Diagnosis and Management of Sodium Disorders: Hyponatremia and Hypernatremia

Diagnosis and Management of Sodium Disorders: Hyponatremia and Hypernatremia

Published in: American Family Physician, 2023 November

Authors: Nathaniel E Miller, David Rushlow, Stephen K Stacey

Hyponatremia:

• Mild: Sodium concentration 130-134 mEq/L.
• Moderate: 125-129 mEq/L.
• Severe: <125 mEq/L.

• Mild: Nausea, vomiting, weakness, headache, mild neurocognitive deficits.
• Severe: Delirium, confusion, impaired consciousness, ataxia, seizures, brain herniation, death.

• Severe cases (<125 mEq/L with severe symptoms): Emergency infusions with 3% hypertonic saline.
• Avoid overly rapid correction to prevent osmotic demyelination syndrome; use calculators for fluid replacement guidance.
• Identify underlying causes: medications, excessive alcohol, low-salt diets, excessive water intake during exercise.
• Based on patient volume status:
• Hypovolemic: Normal saline infusions.
• Euvolemic: Restrict free water, salt tablets, or IV vaptans.
• Hypervolemic: Manage underlying cause (e.g., heart failure, cirrhosis), restrict free water.

Hypernatremia:

• Mild: Often dehydration due to impaired thirst mechanism or lack of water access.
• Others: Diabetes insipidus.

• Address underlying etiology and correct fluid deficit.
• Severe or symptomatic cases, or when IV fluids required: Hypotonic fluid replacement.

Implications:

This review underscores the importance of accurately diagnosing and managing sodium imbalances in clinical practice. Hyponatremia and hypernatremia, while common, can lead to serious complications if not treated appropriately. The management strategies differ based on the severity of the condition and the underlying causes, highlighting the need for a tailored approach to each patient. Understanding the nuances of these electrolyte disorders is crucial for family physicians and other healthcare providers, particularly in emergency and acute care settings. Prompt and appropriate intervention can significantly improve patient outcomes and prevent complications associated with these conditions.