Can we stop 3% Normal Saline (NS) abruptly if sodium correction is exceeding 10 milliequivalents per liter (meq/L) in 24 hours?

Can 3% Normal Saline Be Stopped Abruptly When Correction Exceeds 10 mEq/L in 24 Hours?

Yes, 3% hypertonic saline should be stopped immediately when sodium correction approaches or exceeds 8 mEq/L in 24 hours, not 10 mEq/L, to prevent osmotic demyelination syndrome. 1

Critical Correction Limits

The maximum safe correction is 8 mmol/L in 24 hours, not 10 mEq/L as suggested in your question 2, 3, 1. Exceeding this limit significantly increases the risk of osmotic demyelination syndrome, a potentially fatal neurological complication 4, 5.

• Standard risk patients: Maximum 8 mmol/L per 24 hours 2, 3
• High-risk patients (cirrhosis, alcoholism, malnutrition, severe hyponatremia): Maximum 4-6 mmol/L per day 3, 5

When to Stop 3% Saline

Primary Indication for Discontinuation

Stop 3% hypertonic saline when severe symptoms resolve, regardless of the total correction achieved 2, 1. Severe symptoms include:

• Seizures, coma, or altered mental status 2
• Respiratory distress 6
• Confusion or delirium 6

Correction-Based Stopping Points

Initial correction goal: 6 mmol/L over 6 hours OR until severe symptoms resolve 2, 1

If 6 mmol/L is corrected in the first 6 hours, you can only allow an additional 2 mmol/L correction in the following 18 hours to stay within the 8 mmol/L/24-hour limit 2, 1.

Transition Protocol After Stopping 3% Saline

Once you discontinue hypertonic saline:

1. Switch to mild symptom or asymptomatic protocol 2, 1
2. Implement fluid restriction to 1 L/day (for SIADH) 2, 1
3. Change monitoring frequency from every 2 hours to every 4 hours 2, 1
4. Add oral sodium chloride 100 mEq three times daily if no response to fluid restriction 2, 3

Managing Overcorrection

If you've already exceeded 8 mmol/L in 24 hours:

• Immediately discontinue all current fluids 3
• Switch to D5W (5% dextrose in water) to relower sodium 3, 5, 7
• Consider desmopressin (dDAVP) to slow or reverse the rapid rise 3, 5, 7
• The goal is to bring total 24-hour correction back to ≤8 mmol/L from baseline 3

Critical Pitfalls to Avoid

Never continue 3% saline beyond symptom resolution just to reach a target sodium level 1. The treatment goal is symptom control with safe correction rates, not achieving a specific sodium number rapidly 2.

Do not use the 10 mEq/L limit mentioned in your question—this exceeds current safety guidelines and increases demyelination risk 3, 4, 5. Some older literature mentions 10-15 mEq/L limits, but current consensus is stricter at 8 mmol/L 5, 8.

**Acute hyponatremia (<48 hours)** can tolerate faster initial correction rates (up to 1 mmol/L/hour) without demyelination risk, but chronic hyponatremia (>48 hours) requires strict adherence to the 8 mmol/L/24-hour limit 2, 5, 9.

Special Populations Requiring Extra Caution

Patients with these risk factors need even slower correction (4-6 mmol/L/day maximum) 3, 5, 9:

• Advanced liver disease or cirrhosis
• Alcoholism or malnutrition
• Severe protein depletion
• Hypokalemia
• Prior encephalopathy

In these high-risk patients, osmotic demyelination can occur even with correction rates that appear "safe" for standard patients 9.