From the Guidelines
Hypertonic 3% saline is the solution that will bring sodium levels up in patients with hyponatremia. This solution contains approximately 513 mEq/L of sodium, which is significantly higher than the normal serum sodium concentration (135-145 mEq/L) 1. When administered intravenously, hypertonic 3% saline draws water from the intracellular space into the extracellular space through osmosis, effectively increasing serum sodium concentration. Some key points to consider when using hypertonic 3% saline include:
- Typical dosing for severe symptomatic hyponatremia is 100-150 mL of 3% saline given as a bolus over 10-20 minutes, which may be repeated if necessary 1.
- For less severe cases, slower infusion rates are used.
- This therapy requires careful monitoring of serum sodium levels, as rapid correction can lead to osmotic demyelination syndrome.
- The rate of sodium correction should generally not exceed 8-10 mEq/L in 24 hours 1.
- Hypertonic saline should be administered in a monitored setting with frequent electrolyte checks. It's also important to note that the use of hypertonic saline is reserved for short-term treatment of patients with symptomatic or severe hyponatremia or those with imminent liver transplant 1. Additionally, when correction of chronic hyponatremia is indicated in patients with cirrhosis, 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 1.
From the Research
Sodium Correction
To correct sodium levels, the type of solution used is crucial.
- Hypertonic solutions have a higher concentration of solutes than blood, while hypotonic solutions have a lower concentration.
- In the case of hyponatremia, a hypertonic solution is used to increase sodium levels.
Hypertonic Saline
Hypertonic saline is commonly used to treat severe symptomatic hyponatremia.
- A 3% hypertonic saline solution is often recommended for this purpose 2.
- This solution can help increase serum sodium levels by 4-6 mEq/L within 1-2 hours, but the correction limit is 10 mEq/L within the first 24 hours to avoid overly rapid correction 3.
Treatment Approach
The treatment approach for hyponatremia depends on the underlying cause and the severity of symptoms.
- For severely symptomatic hyponatremia, hypertonic saline is the recommended treatment 3, 4, 5.
- In cases where the patient has a history of seizures or is at risk of seizures, anti-convulsants may be used in combination with hypertonic saline 2.
Conclusion is not allowed, so the information will be presented as a continuation of the previous section
It is essential to monitor the patient's sodium levels closely during treatment to avoid overly rapid correction, which can lead to central pontine myelinolysis (CPM) 3, 2.