Management of Sodium Level 132 mmol/L
For a sodium level of 132 mmol/L, you should focus on identifying the underlying cause through volume status assessment and treating accordingly, while recognizing this represents mild hyponatremia that typically does not require aggressive intervention but warrants investigation and monitoring. 1
Initial Assessment
Your sodium of 132 mmol/L falls into the mild hyponatremia category (130-135 mmol/L), which often presents with minimal symptoms but should not be dismissed as clinically insignificant 1, 2. Even mild hyponatremia is associated with increased fall risk, cognitive impairment, gait disturbances, and increased mortality 1, 3.
Key evaluation steps:
- Assess your volume status - Are you dehydrated (dry mouth, decreased skin turgor, orthostatic symptoms), normal volume, or fluid overloaded (swelling, shortness of breath)? 1, 4
- Review all medications - Diuretics, antidepressants (SSRIs, trazodone), carbamazepine, NSAIDs, and opioids commonly cause hyponatremia 1, 5
- Evaluate symptoms - Nausea, headache, weakness, confusion, or balance problems suggest the hyponatremia is clinically significant 2, 6
Treatment Based on Volume Status
If You Are Dehydrated (Hypovolemic)
Stop any diuretics immediately and increase fluid intake with electrolyte-containing beverages or oral rehydration solutions 1. If you cannot tolerate oral fluids or symptoms are severe, intravenous normal saline (0.9% NaCl) is appropriate 1, 2.
If You Have Normal Volume (Euvolemic - Most Likely SIADH)
Implement fluid restriction to 1 liter (about 4 cups) per day as first-line treatment 1, 5, 2. This means:
- Limit all fluids including water, coffee, tea, soup, and other beverages to 1000 mL daily 1
- Increase dietary salt and protein intake 7
- If fluid restriction fails after several days, your physician may consider adding oral salt tablets (sodium chloride 100 mEq three times daily) or medications like urea or tolvaptan 1, 5
If You Have Fluid Overload (Hypervolemic)
Implement fluid restriction to 1-1.5 liters per day and restrict dietary sodium to 2-2.5 grams (88-110 mmol) daily 1. This applies if you have:
- Heart failure with leg swelling and shortness of breath 1, 2
- Liver disease with ascites (abdominal fluid accumulation) 1
Important Safety Considerations
Do not attempt rapid correction - Your sodium should increase no faster than 8 mmol/L in 24 hours to prevent a serious neurological complication called osmotic demyelination syndrome 1, 8, 2. At your current level of 132 mmol/L, gradual correction over days is appropriate 7.
Monitor for worsening - Seek immediate medical attention if you develop:
- Confusion, severe headache, or altered consciousness 2, 6
- Seizures or severe weakness 2, 4
- Inability to drink fluids 8
Common Causes to Discuss with Your Doctor
- Medications - Diuretics, antidepressants, pain medications 1, 5
- Excessive water intake - Particularly during exercise or with certain psychiatric conditions 2
- Underlying conditions - Lung disease, brain disorders, thyroid problems, adrenal insufficiency 1, 5
- Recent surgery or illness - Postoperative states commonly cause temporary hyponatremia 4
Follow-Up
Have your sodium level rechecked in 24-48 hours after starting treatment to ensure appropriate correction rate 1, 7. Continue monitoring until your sodium stabilizes above 135 mmol/L 1.
Track daily weights - Sudden weight changes can indicate fluid imbalance requiring treatment adjustment 1.