DischargeNa corrected safely (≤8/24 h), cause treated, restriction plan
Never
Correct Na faster than ~8 mEq/L/24 h → osmotic demyelination
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
Na <120 with seizures/↓GCS
Differentials
Hypovolaemia
Hypothyroidism
Adrenal insufficiency
Cerebral salt wasting
Common mistakes
Rapid correction (osmotic demyelination)
Fluids worsening hyponatraemia
Disposition & follow-up
Fluid restriction; hypertonic saline if severe; treat cause.
Discharge package
MedicationsTreat cause; fluid limits
Follow-upRecheck sodium
LifestyleFluid restriction as advised
Warning symptomsConfusion, seizures, drowsiness
💊 Treatment detail — doses & preparation
Fluid restrictionfirst-line
DoseRestrict to 800–1000 mL/day (all fluids)
Preparation—
MonitorNa⁺ daily initially; strict input chart
Hypertonic saline 3%severe hyponatraemia/ICP
DoseSymptomatic hypoNa: 100–150 mL of 3% over 10–20 min, repeat ×2–3 until symptoms settle (target Na +4–6 in first 6 h). ICP: 250 mL bolus
Preparation3% NaCl via pump, central or large peripheral vein
MonitorNa⁺ q2–4 h — max rise 8–10 mmol/L/24 h (osmotic demyelination); overcorrection → DDAVP clamp/rescue: desmopressin 2 µg IV (± D5W) to halt the rise
Furosemide POloop diuretic
Dose20–80 mg OD/BD, titrate to dry weight
Preparation20/40/500 mg tablets; take morning/midday
MonitorDaily weight, K⁺, renal function
TolvaptanV2 antagonist
Dose15 mg OD, titrate q≥24 h to max 60 mg OD (SIADH, selected)
Preparation15/30 mg tablets
MonitorNa⁺ q6–8 h initially (rapid correction risk), thirst/dehydration, LFTs
📖 European Hyponatraemia GuidelineReviewed July 2026
ICU Decoded — original critical-care and internal-medicine pathways by
Dr Javed Akhtar, each cited to a current guideline. For education and quick
reference; verify every dose against local protocols before prescribing.