Hyponatremia — Quick Review

Presenters: Richard Sterns, MD and Joseph Verbalis, MD (Georgetown University)

The key learning points from the session:
Goals for correction of symptomatic acute hyponatremia

1st 6 hrs: ~6meg/L
1st 24 hrs: 6–8meq/L
1st 48 hrs: 18meq/L

According to the presenters, normal saline is not recommended any more.

Hypertonic saline: hot shot boluses or 3% HS are recommended for acute hyponatremia with severe neurological symptoms:

seizure, coma/stupor, respiratory arrest

Otherwise with mild or moderate symptomatology, vaptans are a good option. Vaptans would correct a little slower, but there is less risk of overcorrection and demyelinating lesions.

Fluid restriction for chronic mild hyponatremia with no symptoms is still appropriate.

Reintroduction of mild hyponatremia should be attempted in cases of overcorrection of hyponatremia with worsening mental status and may improve clinical findings.