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Hyponatremia in the ED
Four questions to ask yourself:
- Is the patient symptomatic from their hyponatremia (confusion, nausea/vomiting, ams, seizures, etc)?
- If not, outpatient followup (unless super low)
- Is the patient having severe neurologic symptoms from their hyponatremia? (seizures, AMS)
- If yes, treat with hypertonic saline (3%)
- Is the patient going to be admitted from their hyponatremia?
- If yes, obtain serum osmolarity to rule out pseudohyponatremia
- Is the patient dehydrated/hypovolemic?
- If yes, treat with NS bolus
- If euvolemic/hypervolemic, treat with fluid restriction