism, liver disease, and malnutrition were identified as risk factors for ODS. While overly rapid correction showed no association with ODS in the primary analysis group, it became the predominant risk factor in a reduced dataset with a more accurate estimate of 24-h sodium correction. Correction rate had no impact on mortality or length of stay.

conclusionsGiven the low rate of cerebral edema even in severely symptomatic patients, aggressive treatment may not be necessary in most cases. The risk to develop ODS seems to be higher than the risk of brain edema. Since we found no beneficial impact of a liberal correction strategy, current treatment limits should stay in place.

Indexed as

Brain EdemaDemyelinating DiseasesEmergency Service, HospitalHyponatremiaAdultAgedFemaleHumansIncidenceLength of StayMaleMiddle AgedRetrospective StudiesRisk FactorsSodiumSyndromeSodium

Identifiers

PMID41069084
PMCPMC12820600

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.