FLUID

MANAGEMENT
HYPONATREMIA
KOREKSI HYPONATREMIA
(MORGAN)
 Acute symptomatic hyponatremia requires prompt treatment. In such instances, correction of
plasma [Na+] to greater than 125 mEq/L is usually sufficient to alleviate symptoms. The
amount of NaCl necessary to raise plasma [Na+] to the desired value, the Na+ deficit, can be
estimated by the following formula:

 Na+ deficit = TBW × (desired [Na+] − present [Na+])

 Excessively rapid correction of hyponatremia has been associated with demyelinating lesions
in the pons (central pontine myelinolysis), resulting in permanent neurological sequelae. The
rapidity with which hyponatremia is corrected should be tailored to the severity of symptoms.
The following correction rates have been suggested: for mild symptoms, 0.5 mEq/L/h or less;
for moderate symptoms, 1 mEq/L/h or less; and for severe symp- toms, 1.5 mEq/L/h or less.
 Example
 An 80-kg woman is lethargic and is found to have plasma [Na+] of 118 mEq/L. How much
NaCl must be given to raise her plasma [Na+] to 130 mEq/L?
 Na+ deficit = TBW × (130 − 118)
TBW is approximately 50% of body weight in female and 60% in male
 females:
Na+ deficit=80×0.5×(130−118)=480mEq
 Because normal (isotonic) saline contains 154 mEq/L, the patient should receive 480 mEq ÷
154 mEq/L, or 3.12 L of normal saline. For a cor- rection rate of 0.5 mEq/L/h, this amount of
saline should be given over 24 h (130 mL/h).
 In NaCl 3% contain 514 mEq/L
 Note that this calculation does not take into account any coexisting isotonic fluid deficits,
which, if present, should also be replaced. More rapid cor- rection of hyponatremia can be
achieved by giving a
 loop diuretic to induce water diuresis while replacing urinary Na+ losses with isotonic saline.
Even more rapid corrections can be achieved with intravenous hypertonic saline (3% NaCl).
Hypertonic saline may be indicated in markedly symptomatic patients with plasma [Na+] less
than 110 mEq/L. Three percent NaCl should be given cautiously as it can precipi- tate
pulmonary edema, hypokalemia, hyperchlore- mic metabolic acidosis, and transient
hypotension; bleeding has been associated with prolongation of the prothrombin time and
activated partial throm- boplastin time.