In this episode, I’ll discuss why you don’t need to know the cause of severe, symptomatic hyponatremia before treating it.
Severe, symptomatic hyponatremia is characterized by a serum sodium < 125 mEq/L and symptoms such as seizure, mental status changes, respiratory depression, coma or obtundation.
Without immediate treatment, this can lead to cerebral edema, respiratory failure, permanent brain injury, or death. Such symptoms are generally seen when the hyponatremia develops acutely rather than chronically.
When a patient has severe, symptomatic hyponatremia, it should be promptly treated with hypertonic 3% saline. The simplest method is to give a 100 mL IV bolus of 3% saline, repeated up to 2 more times until symptoms resolve.
The goal is to produce a rapid but small increase in the serum sodium of about 4 mEq/L. This should be sufficient to quickly reverse the symptoms of severe hyponatremia and buy enough time to investigate the cause and develop a treatment plan.
Once symptoms resolve, it is important to determine what the cause of hyponatremia is before selecting the next course of treatment.
You can get a comprehensive training video of the treatment of severe hyponatremia and how to determine the cause from a pharmacist’s point of view as a member of my Hospital Pharmacy Academy. To learn more, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.