In the management of acute hyponatremia, particularly in cases where patients present with serious signs or symptoms, the administration of hypertonic saline is a crucial intervention. The goal of using hypertonic saline is to raise the serum sodium levels gradually to avoid complications such as osmotic demyelination syndrome. Studies have indicated that hypertonic saline should be given at a rate of approximately 1 ml/kg/h for the first few hours, aiming to increase the serum sodium concentration by around 10-12 mmol/day within the initial 24 hours of treatment and by less than 18 mmol/l over 48 hours (Pekic et al., 2011).
When hyponatremia is of recent onset and associated with severe symptoms, immediate administration of hypertonic saline is recommended as it can be life-saving. The quantity of hypertonic saline administered should be calculated to increase serum sodium levels by approximately 10 mmol/L (Knöchel, 1999). In cases where patients with desmopressin-associated hyponatremia are in an antidiuretic state and acutely symptomatic, early intervention with hypertonic saline is necessary to increase serum sodium concentration and prevent cerebral edema (Achinger & Ayus, 2019). The use of hypertonic saline as the mainstay treatment for symptomatic hyponatremia is well-established, as rising serum sodium levels help reduce brain edema, a critical concern in these cases (Fan et al., 2022).
Guidelines suggest that in the initial management of acute hyponatremia, patients should receive 150 ml of hypertonic saline with a concentration of 3% over 20 minutes, followed by a reassessment of serum sodium levels (Naumovski et al., 2019; Duyan & VURAL, 2023). It is crucial to monitor the response to hypertonic saline therapy closely, adjusting the treatment based on the patient's clinical status and serum sodium levels. The administration of hypertonic saline should be stopped once the symptoms related to hyponatremia resolve, a safe blood sodium concentration is achieved, or the maximum sodium correction limits are approached (Jaal et al., 2015).
In the context of euvolemic hyponatremia, the appropriate infusion rate for hypertonic saline should be based on a calculated sodium deficit being infused, determined by the total body water multiplied by the desired correction rate (Onitilo et al., 2007). This individualized approach ensures that the correction of hyponatremia is tailored to each patient's specific needs, minimizing the risk of overcorrection and associated complications. Additionally, the combination of hypertonic saline with low-dose furosemide has been shown to be effective in treating refractory congestive heart failure with hyponatremia, highlighting the versatility of hypertonic saline in managing various clinical scenarios (Morisawa et al., 2014).
Overall, the judicious use of hypertonic saline in the management of acute hyponatremia is supported by guidelines and clinical evidence. By following recommended protocols for administration and monitoring, healthcare providers can effectively correct serum sodium levels, alleviate symptoms, and prevent adverse neurological outcomes associated with hyponatremia.
References:
- Achinger, S. and Ayus, J. (2019). Use of desmopressin in hyponatremia: foe and friend. Kidney Medicine, 1(2), 65-70.
https://doi.org/10.1016/j.xkme.2019.02.002
- Duyan, M. and VURAL, N. (2023). The association between hyponatremia and optic nerve sheath diameter: a prospective study. Cureus.
https://doi.org/10.7759/cureus.34084
- Fan, L., Wen, W., & Zhou, H. (2022). Brain edema after oocyte retrieval: a case report. BMC Women S Health, 22(1).
https://doi.org/10.1186/s12905-022-02098-x
- Jaal, J., Jõgi, T., & Altraja, A. (2015). Small cell lung cancer patient with profound hyponatremia and acute neurological symptoms: an effective treatment with fludrocortisone. Case Reports in Oncological Medicine, 2015, 1-4.
https://doi.org/10.1155/2015/286029
- Knöchel, J. (1999). Hypoxia is the cause of brain damage in hyponatremia. Jama, 281(24), 2342.
https://doi.org/10.1001/jama.281.24.2342
- Morisawa, D., Hirotani, S., Oboshi, M., Sugahara, M., Fukui, M., Ando, T., … & Masuyama, T. (2014). Combination of hypertonic saline and low-dose furosemide is an effective treatment for refractory congestive heart failure with hyponatremia. Journal of Cardiology Cases, 9(5), 179-182.
https://doi.org/10.1016/j.jccase.2013.12.014
- Naumovski, F., Kuzmanovska, B., Kartalov, A., Trposka, A., Stojkovska, A., & Toleska, M. (2019). Acute hyponatriemia in a patient with schizophrenia: case report water intoxication induced acute hyponatriemia. Serbian Journal of Anesthesia and Intensive Therapy, 41(3-4), 77-80.
https://doi.org/10.5937/sjait1904077t
- Onitilo, A., Kio, E., & Doi, S. (2007). Tumor-related hyponatremia. Clinical Medicine & Research, 5(4), 228-237.
https://doi.org/10.3121/cmr.2007.762
- Pekic, S., Doknic, M., Miljic, D., Saveanu, A., Reynaud, R., Barlier, A., … & Popovic, V. (2011). Case seminar: a young female with acute hyponatremia and a sellar mass. Endocrine, 40(3), 325-331.
https://doi.org/10.1007/s12020-011-9516-8