Table 3.

Basic principles of hyponatremia management.

Determination of time onset of hyponatremia (acute < 48 h and chronic > 48 h).

Proper correction rate < 8–10 mEq/L/24 h.

Proper correction rate of 4–6 mEq/L/24 h in high risk conditions for ODS. Hypokalemia, malnutrition, advanced liver disease, alcoholism, serum sodium ≤ 105 mEq/L.

In acute symptomatic hyponatremia, administration of hypertonic saline solution (3% sodium chloride) is prudent.

In patients with SIADH, fluid restriction, furosemide, or vaptans are the major treatment options.

In hypovolemic patients and CSWS, fluid restriction, furosemide, and vaptans are contraindicated. Instead, isotonic saline solution may be administered.

CSWS: cerebral salt wasting syndrome, h: hours, ODS: osmotic demyelination syndrome, SIADH: syndrome of inappropriate secretion of antidiuretic hormone.