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Abstract
Case reports and the literature on the treatment of severe hyponatremia were reviewed.
It appeared that the conflicting opinions with respect to the rate of correction of
severe hyponatremia could be reduced to not differentiating between acute and chronic
hyponatremia, to using different criteria for this distinction, and to differences
in treatment strategy. After reviewing the available data in the literature, it is
suggested that hyponatremia should be classified as acute whenever the rate of decrease
of serum sodium exceeds 0.5 mmol/L/hour. If it is unknown at which rate the hyponatremia
has developed, it can be assumed to be acute if within a short period of time (two
to three days), large quantities of fluid are ingested orally or administered parenterally,
especially hypotonic fluids in the presence of impaired water excretion. In other
cases, chronic hyponatremia is probable. It is concluded that acute hyponatremia should
be treated without delay and rapidly at a rate of at least 1 mmol/L/hour, to prevent
severe neurologic damage or death. With respect to chronic hyponatremia, it appeared
that severe neurologic complications almost exclusively occurred in patients who were
treated with hypertonic or isotonic saline without the addition of furosemide or an osmotic diuretic agent, resulting in a (rapid) correction
rate of 0.5 mmol/L/hour or more. In contrast, patients with severe chronic hyponatremia
treated with furosemide and isotonic or hypertonic saline almost uniformly did well
after rapid correction. Uneventful recovery is also the rule when severe chronic hyponatremia
is corrected slowly, at a rate less than 0.5 mmol/L/hour. On pathophysiologic grounds,
and bearing in mind that slow correction was used in the majority of reported patients
in the literature with severe chronic hyponatremia who recovered without neurologic
complications, this treatment modality is preferable. Whenever the available data
do not permit a differentiation between acute or chronic hyponatremia, rapid correction
has to be pursued by means of administration of hypertonic or isotonic saline together
with furosemide.
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Article info
Publication history
Received in revised form:
July 12,
1989
Received:
November 21,
1988
Identification
Copyright
© 1990 Published by Elsevier Inc.
