On 2014 Jun 19, Swapnil Hiremath commented:

This guideline was discussed on June 10th 2014 on the open online nephrology journal club, #NephJC, on twitter. Introductory comments are available on PBFluids and at the NephJC website. It was quite a spirited discussion, with participation from nephrologists, clinical pharmacologists, internists, and more. A transcript and three different curated (i.e. Storified) versions of the tweetchat are available at the same NephJC link.

On June17th 2014, we conducted a video chat via Google Hangout, among the NephJC editors, Dr Richard Sterns and Dr Hatim Hassan, an archived version of which can be viewed on Youtube.

The highlights of the tweetchat and the hangout were: 1. These guidelines are extensive and exhaustive and will serve as an extremely useful resource for students, residents and practicing physicians. 2. There was widespread agreement that 'asymptomatic' hyponatremia is rarely asymptomatic, and doing away with that qualifier is a good move. 3. The recommendation against use of vasopressin antagonists in chronic hyponatremia is appropriate given lack of superiority in comparison against standard treatment, and possibility of neurological sequelae from rapid correction (and the high cost of these agents remains a concern). 4. The empiric treatment with hypertonic saline in hyponatremic patients with moderate to severe symptoms will be quite handy, particularly since the intricate calculations otherwise needed are often found to be daunting. 5. The lack of strong evidence (made especially apparent by the use of the GRADE methodology) is disappointing, especially given how common hyponatremia is, and highlights a need for future research.

Interested individuals can track and join in the conversation by following @NephJC or #NephJC, or visit the webpage at NephJC.com.

This comment is cross-posted at the other two versions of the guidelines also.

On 2014 Jun 19, Swapnil Hiremath commented:

This guideline was discussed on June 10th 2014 on the open online nephrology journal club, #NephJC, on twitter. Introductory comments are available on PBFluids and at the NephJC website. It was quite a spirited discussion, with participation from nephrologists, clinical pharmacologists, internists, and more. A transcript and three different curated (i.e. Storified) versions of the tweetchat are available at the same NephJC link.

On June17th 2014, we conducted a video chat via Google Hangout, among the NephJC editors, Dr Richard Sterns and Dr Hatim Hassan, an archived version of which can be viewed on Youtube.

The highlights of the tweetchat and the hangout were: 1. These guidelines are extensive and exhaustive and will serve as an extremely useful resource for students, residents and practicing physicians. 2. There was widespread agreement that 'asymptomatic' hyponatremia is rarely asymptomatic, and doing away with that qualifier is a good move. 3. The recommendation against use of vasopressin antagonists in chronic hyponatremia is appropriate given lack of superiority in comparison against standard treatment, and possibility of neurological sequelae from rapid correction (and the high cost of these agents remains a concern). 4. The empiric treatment with hypertonic saline in hyponatremic patients with moderate to severe symptoms will be quite handy, particularly since the intricate calculations otherwise needed are often found to be daunting. 5. The lack of strong evidence (made especially apparent by the use of the GRADE methodology) is disappointing, especially given how common hyponatremia is, and highlights a need for future research.

Interested individuals can track and join in the conversation by following @NephJC or #NephJC, or visit the webpage at NephJC.com.

This comment is cross-posted at the other two versions of the guidelines also.