From the Guidelines
No, 3% saline 100ml should not be given over 15 minutes, as the recommended administration for severe symptomatic hyponatremia is up to three 100 mL boluses of 3% sodium chloride solution spaced at 10-min intervals, not continuously over 15 minutes. This approach is based on current consensus guidelines to correct symptoms in severe cases of EAH, with presenting symptoms of confusion, seizures, or coma 1. When administering hypertonic saline, close monitoring is essential as too rapid correction can lead to osmotic demyelination syndrome.
- Vital signs, neurological status, and serum sodium levels should be checked frequently during and after infusion.
- The patient should be on continuous cardiac monitoring due to potential cardiac effects of rapid sodium shifts.
- The recommended approach is to administer small boluses with frequent reassessment rather than continuous infusion when possible. For patients with severe symptoms like seizures or coma due to hyponatremia, the bolus administration spaced at 10-min intervals may be appropriate, but for less severe presentations, a slower rate might be preferred. The goal is typically to raise serum sodium by no more than 6-8 mEq/L in 24 hours to avoid neurological complications, as seen in studies of marathon runners with EAH 1.
From the Research
Administration of 3% Saline
- The administration of 3% saline is a common practice in the treatment of severe hyponatremia and elevated intracranial pressure 2, 3, 4.
- The optimal dose and administration rate of 3% saline are still under debate, with some studies suggesting that a bolus of 250 mL may be more effective than 100 mL in correcting severe hyponatremia 3.
- However, the question of whether 3% saline 100ml can be given over 15 minutes is not directly addressed in the provided studies.
Safety of Administration
- The safety of administering 3% saline via peripheral intravenous access has been assessed in several studies, with results indicating a low rate of complications such as infiltration, phlebitis, and venous thrombosis 5.
- The overall incidence of complications was found to be relatively low, with infiltration occurring in 3.3% of cases, phlebitis in 6.2%, and venous thrombosis in 1% 5.
Considerations for Administration
- When administering 3% saline, it is essential to monitor the patient's serum sodium concentration closely to avoid overcorrection, which can lead to osmotic demyelination 2, 6.
- The choice of treatment for severe hyponatremia depends on the underlying cause and the patient's clinical presentation, with some patients benefiting from infusion of desmopressin or vasopressin inhibitors 6.
- While the provided studies do not specifically address the administration of 3% saline 100ml over 15 minutes, they do emphasize the importance of careful monitoring and individualized treatment plans in the management of severe hyponatremia 2, 3, 6.