What steps should be taken to reduce the risk of neurologic complications during the correction of serum Na+ levels in hyponatremia?

Updated: Aug 16, 2019
  • Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN  more...
  • Print

The goal is to correct hyponatremia at a rate that does not cause neurologic complications. The objective is to raise serum Na+ levels by 0.5-1 mEq/h, and not more than 10-12 mEq in the first 24 hours, to bring the Na+ value to a maximum level of 125 -130 mEq/L. Administration of 3% hypertonic saline should be restricted to these emergent circumstances, and both neurological symptoms and serum Na+ should be monitored frequently to achieve the desired target and to prevent overcorrection.

Correction of serum Na+ levels by 6 mEq/L in 24 hours has been dubbed the "rule of sixes." The rule states that, "Six a day makes sense for safety; 6 in 6 hours for severe symptoms and stop." [33]

Other authors have recommended a rate of initial correction of 1-2 mEq/L/h in severely symptomatic patients until symptoms resolve (or for the first 3-4 h). However, total correction in the first 24 hours must not exceed 10-12 mEq. CMP has been reported in cases in which the initial correction exceeded 12 mEq and even in cases in which the correction was 9-10 mEq/24 h. This has led some authors to recommend a lower target of 8 mEq in 24 hours. In the special situation of exercise-induced hyponatremia with neurological symptoms, some authors recommend an immediate bolus of 100 mL of 3% hypertonic saline repeated every 10 minutes until symptoms resolve. [22]

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!