There are several different methods that physicians use to treat hyponatremia. Below is a list of some of these.
Vasopressin Receptor Antagonists (Vaptans)1,2
*Not FDA-approved for treatment of hyponatremia
Hyponatremia treatment approach depends on several criteria
Specific recommendations will not be mentioned here; however, it is important to point out critical differences in the treatment approaches based on the rate of onset of hyponatremia.
Treatment based on rate of onset of hyponatremia
Acute hyponatremia (<48 hours)
- Goal: Rapid and immediate treatment of hyponatremia to prevent the neurologic complications associated with acute hyponatremia3-5
- Treatment: Hypertonic saline (3% NaCl) infusion until an increase of 4-6 mmol/L in serum sodium concentration is achieved3,5
- Neurologic symptoms are typically present in cases of acute hyponatremia with serum sodium3 ≤120 mEq/L
Chronic hyponatremia (≥48 hours)
- Goal: Slow, cautious correction. A minimum correction of 4-8 mmol/L per day, or 4-6 mmol/L per day for patients with a high risk of osmotic demyelination. Correction rate should not exceed 10-12 mmol/L in the first 24 hours (or 8 mmol/L for the first 24 hours in patients at high risk of osmotic demyelination), AND total correction over the first 48 hours should not exceed3 18 mmol/L
- Douglas I. Hyponatremia: why it matters, how it presents, how we can manage it. Cleve Clin J Med. 2006;73(Suppl 3):S4-S12.
- Goldsmith SR. Current treatments and novel pharmacologic treatments for hyponatremia in congestive heart failure. Am J Cardiol. 2005;95(9A):14B-23B.
- Verbalis JG, Goldsmith SR, Greenberg A, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013;126(10 Suppl 1):S1-S42. doi:10.1016/j.amjmed.2013.07.006.
- Adrogué HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;343(21):1581-1589.
- Adrogué HJ, Madias NE. The challenge of hyponatremia. J Am Soc Nephrol. 2012;23(7):1140-1148.