Nephrology Book

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Hyponatremia Management

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  1. See Specific Hyponatremia Management Protocols
    1. Hyperosmolar Hyponatremia (Serum Osms >300)
    2. Hypoosmolar Hyponatremia (Serum Osms <280)
      1. Hypovolemic Hypoosmolar Hyponatremia
      2. Isovolemic Hypoosmolar Hyponatremia
      3. Hypervolemic Hypoosmolar Hyponatremia
    3. Normoosmolar Hyponatremia (Serum Osms 280-300)
  2. Chronic Hyponatremia (develops over >48 hours)
    1. Avoid too rapid correction of Serum Sodium
    2. Risk of Central Pontine Myelinolysis
    3. Treat Hyponatremia based on Serum Osmolality (above)
    4. Do not use greater than normal saline (0.9%)
  3. Acute Hyponatremia (develops over <24 hours)
    1. Sodium corrected faster than chronic Hyponatremia
      1. Higher risk for cerebral edema from Hyponatremia
      2. Less risk of Central Pontine Myelinolysis
    2. Severe, symptomatic acute Hyponatremia
      1. Monitor closely in intensive care unit setting
      2. Initial correction until Serum Sodium increased 10%
        1. Furosemide (Lasix) 1 mg/kg
        2. Replace Urine Sodium and Urine Potassium losses
          1. Hypertonic Saline (3%: 513 meq/L) - controversial
          2. Normal Saline (0.9%)
      3. Later correction
        1. More gradual Serum Sodium correction
        2. Treat Hyponatremia based on Serum Osmolality
    3. Less severe or asymptomatic acute Hyponatremia
      1. Treat Hyponatremia based on Serum Osmolality
  4. Follow Serum Sodium Correction closely
    1. Limit hourly correction to <1.5-2.0 meq/L/hour
    2. Limit daily correction to <20 meq/L/day
  5. References
    1. Kone in Tisher (1993) Nephrology, p. 87-100
    2. Levinsky in Wilson (1991) Harrison's IM, p. 281-84
    3. Rose (1989) Acid-Base and Electrolytes, p. 601-38

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