Sodium Correction for Hyperglycemia

Search...

⌘K

Try AI Medical Scribe

Save 2+ hours daily with instant clinal dicumentation.

Start Free Trial

All tools /

Sodium Correction for Hyperglycemia

Adjusts serum sodium to reflect true levels in patients with high blood glucose

All tools /

Sodium Correction for Hyperglycemia

Adjusts serum sodium to reflect true levels in patients with high blood glucose

Correction Factor

Choose between Katz (1.6) or Hillier (2.4, for glucose >400 mg/dL)

Katz (1.6)Hillier (2.4)

Measured Serum Sodium

mEq/L

Serum Glucose

mg/dL

Corrected Sodium —

0/2 answered · enter values to update

Instructions

Measure serum sodium and blood glucose levels. For every rise in glucose above normal, adjust the sodium value upward by a correction factor to account for dilutional effects. Report the corrected sodium alongside the measured value to improve accuracy.

Overview

When to use

Why use

Evidences

Interpretation

Corrected Sodium Result	Meaning
Normal range (135–145 mEq/L)	True sodium is normal
Low after correction	True hyponatremia
High after correction	True hypernatremia

Katz factor (traditional): corrected Na = measured Na + 1.6 mmol/L × [(glucose mg/dL − 100) / 100], grounded in theoretical modeling and widely used in bedside calculators and legacy guidance.
https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.00477/full

Hillier factor (experimental): corrected Na = measured Na + 2.4 mmol/L × [(glucose mg/dL − 100) / 100]; in a clamp study of acute hyperglycemia in healthy volunteers, mean Na change was 2.4 per 100 mg/dL glucose, with nonlinearity above ~400 mg/dL where a factor near 4.0 performed better.
https://pubmed.ncbi.nlm.nih.gov/10225241/

Practical nuance: International consensus guidance for DKA/HHS acknowledges that serum sodium often rises by ~1.6 mmol/L for each 100 mg/dL fall in glucose early in treatment, but clinicians should individualize fluid choices based on measured osmolality trends rather than a single correction factor.
https://www.ccjm.org/content/ccjom/92/3/152.full.pdf

Corrected Na normal/eunatremic (≈135–145 mmol/L): hypertonicity largely from glucose; continue isotonic fluids initially, adding dextrose when glucose <250 mg/dL in DKA to allow ongoing insulin while avoiding hypoglycemia.
https://diabetesjournals.org/care/article/47/8/1257/156808/Hyperglycemic-Crises-in-Adults-With-Diabetes-A

Corrected Na high (>145 mmol/L): suggests significant free water loss via osmotic diuresis; after initial resuscitation, consider hypotonic solutions if osmolality is not declining appropriately and monitor sodium/tonicity closely to avoid overly rapid shifts.
https://www.ncbi.nlm.nih.gov/books/NBK279052/

Corrected Na low (<135 mmol/L): consider concomitant hyponatremic processes; evaluate measured/estimated osmolality, volume status, and potential SIAD or other etiologies while treating hyperglycemia.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7479837/

Overview

When to use

Why use

Evidences

Sodium correction for hyperglycemia is a clinical tool used to obtain a more accurate assessment of a patient’s sodium status when blood glucose is elevated. In hyperglycemia, excess glucose in the bloodstream increases plasma osmolality, leading to a shift of water from the intracellular to the extracellular space. This dilutional effect lowers the measured sodium concentration, creating a misleading impression of hyponatremia. Without correction, clinicians may underestimate the severity of hypernatremia or overdiagnose hyponatremia, potentially leading to inappropriate treatment.

Corrected sodium provides a truer reflection of a patient’s electrolyte balance and is particularly important in conditions such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), where accurate fluid and electrolyte management is critical. By applying a standard correction factor, clinicians can distinguish between dilutional changes caused by hyperglycemia and actual sodium imbalances.

This correction helps guide safe fluid resuscitation, prevents overly aggressive sodium replacement, and improves overall clinical decision-making. While the correction is not a substitute for continuous monitoring, it is a widely used and reliable adjustment in the acute management of hyperglycemic crises. Its simplicity and practicality make it a key step in evaluating patients with elevated blood glucose and altered electrolyte profiles.

Overview

When to use

Why use

Evidences

Interpretation

Corrected Sodium Result	Meaning
Normal range (135–145 mEq/L)	True sodium is normal
Low after correction	True hyponatremia
High after correction	True hypernatremia