Hypertonic Saline for Treatment of Hyponatremic Encephalopathy
1) 100 ml bolus of 3% NaCl over 10 min. May repeat until clinical response achieved with a goal of 5-6 mEq/L in the first 1-2 hours.
2) Serum sodium should be checked after each second or third bolus or Q 2 hours.
3) Stop further therapy with 3% saline when either:
a. Symptoms improve with patient being awake, alert, responsive with improved headache and nausea
b. Increase in sodium of 10 mEq/L in the first 5 hours.
4) Correction in the first 48 hours should not exceed 15-20 mEq/L.
5) Monitor urine output for signs of a free water diuresis and consider desmopressin to prevent or therapeutically re-lower overcorrection.
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