Research paper
Nagler EV, Vanmassenhove J, van der Veer SN, Nistor I, Van Biesen W, Webster AC, Vanholder R. Diagnosis and treatment of hyponatremia: a systematic review of clinical practice guidelines and consensus statements. BMC Medicine. 2014 Dec 11;12(1):1. doi:10.1186/s12916-014-0231-1. PMID: 25539784; PMCID: PMC4276109.
Why we cite it
Systematic review in BMC Medicine appraising ten guidance documents (five clinical practice guidelines, five consensus statements) on hyponatremia diagnosis and treatment using the AGREE II quality instrument. Found mixed overall quality: two clinical practice guidelines scored above 50% for all domains, three rated the evidence systematically, two graded recommendation strength, and all five consensus statements scored below 60% on every domain. In the most recent guideline, 98% of graded recommendations rested on very low or low level evidence (scope corrected 2026-09-19). Despite these limitations, the review documents substantial consensus on core approaches: serum osmolality testing for diagnosis, three-category classification by volume status (hypovolemic, euvolemic, hypervolemic), hypertonic saline for acute symptomatic cases, and fluid restriction for chronic euvolemic cases. Importantly documents the variability in sodium correction speed limits (8-12 mmol/L per 24 hours), which has direct clinical safety implications (osmotic demyelination syndrome risk). Not a source for the symptoms of low sodium, and not for anything about fasting. This paper lists no symptoms and never mentions fasting (see Verification depth). Companion 406’s use of it, and `kfe03`’s, need a clinical source this library does not yet hold (corrected 2026-09-19: this sentence had presented the record as clinical background for the symptom cluster).
DOI: 10.1186/s12916-014-0231-1 · PubMed 25539784 · Publisher