The Need for Close Monitoring in Hyponatremia: Osmotic Demyelination Syndrome (Claims Corner CME)


In reviewing closed malpractice claims, The Doctors Company identified mismanagement of sodium levels during correction of severe hyponatremia as a serious problem that can result in catastrophic permanent neurological injury due to osmotic demyelination syndrome (also known as central pontine myelinolysis). This article highlights the importance of close monitoring of sodium levels during correction of severe hyponatremia, with a slow and controlled pace of sodium correction. Contributing factors discussed include clinical judgment with regard to rate of rise of sodium levels, patient monitoring, choice of practice setting, and communication between providers, especially at points of transition in care.

Course ID #: TDE 210926.0 Issue Date: 6/24/2021 Expiration Date: 6/24/2024


After completing this activity, learners will be able to:

  • Identify the safe target rate of sodium correction in the treatment of
    severe hyponatremia.
  • Evaluate the appropriate frequency of monitoring of patient sodium
    levels and neurological status during treatment of severe hyponatremia.
  • Identify the preferred hospital unit where a patient with severe
    hyponatremia should be admitted for treatment and monitoring.
  • Recognize the importance of clear communication between care providers regarding the patient’s condition and the goals of the plan of care, with particular attention to transitions in care (i.e., during shift
    changes, or when the patient transitions from the ER to an inpatient unit, or when another physician covers or assumes care).
  • Develop strategies to reduce risk for a malpractice claim involving mismanagement of hyponatremia correction.


No individual in a position to control or influence the content of this activity has reported relevant financial relationships with commercial interests. No commercial support was provided for this activity.


The information and guidelines contained in this activity are generalized and may not apply to all practice situations. We recommend that legal advice be obtained from a qualified attorney for specific application to your practice. The information is intended for educational purposes and should be used as a reference guide only.

Course Developers

Melissa Nelson, RN, BSN, Senior Patient Safety Analyst, Department of Patient Safety and Risk Management The Doctors Company

Susan Shepard, MSN, MA, RN, CPHRM, Senior Director, Patient Safety and Risk Management Education, Department of Patient Safety and Risk Management, The Doctors Company

Johanna Lackner, MPH, MSW, Senior Director, Continuing Professional Development, Department of Patient Safety and Risk Management, The Doctors Company

Continuing Education Credit

The Doctors Company is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical educational activities for physicians.

The Doctors Company designates this activity for a maximum of 0.5 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Complies with State Requirements

Please SEE the Federation of State Medical Boards overview of Continuing Medical Education requirements by State. 

Technical Requirements

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Visit our Resource document for this program.