DR Medhat MRCP

B) TTT of hyponatremia without encephalopathy (conservative) :
If hypovolemic : slow correction with normal saline (slow to avoid
central pontine myelolysis & brain dehydration)
If euvolemic :
plain water restriction (< 5 cups/day) or to give oral
NaCl 600mg 4-8 tab/day + furosemide 20-40 mg/day.
If fluid overload : plain water restriction + furosemide 20-40 mg/day
C) TTT of hyponatremia with encephalopathy :
If acute ( 10 mmol/L/day & don’t correct to > 120-130.
- Na deficit = (desired Na- measured Na) x 0.6 x B.W (in kg)
- Administration of 3% NaCl should only be required in patients
with severely symptomatic hyponatremia (eg, seizures) or
potentially in patients with Serum Sodium Level of less than 110
mmol/L
- 1 L of 3% saline contains 513 mmol Na/L
- Volume of 3% Saline (L) = (Na Deficit)/513 mmol Na/L.
- Time Needed for Correction = (Desired Na – Measured Na)/0.5
mEq/L per hour.
- The Rate of Infusion of Hypertonic Saline
Rate = (Volume of 3% Saline)/(Time Needed for Correction)
If chronic (> 48 hrs) :
- Aim is to by 0.5 mmol/L/hr or until asymptomatic
- Don’t correct by >10 mmol/L/day.
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