Management of Hyponatraemia
- Early symptoms include: anorexia, lethargy, and nausea. Late symptoms include: agitation, seizures, focal neurology, and coma. Symptom severity depends on speed of onset.
- Initial assessment should include:
- Presenting complaint and past medical history: GI losses, heart / liver failure, malignancy, endocrine causes.
- Clinical assessment of fluid status: is patient fluid overloaded or fluid depleted?
- Medication review e.g. diuretics, Angiotensin-Converting Enzyme (ACE) inhibitors, antidepressants, anti-convulsants, and review others in BNF.
Note: *SIADH: serum osmolality <285mmol/L, with inappropriately high urinary sodium and osmolality; renal / adrenal / pituitary / cardiac causes excluded and not dehydration or medication-related.
#Rate of Na correction should not exceed 2mmol/L/hr or 12mmol/L in 24 hours, to avoid central pontine myelinolysis.