GGC Medicines


Adult Therapeutics Handbook

Management of Hyponatraemia

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.