What are the guidelines regarding the treatment of true hypotonic hyponatremia?

Updated: Jun 17, 2019
  • Author: Eric E Simon, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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The European Society of Intensive Care Medicine, the European Society of Endocrinology, and the European Renal Association–European Dialysis and Transplant Association have released guidelines on the diagnosis, classification, and treatment of true hypotonic hyponatremia. Treatment recommendations include the following [2] :

  • For serious symptomatic hyponatremia, the first line of treatment is prompt intravenous infusion of hypertonic saline, with a target increase of 6 mmol/L over 24 hours (not exceeding 12 mmol/L) and an additional 8 mmol/L during every 24 hours thereafter until the patient’s serum sodium concentration reaches 130 mmol/L
  • First-line treatment for patients with SIADH and moderate or profound hyponatremia should be fluid restriction; second-line treatments include increasing solute intake with 0.25–0.50 g/kg per day of urea or combined treatment with low-dose loop diuretics and oral sodium chloride
  • For patients with reduced circulating volume, extracellular volume should be restored with an intravenous infusion of 0.9% saline or a balanced crystalloid solution at 0.5 to 1.0 mL/kg per hour
  • Lithium, demeclocycline, and vaptans are not recommended for patients with moderate or profound hyponatremia

Consultation with either a nephrologist or a critical care specialist is often of considerable value in managing patients with symptomatic or refractory hyponatremia.

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