Sodium Chloride Tablets for Hyponatremia Management
For hyponatremia, sodium chloride tablets should be dosed at 1-4 grams (17-70 mEq) per day in divided doses, with specific dosing based on severity, with fluid restriction of 1-1.5 L/day reserved for severe hyponatremia (serum sodium <125 mmol/L). 1
Dosing Guidelines for Sodium Chloride Tablets
- Standard adult dosing: 4 ml of 23.4% sodium chloride solution (equivalent to 936 mg of sodium chloride) 2
- Children under 9 years and adults over 50 years: Physician consultation required 2
- For SIADH and refractory hyponatremia: 1-4 grams daily in divided doses 3
Treatment Approach Based on Type of Hyponatremia
1. Hypovolemic Hyponatremia
- First-line: Normal saline infusion to correct volume depletion 1
- If diuretic-induced: Discontinue diuretics and expand plasma volume with normal saline 4
- Monitoring: Frequent serum sodium measurements to avoid overly rapid correction 5
2. Euvolemic Hyponatremia (e.g., SIADH)
- First-line: Fluid restriction (1-1.5 L/day) if serum sodium <125 mmol/L 1
- Second-line: Sodium chloride tablets (1-4 g/day in divided doses) 3
- Third-line: Consider urea or vaptan therapy in refractory cases 6
3. Hypervolemic Hyponatremia (e.g., cirrhosis, heart failure)
- First-line: Sodium restriction (5-6.5 g/day or 87-113 mmol/day) 4
- Second-line: Fluid restriction (1-1.5 L/day) if serum sodium <125 mmol/L 4
- Third-line: Consider vaptan therapy in selected cases 4
Administration Guidelines
- Hourly administration: For acute, symptomatic hyponatremia, hourly oral NaCl tablets may provide a predictable increase in serum sodium (equivalent to 0.5 ml/kg/h of 3% NaCl) 7
- Divided dosing: For chronic hyponatremia, spread salt supplements throughout the day 4
- Monitoring: Check serum sodium levels frequently during correction 5
Important Considerations and Cautions
- Maximum correction rate: Limit sodium correction to no more than 8-10 mEq/L in 24 hours to prevent osmotic demyelination syndrome 5, 6
- Severe symptomatic hyponatremia: Consider 3% hypertonic saline for patients with seizures, coma, or cardiorespiratory distress 1
- Cirrhosis with ascites: Moderate salt restriction with daily salt intake of no more than 5-6.5 g (87-113 mmol sodium) 4
- Bartter syndrome: Consider higher doses of sodium chloride supplementation (5-10 mmol/kg/day) 4
Common Pitfalls to Avoid
- Overly rapid correction: Can lead to osmotic demyelination syndrome with severe neurological consequences 5
- Inadequate monitoring: Serum sodium should be checked frequently during correction 6
- Inappropriate use in hypervolemic states: May worsen edema and ascites in heart failure or cirrhosis 1
- Relying solely on salt tablets: Treatment should address the underlying cause of hyponatremia 5
Salt tablets provide a practical and effective approach for managing hyponatremia, particularly in cases where fluid restriction alone is insufficient or when patients cannot be transferred to intensive care settings for hypertonic saline administration.