Hyponatremia

Hypertonic Saline

  • Definitely give for seizure, some would give for any neuro dysfunction or imaging findings of cerebral edema
  • HTS – 3% x 100 ml over 10-15 min – can give 3 x if needed for seizures
  • Wt-based/Peds dosing – 2 ml/kg up to max of 100 ml
  • Good to get urine sample prior to HTS if possible
  • Each 100 ml will raise serum level ~ 2 mmol/L

Correction goals and Overcorrection

  • 6 mmol/L in the first 24 hrs for people with chronic hyponatremia
  • 6 mm/L in 6 hrs for severe symptoms – then stop
  • For overcorrection – DDAVP 1-2 mcg IV x 1

Workup

  • Volume status assessment – e.g . US
  • Labs including osmolality and LFTs
  • Urine studies – Urine osm, Urine Na, Urine Cr, Urine urea (if on diuretics)
  • Cortisol and TSH

Etiologies

  • Drugs for SIADH – Thiazides, SSRI, opioids, sulfonylureas