Given that the target rise in sodium over the first day is ~6 mM, after the initial increase in sodium, fluid intake is stopped for one day causing the sodium to be stable. Boluses of hypertonic therapy are provided initially to improve symptoms and raise the sodium by ~5 mM.
#Istat sodium low free
DDAVP is started immediately to block renal free water excretion. If volume overload occurs, this may be managed with furosemide.Īn example of how this strategy would work for a patient with severe symptomatic hyponatremia is shown below.100 ml of D5W will negate the effect of ~30ml of 3% NaCl) Medications formulated in D5W should be avoided if possible, or otherwise taken into account (e.g.40 mEq KCl tablet is roughly equivalent to ~80ml of 3% NaCl). Potassium supplementation should be taken into account as this is osmotically equivalent to sodium (e.g.Oral fluid intake must be restricted while on DDAVP.
This differs from approaches based on treatment of the underlying problem and waiting for the kidneys to excrete free water.
The key point is that the sodium is increased by a direct effect of the infused solutions. For a patient requiring volume resuscitation, a large volume of normal saline could be used as well. Of course, hypertonic bicarbonate could also be used, as discussed last week.
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