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General / Metabolic

Corrected Sodium in Hyperglycemia

Adjusts measured sodium for high glucose, which artificially lowers sodium by drawing water into the vascular space - important before diagnosing true hypo/hypernatremia in DKA or HHS.

What is corrected sodium in hyperglycemia?

High blood glucose draws water osmotically into the vascular space, diluting serum sodium without reflecting a true change in total body sodium or water balance - a phenomenon called pseudohyponatremia or translocational hyponatremia. This matters most in diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), where glucose is often markedly elevated and the measured sodium can look falsely low.

How to calculate corrected sodium

Two correction formulas are in common use:

Both use glucose in mg/dL. Katz is the traditional, more commonly taught formula. Hillier's study suggested the correction factor is larger than originally thought, especially at very high glucose levels (e.g. above 400 mg/dL), which is why this calculator shows both.

Interpretation

Once corrected, interpret the result like any other sodium value: roughly 135-145 mEq/L is normal. If the corrected sodium is still low, that supports a true hyponatremia requiring its own workup rather than one fully explained by hyperglycemia alone.

References

Katz MA. Hyperglycemia-induced hyponatremia - calculation of expected serum sodium depression. N Engl J Med. 1973. Hillier TA, Abbott RD, Barrett EJ. Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med. 1999.

See also: Electrolyte Disorders Guide — sodium, potassium, and calcium.

Frequently Asked Questions

Which formula should I trust — Katz or Hillier?

Katz is the traditional, more commonly taught formula. Hillier's correction factor is larger and may be more accurate at very high glucose levels (above roughly 400 mg/dL).

Does this calculator diagnose hyponatremia?

No — it only removes the dilutional effect of high glucose. If the corrected value is still low, that supports true hyponatremia needing its own workup.