- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02887469
Efficacy and Safety of Rapid Intermittent Compared With Slow Continuous Correction in Severe Hyponatremia Patients
Efficacy and Safety of Rapid Intermittent Correction Compared With Slow Continuous Correction With Hypertonic Saline in Patient With Moderately Severe or Severe Symptomatic Severe Hyponatremia (SALSA Trial)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
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Seoul, Korea, Republic of
- Seoul National University Boramae Hospital
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Gyeonggi-do
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Hwaseong-si, Gyeonggi-do, Korea, Republic of, 445-907
- Hallym University Dongtan Sacred hospital
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Seongnam, Gyeonggi-do, Korea, Republic of, 13605
- Seoul National University Bundang Hospital Clinical Trial Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- In emergency setting (2016.6-) and/or inpatients at ward (2018.9-)
- Glucose corrected serum sodium ≤125 mmol/L
Patients with moderately severe or severe symptom
Moderately severe
:Nausea without vomiting Drowsy, Headache General weakness, myalgia
- Severe :Vomiting, Stupor, Seizures, Coma (Glasgow Coma Scale ≤8)
- written consent
Exclusion Criteria:
Pseudohyponatremia: serum osmolality > 275 mOsm/kg
- If the serum osmolality is > 275 mOsm/kg but the BUN is ≥ 30 mg/dL, the patients can be registered if calculated serum osmolality (2 x plasma [Na] + [Glucose]/18) is <275 mOsm/kg
- Primary polydipsia: urine osmolality ≤ 100 mOsm/kg
- Glucose corrected serum sodium >125 mmol/L
- Arterial hypotension (SBP <90mmHg and MAP <70mmHg)
- Anuria or urinary outlet obstruction
Liver disease
- transaminase levels >3 times the upper limit normal
- Known LC with ascites or diuretics use or PSE Hx or Varix Hx
- Uncontrolled diabetes mellitus (HbA1C > 9%)
- Women who are pregnant or breast feeding
- History of cardiac surgery excluding PCA, acute myocardial infarction, sustained ventricular tachycardia, ventricular fibrillation, acute coronary syndrome, cebrovascular trauma, and increased intracranial pressure within the 3 months prior to randomization
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Intermittent bolus group
<<Within 6hr>>
<additional treatment> Repeat 3% saline 2ml/kg over 20min at every sample time point (at 1/6hr) till Na 5-9 mmol/L inc from initial Na and sx relief <<During 6-24hr>> - Moderately Severe or Severe : Repeat 3% saline 2ml/kg over 20min at every sample time point(at 12/18/24hr) till Na 5-9 mmol/L inc from initial Na and sx relief <<During 24-48hr>>
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The same as above
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Active Comparator: slow continuous infusion group
<<Within 24hr>> - Moderately Severe: 3% saline 0.5ml/kg/hr (unknown bwt 25ml/hr) - Severe: 3% saline 1ml/kg/hr (unknown bwt 50ml/hr) Infusion protocol modification as below by Na at every sample time point (at 1/6/12/18/24 hr) If Na 5-9 mmol/L inc from initial Na and sx relief : stop 3% saline infusion regardless of △ Na if △ Na inc <0.5mmol/hr or △ Na inc <3mmol/6hr : add 0.25ml/kg/hr, restart 0.5ml/kg/hr if previously stopped if △ Na inc ≥0.5mmol/hr or △ Na inc ≥ 3mmol/6hr : maintain infusion rate <<During 24-48hr>> - Moderately Severe and Severe Infusion protocol modification as below by Na at every sample time point (at 30/36/42/48hr) If Na 10-17 mmol/L inc from initial Na or Na ≥ 130mmol and sx relief : stop 3% saline infusion regardless of △ Na if △ Na inc <1.5mmol/6hr : add 0.25ml/kg/hr or restart 0.25ml/kg/hr if previously stopped if △ Na inc ≥ 1.5mmol/6hr : maintain infusion rate |
The same as above
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of overcorrection rate at any given period
Time Frame: up to 48 hours
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Increase in sNa by >12 mmol/L within 24 hours or Increase in sNa by >18 mmol/L within 48 hours All subjects receive hypertonic saline by intermittent bolus or slow continuous infusion for 48 hours, serum Na will be measured.
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up to 48 hours
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rapid improvement of symptoms
Time Frame: up to 24 hours
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Change of symptoms from baseline to 24 hours after hypertonic fluid treatment
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up to 24 hours
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Time from treatment initiation to an increase of serum Na ≥ 5 mmol/L
Time Frame: up to 48 hours
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up to 48 hours
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Incidence of target correction rate
Time Frame: up to 48 hours
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Target correction rate is defined by achieved serum Na <10 mmol/L within 24 hours, achieved serum Na <18 mmol/L within 48 hours
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up to 48 hours
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Time to serum Na >130 mmol/L
Time Frame: up to 48 hours
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Time from treatment initiation to achieved serum Na> 130mmol/L
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up to 48 hours
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Length of hospital stay
Time Frame: up to 8 weeks
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up to 8 weeks
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Incidence of additional treatment
Time Frame: up to 48 hours
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Additional treatment is performed if symptom is not relieved or undercorrection develops (achieved Na < 5mmol/L with 24 hours or achieved Na <12mmol/L within 48 hours)
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up to 48 hours
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Incidence of osmotic demyelinating syndrome confirmed by ICD -10 code or MRI
Time Frame: up to 48 hours
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up to 48 hours
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Incidence of relowering treatment
Time Frame: up to 48 hours
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Relowering treatment is performed as below if achieved serum Na is <10 mmol/L within 24 hours, achieved serum Na is <18 mmol/L within 48 hours.
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up to 48 hours
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Change of Glasgow coma scale (GCS) ≤8
Time Frame: up to 48 hours
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Change in GCS of hyponatremia symptoms at pretreatment, 24 hours, and 48 hours after treatment
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up to 48 hours
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Seon Ha Baek, PhD, Hallym University Dongtan Sacred hospital
Publications and helpful links
General Publications
- Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, Decaux G, Fenske W, Hoorn EJ, Ichai C, Joannidis M, Soupart A, Zietse R, Haller M, van der Veer S, Van Biesen W, Nagler E; Hyponatraemia Guideline Development Group. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol. 2014 Feb 25;170(3):G1-47. doi: 10.1530/EJE-13-1020. Print 2014 Mar. Erratum In: Eur J Endocrinol. 2014 Jul;171(1):X1.
- Baek SH, Jo YH, Ahn S, Medina-Liabres K, Oh YK, Lee JB, Kim S. Risk of Overcorrection in Rapid Intermittent Bolus vs Slow Continuous Infusion Therapies of Hypertonic Saline for Patients With Symptomatic Hyponatremia: The SALSA Randomized Clinical Trial. JAMA Intern Med. 2021 Jan 1;181(1):81-92. doi: 10.1001/jamainternmed.2020.5519.
- Lee A, Jo YH, Kim K, Ahn S, Oh YK, Lee H, Shin J, Chin HJ, Na KY, Lee JB, Baek SH, Kim S. Efficacy and safety of rapid intermittent correction compared with slow continuous correction with hypertonic saline in patients with moderately severe or severe symptomatic hyponatremia: study protocol for a randomized controlled trial (SALSA trial). Trials. 2017 Mar 29;18(1):147. doi: 10.1186/s13063-017-1865-z.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- B1605346003
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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