From the Research
A critical sodium level is generally considered to be below 120 mmol/L or above 160 mmol/L, requiring immediate medical attention. For severe hyponatremia (low sodium), treatment typically involves careful administration of hypertonic saline (3% NaCl) at 1-2 mL/kg/hr, with the goal of increasing sodium by 4-6 mmol/L in the first 24 hours to prevent cerebral edema while avoiding too rapid correction which can cause osmotic demyelination syndrome, as recommended by recent studies 1.
Key Considerations
- The underlying cause must be identified and addressed simultaneously, whether it's dehydration, medication effects, endocrine disorders, or other conditions.
- Frequent monitoring of serum sodium levels (every 2-4 hours initially) is essential during correction of critical sodium imbalances, along with neurological assessments, as both conditions can cause altered mental status, seizures, and potentially coma if not properly managed.
- For severe hypernatremia (high sodium), treatment focuses on controlled rehydration with hypotonic fluids like 0.45% saline or 5% dextrose in water, correcting at a rate not exceeding 10 mmol/L per day to prevent cerebral edema, although recent evidence suggests that the rate of correction may not be as critical as previously thought 2.
Treatment Approaches
- Hypertonic saline is used to treat severe symptomatic hyponatremia, with the goal of increasing sodium levels gradually to prevent complications 3, 4.
- Desmopressin may be used concomitantly with hypertonic saline to prevent rapid correction of serum sodium, especially in cases where a water diuresis is anticipated 4, 1.
- The treatment of hypernatremia involves correcting the underlying cause and correcting the free water deficit, with careful monitoring to avoid overcorrection 5, 2.