United States

Subject Guideline European Guideline

Severe symptoms: Severe symptoms:

Bolus 3% NaCl (100 ml Bolus 3% NaCl (150
over 10 min × 3 as ml over 20 min 2–3
needed) times as needed)

Moderate symptoms: Moderate symptoms:

Acute or Continuous infusion Bolus 3% NaCl (150
symptomatic 3% NaCl (0.5–2 ml/kg ml 3% over 20 min
hyponatremia per h) once)

Chronic hyponatremia

Fluid restriction (first Fluid restriction (first

 SIAD line) line)

Urea or loop
Demeclocycline, urea, diuretics + oral NaCl
or vaptan (second line) (second line)

Do not recommend
or recommend
against vaptana

Recommend against
lithium or
demeclocycline

Isotonic saline or
 Hypovolemic balanced crystalloid
hyponatremia Isotonic saline solution

 Hypervolemic
hyponatremia Fluid restriction Fluid restriction

Recommend against
Vaptans b
vaptan
 United States
Subject Guideline European Guideline

Minimum: 4–8 mmol/L

per d, 4–6 mmol/L per d
(high risk of ODS) No minimum

Limits: 10–12 mmol/L

per d, 8 mmol/L per d Limit: 10 mmol/L per
Correction rates (high risk of ODS) d

Baseline SNa≥120
mmol/L: probably Start once limit is
unnecessary exceeded

Baseline SNa<120 Consult an expert to

mmol/L: start discuss infusion
relowering with containing
electrolyte-free water electrolyte-free
or desmopressin after water (10 ml/kg) with
Management of correction exceeds 6– or without 2 μg
overcorrection 8 mmol/L per d desmopressin iv
 ↵a “Do not recommend” when SNa<130 mmol/L, “recommend against”
when SNa<125 mmol/L.
 ↵b In liver cirrhosis, restrict to patients where potential benefit
outweighs risk of worsened liver function.9