What is the treatment for hyponatremia using intravenous (IV) albumin?

From the Guidelines

Intravenous (IV) albumin may be beneficial in the management of hyponatremia, specifically in cases associated with cirrhosis, nephrotic syndrome, or other conditions causing hypoalbuminemia with third-spacing of fluid, as it helps increase effective circulating volume, improving renal perfusion and reducing antidiuretic hormone release. The primary approach to hyponatremia management depends on the underlying cause, severity, and rate of development. For acute symptomatic hyponatremia, 3% hypertonic saline is preferred, typically given as 100-150 mL boluses over 10-20 minutes, which can be repeated if necessary 1. For chronic hyponatremia, fluid restriction (typically 800-1000 mL/day) is often the first step, particularly in SIADH or hypervolemic states.

Some key points to consider in the management of hyponatremia include:

• The goal rate of increase of serum sodium is 4-6 mEq/L per 24-hour period, not to exceed 8 mEq/L per 24-hour period to ameliorate the risk of osmotic demyelination syndrome (ODS) 1.
• Severe hyponatremia (<120 mEq/L) at the time of liver transplantation increases the risk of ODS, and multidisciplinary coordinated care may mitigate this risk 1.
• IV albumin may be used in combination with other treatments, such as diuretics (furosemide 20-40mg IV) in hypervolemic states, to correct hyponatremia 1.
• Frequent monitoring of serum sodium (every 2-4 hours initially) is essential during correction to prevent overcorrection and mitigate the risk of ODS 1.

In cases of hypovolemic hyponatremia, treatment is the discontinuation of diuretics and/or laxatives and providing fluid resuscitation, typically with 5% IV albumin or crystalloid (preferentially lactated Ringer’s) solution 1. For hypervolemic hyponatremia, treatment includes fluid restriction, reduction or discontinuation of diuretics and laxatives, administration of hyperoncotic albumin, and/or vasopressin receptor antagonists (“vaptans”) 1.

From the Research

Hyponatremia and IV Albumin

• Hyponatremia is a common electrolyte disorder that affects approximately 5% of adults and 35% of hospitalized patients 2
• It is defined by a serum sodium level of less than 135 mEq/L and most commonly results from water retention 2
• Symptoms and signs of hyponatremia range from mild and nonspecific to severe and life-threatening, depending on the rapidity of development, duration, and severity of hyponatremia 2, 3

Treatment of Hyponatremia

• The approach to managing hyponatremia should consist of treating the underlying cause 2
• Urea and vaptans can be effective treatments for the syndrome of inappropriate antidiuresis and hyponatremia in patients with heart failure, but have adverse effects 2
• Severely symptomatic hyponatremia is a medical emergency and should be treated with bolus hypertonic saline to reverse hyponatremic encephalopathy 2, 3, 4
• IV albumin is not specifically mentioned as a treatment for hyponatremia in the provided studies, but hypertonic saline is recommended for severe cases 2, 3, 4

Management of Hyponatremia

• Patients with hyponatremia should be categorized according to their fluid volume status (hypovolemic hyponatremia, euvolemic hyponatremia, or hypervolemic hyponatremia) 2, 3
• Treatment should be based on the underlying cause and the severity of symptoms 2, 3, 5
• Overly rapid correction of chronic hyponatremia can cause osmotic demyelination syndrome, a rare but severe neurological condition 2, 6