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 #Osmotic #Demyelination #Syndrome #ODS #goals #limits #management #hyponatremia
