The Adrogue-Madias Formula Revisited

Abstract

Few subjects engender as much heated discussion at various nephrology meetings as the strongly held views by advocates of various approaches to the management of hyponatremia (1). The controversy as to how these patients should best be treated can be traced to the fact that even in a specialty such as ours, which already suffers from a dearth of properly conducted prospective, randomized, controlled trials, not a single such trial is designed to address the optimal management of this most common of electrolyte disorders. There are, therefore, no clearly established and uniformly agreed-on national or international guidelines (2), and those that are put forth in various publications (2–7) are based primarily on retrospective observational analyses on a limited number of patients (7–12). None has the virtue of comparing prospectively two or more therapeutic options and monitoring for well-defined neurological outcomes in a randomized, controlled trial or even in a robust prospective, observational trial (13). Ultimately, the published recommendations are largely opinion based and reflect the experience of the various authors. In the midst of the controversy that surrounds the rate and magnitude that should guide the treatment of hyponatremia, the most accepted intervention is the one that calls for the use of hypertonic sodium chloride (3% NaCl) to treat patients who have severe hyponatremia (Na <125 mEq) and present with marked neurologic symptoms, especially seizures. This intervention is designed to …