Why should salt tablets be stopped if sodium levels are low, specifically in cases of hyponatremia?

From the Guidelines

Salt tablets should be stopped if sodium levels are low (hyponatremia) because they can worsen the condition rather than help it. Hyponatremia often occurs not from insufficient sodium intake but from water retention or other mechanisms that dilute the blood's sodium concentration. Adding more salt through tablets can disrupt the body's careful efforts to restore balance and may lead to rapid changes in sodium levels, which can cause serious neurological complications including cerebral edema, seizures, or even death 1.

The appropriate treatment for hyponatremia depends on its cause—whether it stems from excessive fluid intake, certain medications, hormonal disorders, heart failure, or kidney disease. Treatment typically involves addressing the underlying cause, fluid restriction, and in severe cases, carefully administered intravenous sodium solutions under close medical supervision. For example, in cases of hypovolaemic hyponatraemia, management requires expansion of plasma volume with normal saline and cessation of diuretics 1.

In cases of hypervolaemic hyponatraemia, which is more common in cirrhosis, many hepatologists recommend fluid restriction of between 1 and 1.5 L/day in the presence of severe hyponatraemia (serum sodium <125 mmol/L) 1. However, it is essential to note that sodium restriction and not fluid restriction results in weight loss as fluid passively follows the sodium. Patients with hyponatremia should seek medical attention rather than self-medicating with salt tablets, as proper diagnosis and treatment require blood tests and medical expertise to safely correct sodium levels at an appropriate rate.

Key considerations in managing hyponatremia include:

• Addressing the underlying cause of hyponatremia
• Fluid restriction in severe cases
• Careful administration of intravenous sodium solutions under medical supervision
• Avoiding self-medication with salt tablets to prevent worsening of the condition
• Monitoring sodium levels closely to avoid rapid changes that can lead to neurological complications 1.

From the Research

Stopping Salt Tablets in Hyponatremia

• The decision to stop salt tablets in cases of hyponatremia depends on the underlying cause and severity of the condition 2, 3.
• In cases of euvolemic hyponatremia, salt tablets may be used to restrict free water consumption and increase sodium levels 2.
• However, if the patient's sodium levels are severely low (less than 125 mEq/L) and they are experiencing severe symptoms, emergency infusions with 3% hypertonic saline may be necessary 2.
• The use of salt tablets should be guided by the patient's fluid volume status and the severity of their symptoms 3.
• Overly rapid correction of sodium levels can cause osmotic demyelination syndrome, a rare but severe neurological condition 2, 3, 4.

Management of Hyponatremia

• The management of hyponatremia should be based on the underlying cause and the patient's fluid volume status 2, 3.
• Treatment options include fluid restriction, salt tablets, loop diuretics, and normal saline, but these traditional management strategies have limited efficacy 5.
• Vasopressin receptor antagonists provide a promising treatment for hyponatremia, but their use should be guided by the optimal indications and precautions should be taken to avoid complications 5.
• In some cases, the use of oral sodium chloride tablets can be an effective and safe treatment approach, especially in elderly patients with hyponatremia secondary to refractory idiopathic syndrome of inappropriate anti-diuresis 6.

Considerations for Stopping Salt Tablets

• The decision to stop salt tablets should be made on a case-by-case basis, taking into account the patient's individual needs and response to treatment 2, 3.
• Patients with severe hyponatremia or those who are experiencing severe symptoms may require more aggressive treatment, such as emergency infusions with 3% hypertonic saline 2.
• In cases where salt tablets are used, careful monitoring of the patient's sodium levels and fluid volume status is necessary to avoid overly rapid correction and potential complications 2, 3, 4.