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Severe Hyponatraemia — ESENeph MCQ

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ModerateElectrolyte DisordersSevere HyponatraemiaESENeph

A 58-year-old woman presents with a serum sodium of 108 mmol/L. She is confused but haemodynamically stable. She has been hyponatraemic for at least 48 hours. What is the safe rate of sodium correction?

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Correct answer: E — Increase serum sodium by no more than 10 mmol/L in the first 24 hours

European Hyponatraemia Guidelines (Spasovski et al 2014, ERA-EDTA/ESE/ESA) recommend a correction rate of no more than 10 mmol/L in the first 24 hours and no more than 8 mmol/L in any subsequent 24 hours to avoid osmotic demyelination syndrome (ODS). In symptomatic severe hyponatraemia, initial boluses of 3% hypertonic saline (150 mL over 20 min, can repeat x2) are given for acute symptoms. The 10 mmol/L limit applies to the total 24-hour correction.

Reference: Spasovski et al 2014 – ERA-EDTA/ESE/ESA Hyponatraemia Guideline