Approach to treatment-of-hyponatremia

• depends on volume status, acuity of hyponatremia, and if symptomatic

• Acute sx: initial rapid correction of [Na]serum (2 mEq/L/h for the first 2–3 h) until sx resolve

• Asx or chronic symptomatic: correct [Na]serum at rate of ≤0.5 mEq/L/h

• Rate ↑ Na should not exceed 6 (chronic) to 8 (acute) mEq/L/d to avoid central pontine myelinolysis/osmotic demyelination (CPM/ODS: paraplegia, dysarthria, dysphagia)

• If severe (<120) or neuro sx: consider 3% NaCl. dDAVP 1-2 µg q8h in consultation with nephrology (to prevent rapid overcorrection) (AJKD 2013;61:571; CJASN 2018; 13:641)