Management of Hyponatremia

Hypertonic Saline - Only indicated if patient has severe symptoms + Na < 125

Give a Bolus of 150mL of 3% NaCl over 30 min. Dicsuss with a senior. (Max of 3 doses)

 • Target rise of 4-6 mmol/L over 3-4 hours

 • Check levels after infusion of Hypertonic Saline

 • If still symptomatic after 3 doses - consider ITU review

 • The target for correction over 24 hours including the hypertonic saline correction is 10 mmol/L

Raised ECF volume

 • Offer Fluid Restriction for all

 • Heart Failure - Add Diuretics.

 • Cirrhosis - Correct K & Albumin. Add Diuretics, Consider K-opoid agonists

 • Discuss with endocrinology consultant about use of Tolvaptan if not improving adequately

Normal ECF Volume

 • Consider Fluid restriction for all FEUrate > 11%

 • If not improving in 24 hours — discuss with endocrinology about adding Tolvaptan

 • Rpt. FE Urate post correction - Normalizes in SIADH

 • IF SIADH — look for cause

Reduced ECF Volume

 • Consider correction with N. Saline

 • Calculate water deficit + ongoing losses

 • Calculate correction rate for Na

 • Check Na levels 6 hourly

 • Identify Cause and give specific treatment

 • Additional considerations: Addison's, Renal Tubular Acidosis. TFT



- Dr. Jonny Wilkinson @Wilkinsonjonny



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