Hyponatremia in the ED

Four questions to ask yourself:

  1. Is the patient symptomatic from their hyponatremia (confusion, nausea/vomiting, ams, seizures, etc)?
    • If not, outpatient followup (unless super low)
  2. Is the patient having severe neurologic symptoms from their hyponatremia? (seizures, AMS)
    • If yes, treat with hypertonic saline (3%)
  3. Is the patient going to be admitted from their hyponatremia?
    • If yes, obtain serum osmolarity to rule out pseudohyponatremia
  4. Is the patient dehydrated/hypovolemic?
    • If yes, treat with NS bolus
    • If euvolemic/hypervolemic, treat with fluid restriction

Further Reading:

EMCrit – Hyponatremia

EMDocs – Critical Hyponatremia