Normal Sodium=136-145
Rapid changes in sodium can be life-threatening (demyelination seizures). Correct no more than 10-20 mEq in 24 hours.
Hypernatremia:
- Determine fluid status and correct.
- If acute (occuring over 1-3 days), lower 1-2 mEq/L/h over 24 hours.
- If not acute, correct 0.5 mEq/L/hr over 48 hours.
Hypernatremia:
- 3 % sodium: 100 cc bolus then 100 cc/hr or 1-2 cc/kg/hr to raise 1-2 mEq/hr. CENTRAL LINE ONLY.
- Increase sodium by 2-2.5 for every 100 mg/dL over 100.
- Increase sodium = [(infusate Na) – (Serum Na)] / (TBW +1)
Tolvaptan is discouraged in hyponateriam because hyponateriam returns after it’s discontinued.