Woodfine et al reported a model for predicting overcorrection of hyponatremia. This can help to reduce the complications of overcorrection. The authors are from the Ottawa Hospital, University of Ottawa, University of Toronto, University Health Network, and ICES uOttawa in Canada.
SHOR = Severe Hypernatremia Overcorrection Risk Score
Patient selection: severe hyponatremia (< 116 mmol/L)
Parameters:
(1) level of consciousness
(2) vomiting
(3) severe hypokalemia (< 3.0 mmol/L)
(4) hypotonic urine (< 150 mOsm/kg)
(5) volume overload
(6) chest tumor (not characterized)
(7) age in years
(8) initial sodium concentration in mmol/L
Parameter
Finding
Points
level of consciousness
normal
0
decreased
2
vomiting
no
0
yes
2
severe hypokalemia
no
0
yes
1
hypotonic urine
no
0
yes
4
volume overload
no
0
yes
-5
chest tumor
no
0
yes
-5
age in years
<= 50 years
0
> 50 years
(-1) * ((age)-50) / 10
initial sodium concentration
< 110 mmol/L
4
110-111 mmol/L
2
112-113 mmol/L
1
114 or 115 mmol/L
0
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -17
• maximum score: 13
Total Score
Risk of Overcorrection
< -3
very low
-3 to -1
low
0 to 2
low to moderate
3 to 4
moderate
>= 5
high
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