- Classically, classified based on tonicity and volume status, but consider acuity when treating in emergency department.
- Do not feel you have to treat asymptomatic patients while in the ED.
- 1 ml/kg 3% saline will raise sodium by 1 mEq – start with 100 mL over 10-60 min and re-evaluate.
- Do not exceed 6 meq in 24 hours (consider D5W 6mL/kg and 1 mcg DDAVP if you overshoot).
- Send labs for admitting team to help with work up including urine electrolytes/osm, UA, serum osmoles, uric acid.
- Acute (salt ingestions or DI with acute inability to obtain water)
– 3-6 mL/kg/hr D5W with goal to decrease serum sodium by 1-2 meq/L/hr
- Chronic – 1.35 mL/kg/hr D5W with a goal to lower no more than 10 mEq/L in 24