Hourly oral sodium chloride for the rapid and predictable treatment of hyponatremia

Abstract

Hypertonic NaCl is first-line therapy for acute, severe and symptomatic hyponatremia; however, its use is often restricted to the intensive care unit (ICU). A 35-year-old female inpatient with an optic chiasm glioma and ventriculoperitoneal shunt for hydrocephalus developed acute hyponatremia (sodium 122 mEq/L) perhaps coinciding with haloperidol treatment. The sum of her urinary sodium and potassium concentrations was markedly hypertonic vis-à-vis plasma; it was inferred that serum sodium concentration would continue to fall even in the complete absence of fluid intake. Intravenous (IV) 3% NaCl was recommended; however, a city-wide public health emergency precluded her transfer to the ICU. She was treated with hourly oral NaCl tablets in a dose calculated to deliver the equivalent of 0.5 mL/kg/h of 3% NaCl with an objective of increasing the serum sodium concentration by 6 mEq/L. She experienced a graded and predictable increase in serum sodium concentration. A slight overshoot to 129 mEq/L was rapidly corrected with 0.25 l of D5W, and she stabilized at 127 mEq/L. We conclude that hourly oral NaCl, in conjunction with careful monitoring of the serum sodium concentration, may provide an attractive alternative to IV 3% NaCl for selected patients with severe hyponatremia.

Kinetic Sodium Equation with Built-In Rate of Correction: Aid to Prescribing Therapy for Hyponatremia or Hypernatremia

“…This exercise shows that the required sodium load can far exceed a typical starting dose of NaCl, like 1 gram by mouth 3 times a day. There is even a precedent for salt tablets being given hourly (34). Inadvertent underdosing may explain why salt tablets may not seem to work at times in hyponatremia (35).…”

Concurrence of Inappropriate Antidiuretic Hormone Secretion and Cerebral Salt Wasting Syndromes after Traumatic Brain Injury

“…At this time, only half doses of furosemide and hydrocortisone were administered. According to the total amount of urine sodium excretion, respectively, to give their 8–12 g of sodium chloride tablet per day (Kerns et al, 2014 ), and serum sodium was maintained at a normal level. The follow-up 3 months after injury showed that all patients were discharged and that the serum sodium levels, plasma osmolality and urine flow rate (ml/d) were in the normal range (Table 3 ) with a continuous sodium supplementation program, while the daily liquid intake was limited to no more than 1,000 ml (Furst et al, 2000 ).…”

Hyponatremia in cancer patients: Strategy for safe correction in the hospital

“…Ultimately, all the therapies try to add more Na/K solutes (salt tablet, KCl, NS, and hypertonic saline) or try to remove free water (loop diuretic, urea, V 2 -receptor antagonist, make insensible losses > fluid restriction). [14][15][16][17][18][19][20][21][22][23]…”