From the Guidelines
Sodium chloride tablets are not recommended as a first-line treatment for mild to moderate hyponatremia, and their use should be approached with caution due to the risk of osmotic demyelination syndrome. For patients with mild hyponatremia (Na 126-135 mEq/L) in cirrhosis without symptoms, no specific management apart from monitoring and water restriction is required, as stated in the 2021 practice guidance by the American Association for the Study of Liver Diseases 1. In cases of moderate hyponatremia (120-125 mEq/L), water restriction to 1,000 mL/day and cessation of diuretics is recommended, with a more severe restriction of water intake and albumin infusion considered for severe hyponatremia (<120 mEq/L) 1. The use of hypertonic saline is generally reserved for short-term treatment of patients with symptomatic or severe hyponatremia, or those with imminent liver transplant, with the goal of increasing serum sodium by 4-6 mEq/L per 24-hour period, not to exceed 8 mEq/L per 24-hour period to mitigate the risk of osmotic demyelination syndrome 1. Key considerations in the management of hyponatremia include:
- Regular monitoring of serum sodium levels
- Adequate fluid restriction
- Avoidance of overly rapid correction of serum sodium
- Individualized treatment based on the severity of hyponatremia, body weight, and underlying causes. It is essential to prioritize the prevention of osmotic demyelination syndrome and other complications when managing hyponatremia, and sodium chloride tablets should only be used under close medical supervision and with careful consideration of the potential risks and benefits.
From the Research
Treatment of Mild to Moderate Hyponatremia
- The treatment of mild to moderate hyponatremia depends on the underlying cause and the patient's fluid volume status 2, 3.
- For patients with euvolemic hyponatremia, treatment options include restricting free water consumption or using salt tablets or intravenous vaptans 2.
- Salt tablets can be an effective treatment for mild to moderate hyponatremia, especially in patients with euvolemic hyponatremia 2.
- The goal of treatment is to correct the serum sodium level at a rate of 4-6 mEq/L per day, without exceeding a total correction of 10 mEq/L in the first 24 hours 4, 2.
Important Considerations
- Overly rapid correction of hyponatremia can cause osmotic demyelination, a rare but severe neurological condition 4, 5.
- Patients with severe symptoms of hyponatremia, such as seizures or coma, require emergency treatment with hypertonic saline 4, 2.
- The treatment of hyponatremia should be individualized based on the patient's underlying condition and response to treatment 6, 3.
Recommendations
- Clinicians should identify the cause of hyponatremia and treat the underlying condition whenever possible 2, 3.
- Patients with hyponatremia should be monitored closely for signs of overly rapid correction, such as seizures or changes in mental status 4, 5.
- The use of salt tablets or other treatments for hyponatremia should be guided by the patient's serum sodium level and clinical symptoms 2, 3.