What is the maximum rate at which sodium can be corrected to prevent demyelination?

The maximum rate at which sodium can be safely corrected is ≤0.5 mEq/L/hr. This recommendation is primarily to prevent demyelination, specifically osmotic demyelination syndrome (ODS), which can occur in cases of rapid correction of hyponatremia.

When sodium levels are adjusted too quickly, usually after prolonged periods of low serum sodium, there is a risk of causing significant neuronal injury. The mechanisms involve the shifting of water out of brain cells to accommodate the newly corrected sodium levels, which can lead to demyelination of the central nervous system. Adhering to the guideline of a maximum correction rate of 0.5 mEq/L/hr allows for a cautious and controlled approach to restoring sodium levels, thus minimizing the potential for such complications.

Correcting sodium at a rate greater than this could lead to a rapid change in osmolarity that the brain cannot adapt to, resulting in ODS. Therefore, maintaining a gradual and measured increase is crucial for patient safety and neurological integrity.