Today, we want to share an algorithm treatment for hyponatremia, a condition where the sodium level in the blood is abnormally low. Timely and appropriate management of hyponatremia is crucial to ensure the best patient outcomes. Here’s a step-by-step algorithm that can help guide healthcare professionals in their decision-making process:
Step 1: Assess the severity of hyponatremia and identify the underlying cause.
Step 2: Determine the patient’s volume status (hypovolemic, euvolemic, or hypervolemic).
Step 3: Correct any acute symptoms or neurological complications promptly.
Step 4: If the patient is hypovolemic, address fluid deficits and replace with isotonic or hypertonic saline.
Step 5: For euvolemic hyponatremia, consider fluid restriction and addressing underlying causes (e.g., SIADH).
Step 6: In hypervolemic hyponatremia, manage fluid overload with diuretics and treat the underlying condition.
Step 7: Monitor sodium levels closely and adjust treatment as needed.
Remember, the treatment approach may vary based on individual patient factors, so it’s essential to consult with a healthcare professional.
IMPORTANT NOTES TO BE NOTED
Rates of correction
- Safe limit – 10 mmol/L in first 24 hours, 8 mmol/L in subsequent 24 hours.
- Groups at more risk of osmotic demyelination are elderly patients, children < 16, malnourished, alcoholics, CNS disease and post operative patients. May need to consider lowering limits for correction in these groups of patients.
Tolvaptan advice
If using Tolvaptan (ADH antagonist) the following is advised:
- Discuss with endocrinology team before administration. Prescription must be authorised by a consultant
- Remove any fluid restriction
- Allow patient to drink to thirst response
- Initiate at a dose of 15 mg
- Prescribe on the STAT section of the drug chart
- Repeat Na+ 6 hours later
- Repeat dose if no improvement after 24 hours (and if no improvement after second dose – reconsider diagnosis). May only need one or two doses to correct sodium levels back to normal so do not prescribe on the regular side of the chart.
Related: Clinical Pharmacy Standards of Practice
References :
- The diagnosis and management of inpatient hyponatraemia and SIADH. Grant et al. Eur J Clin
Resource Person: Dr. Jyothi Jetti, Pharm-D