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 #Hyponatremia #Management #algorithm #treatment #sodium
