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Hyponatraemia: Difference between revisions
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== Management == | == Management == | ||
Mild hyponatraemia does not usually require hospitalisation, but moderate, severe, or symptomatic hyponatraemia requires hospitalisation. Sever hyponatraemia requires [[intensive care]]. | |||
Treatment depends on the underlying cause. Any drugs which can contribute to hyponatraemia should be discontinued if possible. Fluid restriction and increased intake of dietary salt is usually sufficient, but fluid restriction should not be used in those who are hypovolaemic. People who have symptomatic hyponatraemia require hospital admission. | Treatment depends on the underlying cause. Any drugs which can contribute to hyponatraemia should be discontinued if possible. Fluid restriction and increased intake of dietary salt is usually sufficient, but fluid restriction should not be used in those who are hypovolaemic. People who have symptomatic hyponatraemia require hospital admission. | ||
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=== Rate of correction === | === Rate of correction === | ||
Sodium levels must be corrected slowly to allow the body to reverse its compensatory mechanism to hypotonicity, especially in case of severe chronic hyponatraemia. Failure to do this will causes the serum osmolality to increase faster than the intracellular osmolality, which causes osmotic demyelination syndrome. | |||
The sodium level should not increase more than (all of the following): | |||
* 0,5 mmol/L per hour | |||
* 10 mmol/L per the first 24 hours | |||
* 18 mmol/L per the first 48 hours | |||
In severe cases, the sodium level should increase even more slowly, not more than 6-8 units per 24 hour. | |||
== Complications == | |||
=== Osmotic demyelination syndrome === | |||
Osmotic demyelination syndrome (ODS), previously called central pontine myelinolysis, is a complication of too rapid correction of severe chronic hyponatraemia. This is rare in case of sodium levels above 120 mmol/L or if the hyponatraemia has occured within a few days (as the body's compensatory mechanisms haven't kicked in yet). | |||
Symptoms of ODS occur a few days after the correction, and include cerebellar symptoms and other neurological deficits. Some may experience locked-in syndrome. | |||