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Treatment Options

Treatments

There are several different methods that physicians use to treat hyponatremia. Below is a list of some of these.

Demeclocycline*1–3

Fluid Restriction1,2

Hypertonic Saline2,3

Isotonic Saline3

Lithium1,2

Loop Diuretics*1–3

Urea*3

Vasopressin Receptor Antagonists (Vaptans)1,2

*Not FDA-approved for treatment of hyponatremia

Hyponatremia treatment approach depends on several criteria

These criteria include3,4:

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

Osmotic Demyelination

Watch a video discussing osmotic demyelination and how it can occur with hyponatremia.