Sodium Correction Rate (Hyponatraemia)

How to use it

1. 1

   Is hyponatraemia acute (< 48h) or chronic (≥ 48h)?. Acute: faster correction (2 mmol/L/h) safe. Chronic: max 0.5 mmol/L/h or 10 mmol/L/24h.

2. 2

   Seizures or coma. 3% saline bolus 2 mL/kg over 20 min — raise Na by ~5 mmol/L to terminate seizure.

3. 3

   Overcorrection danger. If Na rises > 10 mmol/L/24h: give dextrose 5% + desmopressin to re-lower Na slowly (ODS risk).

When to use it

Symptomatic hyponatraemia

Seizures, vomiting, GCS decrease: rapid initial correction (3% NaCl) then slow down.

SIADH management

Fluid restrict + urea or vaptans. Correct max 6 mmol/L/24h (ESPEN recommendation for chronic SIADH).

Marathon/beer potomania/psychogenic polydipsia

Acute dilutional: Na may correct rapidly with water restriction alone — monitor every 2h.