Treatment of Hyponatremia

Question 1

treatment of hypo-osmolar hyponatrmia: treat underlying cause and restrict free water intake to:

Answer 1

<800ml/day

Question 2

how do you balance treatment for hyponatremia and cerebral edema.

Answer 2

• you need to raise [Na] quickly to shift fluid from intracellular compartment.
• Need to raise [Na] slowly to minimize shift of fluid from intracellular compartment

Question 3

treatment timeline for hyponatremia

Answer 3

If symptoms & chronic–>rapid Rx to treat symptoms then chronic target
- Chronic hyponatremia if > 48 hours or duration unknown and no obvious source of excess water intake

Question 5

outline the process of giving sodium in hyponatremia for acute and chronic conditions

Answer 5

Question 6

Treatment of [hypo-osmolar] hyponatremia
If giving crystalloid, this should be ___ to urine

Answer 6

hypertonic to urine

Hyponatremia was developed in isotonic saline. You need higher amounts of sodium than isotonic saline.

Question 8

Dynamic approach to hypo[Na] Rx

Answer 8

1. hypertonic saline; Tonicity of fluid given needs to be greater than the tonicity in the urine, or else you’d just give them even more dilution.
2. water intake reduction
3. renal loss

Question 9

note

Question 10

treatment plan?

Answer 10

1. Treat underlying cause– antibiotics for CAP
2. Restrict fluid intake
3. This person is symptomatic– she is confused– we need to rapidly increase serum Na by giving 100ml of hypertonic saline.
4. Does this patient have chronic hyponatremia? The sodium was low when they came in– it’s over than 48 hours, then yes it is chronic. We need to set up 8mm/24 hours. 80kgx40L(total body water)= 320mmol in 24 hours, so follow bolus with 269 mmol Na.
   A. We must ensure the fluid we’re gonna give is hypertonic compared to urine. We can’t use normal saline based on her sodium urine, therefore we need to give 269 mmol in 24 hours (569ml over 24 hours), and the rate of hypertonic saline is 22 ml/hr.