From the Guidelines
No, it is not recommended to give normal saline (NS) fluid to a patient with a sodium level of 124 mEq/L, as this can worsen the condition or correct it too slowly. According to the 2021 practice guidance by the American Association for the Study of Liver Diseases 1, for patients with moderate hyponatremia (120-125 mEq/L), water restriction to 1,000 mL/day and cessation of diuretics is recommended.
Key Considerations
- For severe hyponatremia (<120 mEq/L), a more severe restriction of water intake with albumin infusion is recommended.
- Hypertonic saline is reserved for short-term treatment of patients with symptomatic or severe hyponatremia or those with imminent liver transplant.
- 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.
Management Approach
- Identify and address the underlying cause of hyponatremia, which might include fluid restriction, medication adjustment, or treatment of underlying conditions like liver disease.
- Consultation with a specialist is often beneficial for managing complex cases of hyponatremia.
- Frequent monitoring of serum sodium levels is essential during treatment to ensure appropriate correction rates.
From the Research
Hyponatremia Treatment
- The treatment of hyponatremia depends on the severity and symptoms of the condition, as well as the underlying cause 2, 3, 4, 5, 6.
- For patients with severe hyponatremia (Na < 125 mmol/L), treatment with hypertonic saline may be necessary to rapidly correct the sodium level and prevent cerebral edema 3, 4, 6.
- However, overly rapid correction of chronic hyponatremia can cause osmotic demyelination syndrome, so the rate of correction should be limited to less than 8-10 mmol/L per day 2, 3, 5.
- For patients with mild to moderate hyponatremia (Na 125-135 mmol/L), fluid restriction is often the first-line treatment, but vasopressin receptor antagonists, urea, and loop diuretics may also be used to increase renal free water excretion 2, 5, 6.
- The use of normal saline (NS) fluid in patients with hyponatremia is not typically recommended, as it can worsen the condition by diluting the sodium level further 4, 6.
Specific Considerations for NS Fluid
- There is no clear evidence to support the use of NS fluid in patients with hyponatremia, especially if the sodium level is severely low (Na < 125 mmol/L) 3, 4, 6.
- In general, the treatment of hyponatremia should focus on correcting the underlying cause of the condition, rather than simply administering NS fluid 2, 5.