Sodium Correction for Hyperglycemia
Calculates Na in hyperglycemia.
id
50
full_title
Sodium Correction for Hyperglycemia
short_title
Sodium Correction for Hyperglycemia
med_description
Calculates the actual sodium level in patients with hyperglycemia.
description
The Sodium Correction for Hyperglycemia Calculates the actual sodium level in patients with hyperglycemia.
keywords
Sodium Correction for Hyperglycemia, na correct glucose, sodium correct glucose, sodium correct sugar, sodium correct sugar high, na correct sugar high, sodium correction hyperglycemia, na correction hyperglycemia, hyperglycemia na correct, hyperglycemia, sodium, sodium correction, sodium correction calc, hyperglycemia sodium calc, high sugar na calc, high sugar na calcuate, hyperglycemia na score
complaint
[ "AMS", "Seizure", "Weakness" ]
formula
Corrected Sodium (Katz, 1973) = Measured sodium + 0.016 * (Serum glucose - 100) Corrected Sodium (Hillier, 1999) = Measured sodium + 0.024 * (Serum glucose - 100) Note: Serum glucose must be in mg/dL for these formulae to work.
evidence
Hillier et al. (1999) evaluated 6 healthy subjects, induced hyperglycemia, and measured actual serum sodium levels, finding a sodium correction factor of 2.4mEq/L to be more accurate than the classically taught 1.6mEq/L correction factor from Katz (1973).
A recent study demonstrated some correlation between the severity of corrected hyponatremia and mortality.
This method of correction continues to be supported by more recent literature.
measurements
[ { "name": "Glucose", "unit": "glu", "error_min": "1", "error_max": "1700", "warn_min": "50", "warn_max": "1000", "conversion": "0.0555", "normal_max_si": "5.8", "normal_max_us": "105", "normal_min_si": "3.9", "normal_min_us": "70", "units_si": "mmol/L", "units_us": "mg/dL" }, { "name": "Sodium", "unit": "na", "error_min": "100", "error_max": "200", "warn_min": "0", "warn_max": "170", "conversion": "1", "normal_max_si": "145", "normal_max_us": "145", "normal_min_si": "136", "normal_min_us": "136", "units_si": "mmol/L", "units_us": "mEq/L" } ]
information
refrences
{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/4763428", "text": "Katz MA. Hyperglycemia-induced hyponatremia--calculation of expected serum sodium depression. N Engl J Med. 1973 Oct 18;289(16):843-4. PubMed PMID: 4763428." } ], "Other References": [ { "href": "https://pubmed.ncbi.nlm.nih.gov/32773588/", "text": "Chuang C, Guo YW, Chen HS. Corrected sodium levels for hyperglycemia is a better predictor than measured sodium levels for clinical outcomes among patients with extreme hyperglycemia. J Chin Med Assoc. 2020 Sep;83(9):845-851. " }, { "href": "https://pubmed.ncbi.nlm.nih.gov/32984372/", "text": "Ing TS, Ganta K, Bhave G, Lew SQ, Agaba EI, Argyropoulos C, Tzamaloukas AH. The Corrected Serum Sodium Concentration in Hyperglycemic Crises: Computation and Clinical Applications. Front Med (Lausanne). 2020 Aug 25;7:477" } ], "Outcomes": [], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/10225241", "text": "Hillier TA, Abbott RD, Barrett EJ. Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med. 1999 Apr;106(4):399-403. PubMed PMID: 10225241." } ], "Validations": [] }
pearls
- The classic correction factor of 1.6 mEq/L in serum sodium for every 100 mg/dL increase in serum glucose was challenged by a paper by Hillier et al. in 1999; sometimes their factor of 2.4 mEq/L is used.
-
Repeat sodium levels regularly, as sodium will shift with ongoing fluid replacement.
-
On initial laboratory tests, check osmolality to ensure there is no osmolality gap, as this can lead to false hyponatremia (pseudohyponatremia).
-
In extremely hyperglycemic patients, the corrected hyponatremia may reveal true hyponatremia, which can lead to worse outcomes. Therefore, ensure regular lab monitoring during fluid replacement and glucose control.
usecase
Use in patients with elevated serum glucose who are also found to have a low serum sodium level on lab work.
reasons
Some experts use the severity of corrected hyponatremia as apredictorof clinical outcome. Hyperglycemia causes osmotic shifts of water from the intracellular to the extracellular space, causing a relative dilutional hyponatremia.
next_advice
- Act on the corrected sodium level, not the measured sodium level.
- Treat the underlying cause of hyperglycemia.
- Regularly obtain repeat lab work (frequency will depend on clinical condition and severity of abnormalities) to monitor changes.
next_actions
next_management
diseases
[ "Diabetes Mellitus", "Hyperglycemia", "Hypernatremia", "Hyponatremia" ]
instructions
published
2022-04-21T20:29:43.235Z
purpose
[ "Formula" ]
search_terms
[ "na", "glucose", "dm", "diabetes", "sodium", "hyperglycemia", "hyponatremia" ]
seo
{ "keywords_en": "Sodium Correction for Hyperglycemia, na correct glucose, sodium correct glucose, sodium correct sugar, sodium correct sugar high, na correct sugar high, sodium correction hyperglycemia, na correction hyperglycemia, hyperglycemia na correct, hyperglycemia, sodium, sodium correction, sodium correction calc, hyperglycemia sodium calc, high sugar na calc, high sugar na calcuate, hyperglycemia na score", "meta_description_en": "The Sodium Correction for Hyperglycemia Calculates the actual sodium level in patients with hyperglycemia." }
specialty
[ "Critical Care", "Critical Care (Pediatric)", "Emergency Medicine", "Endocrinology", "Hospitalist Medicine", "Internal Medicine", "Pediatric Subspecialty", "Pediatrics" ]
departments
[ "Endocrine and Metabolic" ]
tags
[]
version_number
1
versions
[]
related
[ { "calcId": 10522, "short_title_en": "IDF-DAR Fasting Risk Assessment", "slug": "international-diabetes-federation-diabetes-ramadan-alliance-idf-dar-fasting-risk-assessment" }, { "calcId": 10529, "short_title_en": "C-Peptide to Glucose Ratio", "slug": "c-peptide-glucose-ratio" }, { "calcId": 10538, "short_title_en": "GIR", "slug": "glucose-infusion-rate-gir" } ]
ismed
false
section
[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]
cleaned_departments
[ "endocrine" ]
cleaned_use
[ "Use in patients with elevated serum glucose who are also found to have a low serum sodium level on lab work." ]
pub
true