slow continuous infusion therapies of hypertonic saline for patients with symptomatic hyponatremia: the SALSA randomized clinical trial. ![]() Risk of overcorrection in rapid intermittent bolus vs. Wilderness medical society clinical practice guidelines for the management of exercise-associated hyponatremia: 2019 update. Diagnosis and management of sodium disorders: hyponatremia and hypernatremia. Clinical practice guideline on diagnosis and treatment of hyponatraemia. ![]() Hyponatraemia Guideline Development Group. Spasovski G, Vanholder R, Allolio B, et al. Moderate hyponatremia is associated with increased risk of mortality: evidence from a meta-analysis. Verbalis JG, Barsony J, Sugimura Y, et al. Prevalence, incidence and etiology of hyponatremia in elderly patients with fragility fractures. Hyponatremia, falls and bone fractures: a systematic review and meta-analysis. Mild hyponatremia is associated with an increased risk of death in an ambulatory setting. Gankam-Kengne F, Ayers C, Khera A, et al. Hyponatremia, all-cause mortality, and risk of cancer diagnoses in the primary care setting: a large population study. Selmer C, Madsen JC, Torp-Pedersen C, et al. Age and gender as risk factors for hyponatremia and hypernatremia. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Verbalis JG, Goldsmith SR, Greenberg A, et al. Diagnosis and management of disorders of body tonicity-hyponatremia and hypernatremia: core curriculum 2020. When sodium is severely elevated, patients are symptomatic, or intravenous fluids are required, hypotonic fluid replacement is necessary. Treatment starts with addressing the underlying etiology and correcting the fluid deficit. Mild hypernatremia is often caused by dehydration resulting from an impaired thirst mechanism or lack of access to water however, other causes, such as diabetes insipidus, are possible. Hypernatremia is less common than hyponatremia. ![]() Hypervolemic hyponatremia is treated primarily by managing the underlying cause (e.g., heart failure, cirrhosis) and free water restriction. Treating euvolemic hyponatremia includes restricting free water consumption or using salt tablets or intravenous vaptans. Hypovolemic hyponatremia is treated with normal saline infusions. Management to correct sodium concentration is based on whether the patient is hypovolemic, euvolemic, or hypervolemic. Common causes include certain medications, excessive alcohol consumption, very low-salt diets, and excessive free water intake during exercise. ![]() Physicians should identify the cause of a patient's hyponatremia, if possible however, treatment should not be delayed while a diagnosis is pursued. Using calculators to guide fluid replacement helps avoid overly rapid correction of sodium concentration, which can cause osmotic demyelination syndrome. Patients with a sodium concentration of less than 125 mEq per L and severe symptoms require emergency infusions with 3% hypertonic saline. Severe symptoms of hyponatremia include delirium, confusion, impaired consciousness, ataxia, seizures, and, rarely, brain herniation and death. Mild symptoms include nausea, vomiting, weakness, headache, and mild neurocognitive deficits. Hyponatremia is considered mild when the sodium concentration is 130 to 134 mEq per L, moderate when 125 to 129 mEq per L, and severe when less than 125 mEq per L. Hyponatremia and hypernatremia are electrolyte disorders that can be associated with poor outcomes.
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