Archive for the ‘acute medicine’ Tag

Hyponatremia: acute correction of low sodium   Leave a comment

Sodium deficit (in mmol or mEq)
= body weight(kg) × (target Na – measured Na) × 0.6 (if male, or 0.5 for female)

  • set ‘target Na’ as 120mmol/L in the first 24 hours and calculate volume of solution required to correct Na deficit; infuse over 24 hours; most centres require the actual rate (in ml/h) to be calculated

  • then correct slowly to 130mmol/L in the next 24-48 hours

  • NEVER correct more than 10mmol/L in 24 hours (or 0.5mEq/L/h): patient may develop central pontine demyelinosis

  • use Na 0.9% as far as possible; reserve Na 3% for emergencies eg. coma, seizures, severe confusion, brainstem herniation where rapid correction is required (but never more than 0.5mEq/L/h).

  • in cases of heart/renal failure and volume overload, water restriction is required; consider iv frusemide.

  • asymptomatic chronic hyponatremia: no urgency to correct using iv saline; instead, investigate and address the cause.

Concentration of Na in various forms:
NaCl 0.9%: 154mEq in 1L (ie. normal saline)
NaCl 3%: 513mEq in 1L
NaCl 300mg tabs: 5mEq per tab