Review Note
Last Update: 09/18/2024 11:09 PM
Current Deck: Pato Qx examen
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Commit #151998
Hiponatremia
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Commit #151998
Etiologia:
Tratamiento:
Tratamiento:
The goal of treating acute and/or severely symptomatic hyponatremia is the rapid increase of serum sodium with hypertonic saline to reverse neurological symptoms and prevent brain herniation. Early specialist consultation (intensive care, nephrology) is advised.
- Indications (any of the following): [1]
- Severely symptomatic hyponatremia (regardless of onset)
- Symptomatic acute hyponatremia (< 48 hours)
- Asymptomatic acute hyponatremia (< 48 hours) with decrease in Na+ concentration of > 10 mEq/L [8]
- Suspected or known increased ICP or intracranial pathology
- Initial sodium goal: ↑ serum sodium 1–2 mEq/L/hour until an increase of 4–6 mEq/L has been reached within 6 hours [1]
- Regimens for rapid correction
- Severely symptomatic hyponatremia: hypertonic saline bolus (e.g., 3% NaCl DOSAGE) [1]
- Acute hyponatremia without severe symptoms: hypertonic saline infusion (e.g., 3% NaCl infusion DOSAGE) [1][8]
- Consider adding desmopressin DOSAGE to prevent overcorrection in patients with sodium < 120 mEq/L. [26]
- Further management and sodium goals: Once the acute sodium goal has been reached, start cause-specific treatment.
- For acute hyponatremia: Recommendations vary; consider rapid autocorrection vs. slower correction goals. [1][8]
- For chronic hyponatremia: See “Sodium correction rates for chronic hyponatremia.”
- Monitoring
- Serial serum sodium measurement
- While receiving hypertonic saline bolus: every 20 minutes until symptoms resolve [8]
- After the initial goal is reached: every 2–4 hours, then every 6–12 hours after stabilization [8][20]
- Monitor urine output closely (e.g., every hour).
- Serial serum sodium measurement