Can a patient with hyponatremia (sodium level of 130 mEq/L) be discharged home?

From the Guidelines

A patient with hyponatremia (sodium level of 130 mEq/L) can be discharged home if they are clinically stable and have no neurological symptoms, as this is considered mild hyponatremia that does not require specific management apart from monitoring and water restriction 1. When considering discharge, it's crucial to assess the patient's overall clinical stability, absence of neurological symptoms such as confusion, headache, or seizures, and the chronic nature or clear, manageable cause of the hyponatremia. Key considerations for discharge include:

• Ensuring the sodium level has stabilized or is improving
• Establishing a clear follow-up plan with repeat sodium checks within 1-3 days
• Educating the patient about fluid restrictions, typically 1-1.5 liters per day, and the importance of avoiding excessive water intake
• Potentially increasing salt intake depending on the underlying cause of hyponatremia
• Adjusting medications if the hyponatremia is medication-induced, as per the guidance for managing hyponatremia in patients with cirrhosis 1
• Instructing the patient on symptoms that warrant immediate medical attention, such as worsening confusion, severe headache, nausea, vomiting, or seizures It's also important to note that the goal rate of increase of serum sodium should not exceed 8 mEq/L per 24-hour period to ameliorate the risk of osmotic demyelination syndrome (ODS) 1. Given the patient's sodium level of 130 mEq/L, which falls into the mild hyponatremia category (Na 126-135 mEq/L), and in the absence of symptoms, discharge with appropriate monitoring and management is feasible, aligning with the 2021 practice guidance by the American Association for the Study of Liver Diseases 1.

From the Research

Discharge Considerations for Hyponatremia Patients

• A patient with hyponatremia (sodium level of 130 mEq/L) may be considered for discharge home, but the decision should be based on the underlying cause of the hyponatremia, the severity of symptoms, and the patient's overall clinical condition 2, 3, 4.
• According to the studies, most patients with hyponatremia can be managed by treating the underlying disease and categorizing them according to their fluid volume status (hypovolemic, euvolemic, or hypervolemic) 2, 3.
• However, severely symptomatic hyponatremia (with signs of somnolence, obtundation, coma, seizures, or cardiorespiratory distress) is a medical emergency and requires immediate treatment with bolus hypertonic saline to reverse hyponatremic encephalopathy 2.
• The treatment approach should aim to correct the serum sodium level by 4-6 mEq/L within 1-2 hours, but not exceed a correction limit of 10 mEq/L within the first 24 hours to avoid overly rapid correction and the risk of osmotic demyelination 2, 3.

Factors to Consider Before Discharge

• The patient's symptoms and signs, such as weakness, nausea, or seizures, should be assessed and managed before discharge 2, 3.
• The underlying cause of the hyponatremia, such as syndrome of inappropriate antidiuretic hormone secretion (SIADH), should be identified and treated accordingly 5, 3, 6.
• The patient's fluid volume status and electrolyte balance should be stabilized before discharge 2, 3, 4.
• The patient should be educated on how to manage their condition, including fluid restriction, medication adherence, and follow-up appointments 3, 4.