ICU SAQs · Electrolytes
Severe symptomatic hyponatraemia — hypertonic saline and the correction ceiling
A CICM Second-Part SAQ on the emergency management of severe symptomatic hyponatraemia — the hypertonic-saline bolus, the correction ceiling (~8-10 mmol/L per 24 h) against osmotic demyelination, and desmopressin to cap an over-shoot.
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Prompt
A 62-year-old woman presents with a seizure and a serum sodium of 112 mmol/L, having taken thiazides for years. Outline the immediate management of her severe hyponatraemia, including the choice and dose of your initial therapy, the target and ceiling for correction, and how you would defend against over-correction.
Question
A 62-year-old woman presents with a generalised seizure and a serum sodium of 112 mmol/L, having taken thiazide diuretics for years. Outline the immediate management of her severe hyponatraemia, including the choice and dose of your initial therapy, the target and ceiling for correction, and how you would defend against over-correction.[3]
References3ShowHide
- [1]Adrogué HJ, Madias NE. Hyponatremia. New England Journal of Medicine, 2000.PMID 10824078
- [2]Verbalis JG, Goldsmith SR, Greenberg A, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. American Journal of Medicine, 2013.PMID 24074529
- [3]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.