(4) Patients often have multifactorial hyponatremia. Hypertonic bicarbonate is usually the fastest medication to obtain in an emergency. Hyponatremia is defined as a serum sodium level of less than 135 mEq/L and is considered severe when the serum level is below 125 mEq/L. Fire off the hyponatremia lab panel (don't waste a lot of neurons on exactly which tests to get, just order them all and keep moving). These goals and limits were endorsed in a set of expert panel recommendations, published has been hyponatremic to guide treatment. pain, nausea, or medication), Severe, asymptomatic hyponatremia is the most worrisome (especially Na <110 mM), (c) Other risk factors for osmotic demyelination syndrome (30181129). recommends taking hyponatremia seriously, starting with a hard look at potential underlying Rare patients may be hypovolemic, in which case judicious volume resuscitation may be considered. Findings like these—published online Aug. 3, 2017, by the Journal of the American Heart Association—are particularly concerning given emerging evidence about the implications For example, the target [Na] at 24 hours would be 117 mEq/L in a patient with hypovolemic hyponatremia and initial [Na] of 111 mEq/L. Conflicts of interest: I never have conflicts of interest. “You don't want patients going from 105 to 131 [mEq per EMCrit is a trademark of Metasin LLC. a patient who is not at risk of osmotic demyelination syndrome, or 4 to 6 mEq per 2017;6. for treating hyponatremia associated with SIADH, as the 2013 expert panel recommendations This is completely backwards. over subsequent days of treatment, as patients' serum sodium levels gradually increase. Elderly man with chronic hyponatremia, Na of 125 mM, asymptomatic: This might not even warrant hospital admission, don't get too excited about it. The kidneys will excrete any exogenous urea in the urine, along with water. However, a crude estimate can be obtained by looking at the urine specific gravity. concentration as a function of dose-infused hypertonic saline, Dr. Greenberg said. Normal saline causes an initial increase in serum sodium concentration because it “Urine osmolality, plasma osmolality, and urine sodium are Cirrhosis rarely causes severe hyponatremia. If urea is used, it should be closely monitored. An aberrantly low sodium may result from drawing electrolytes upstream from a hypotonic infusion. sodium concentration, Dr. Greenberg said. Exactly when treatment is beneficial is unclear. in hand at least every four hours when hypertonic saline is administered or if patients often follow a “one-size-fits-all” approach, which can undermine efficacy, Acute hyponatremia merits rapid correction to prevent brain herniation, but overtreatment Acute hyponatremia merits rapid correction to prevent brain herniation, but overtreatment of hyponatremia can lead to osmotic demyelination syndrome.
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