Goals and limits for treatment of Hyponatremia Stratified by duration and risk of Osmotic Demyelination Syndrome (ODS)

Acute Hypotonic Hyponatremia (duration verified to be <48h)

Severe symptoms

 • Goal: Rapid increase by 4—6 mEq/L. then gradual increase to normalization

 • Rapidly increase serum Na by 4—6 mEg/L with up to three 100 mL boluses of hypertonic saline given over 10 min at a time, followed by hypertonic saline at 1 mL/kg/h until substantial normalization

Mild or moderate symptoms

 • Goal: Normalization

 • Fluid restriction alone if etiology rapidly reversible. Otherwise, hypertonic saline at 1 mL/kg/h until substantial normalization

Chronic Hypotonic Hyponatremia (duration known to be >48h or duration uncertain)

Severe, moderate, or mild symptoms

 • Goal: 4-6 mEq/L in 24h 

 • Limit: 8 mEq/L in any 24h period

Moderate or mild symptoms

 • Goal: Normalization

 • Limit: Normalization



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