Sodium Derrangements - Dr. West

Hyponatremia
- 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.


Hypernatremia
- 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 

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