Does your goal rate of correction in patients with chronic hypoosmolar hyponatremia differ based on the degree of hypoosmolarity?   

Certainly the lower the PNa is, any increase in PNa will have a greater effect on serum osmolality, so yes the lower the PNa the more careful I am. I would suggest never to be complacent, but for instance if the PNa was 105 I would make sure not to increase it by more than 6 in 24 hours, but if it w...

Agree with all; in my opinion, one way to look at it is that the rate of 6-8 is the speed limit, not the target. Hence, if a patient corrects by 4, that’s a success. Unless, of course, the patient is severely symptomatic. 

I agree overall with Dr. @Rodby, with the caveat that with very low PNa (e.g. 105 mM) in symptomatic patients I would front load the correction of 6 mM rise in PNa to the first 6 hrs. Also, in patients with combined hypo-osmolar hyponatremia and hyperglycemia, the hyponatremia may be out of proporti...

The "acceptable" rate of correction has changed over the years, as evidence accumulates. I believe the jury is still out on the safest rates, as corrected for the degree of hyposomolality.