Table 3.

Learning points

•Osmotic demyelination is the major complication to avoid when treating a patient with severe chronic hyponatremia.

•The aim is to slowly correct the serum sodium by 6 to 8 mmol/l per day; this can be extremely challenging when combined with oligoanuric renal failure.

•Continuous renal replacement therapy (CRRT) with customized replacement fluid sodium concentrations provides clinicians with great control over the direction, magnitude, and timing of serum sodium concentration correction.

•Custom CRRT is a safe and efficacious therapeutic option that should be considered when managing severe hyponatremia combined with severe renal failure.